Smoking and mental illness – could they be a toxic combination?

July 4, 2016

August is Mental Illness Awareness Month, a month dedicated to increasing awareness of mental illness. Mental illness and the stigma attached to it is a major concern for South Africa and prevents many people from seeking the help they require. As a country we need to start talking about mental health and encourage people suffering from mental illness to seek the help and support they need.

Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behaviour. Examples of mental illness include depression, anxiety disorders, schizophrenia, bipolar disorder, eating disorders and addictive behaviours. Many people have mental health concerns from time to time.

As part of this awareness initiative this article seeks to highlight some of the health issues around mental illness and smoking status.

In South Africa, one in three people will, or have, a mental illness and 16.4% to 18.2% of South Africans smoke, that is in excess of 8 million smokers.

According to The South African Depression and Anxiety Group (SADAG) smoking rates are higher among people with mental illnesses. Statistics show that around 40% of men and 34% of women with mental illness smoke. Compare that with the national average of just 18%. The smoking rate is even higher among people with schizophrenia. The CDC “Vital Signs” report estimates that globally, 31% of all cigarettes smoked are smoked by adults with mental illness. People affected by mental illness also find it harder to quit smoking and have more severe withdrawal symptoms when they try to stop smoking.

At this point in time it is still unclear whether depression leads to smoking or if smoking leads to depression. The relationship between the two is complex. What has been established is that tobacco is used as a way of dealing with feelings such as anxiety, stress or boredom. In some cases, smoking is utilised to mask symptoms of the mental illness or the side effects of the medicine being used to treat the mental illness.

It is well known that nicotine can improve attention and concentration however these benefits are short-lived, lasting only about five minutes at a time. A smoker needs to keep lighting up to experience the desired effects and this develops into the habit which is the basis of the physical addiction of nicotine.

Many mental health providers and facilities focus on treating the mental illness of their patients and may not consider smoking as a problem. 20 years ago primary care physicians and cardiologists viewed smoking as outside of their scope of practice but as more patients developed lung cancer or suffered heart attacks, they realised that they needed to encourage their patients to stop smoking. Mental health practitioners are reaching the same realisation and tobacco cessation programmes, and nicotine replacement therapy are being introduced as part of therapy.

Smoking can cause unique issues for people with mental illness. Nicotine has mood-altering effects that put people with mental illness at higher risk for cigarette use and nicotine addiction. Withdrawal can be more debilitating and therefore more challenging for this group of individuals when they attempt to quit smoking. The tars in cigarette smoke can interfere with the breakdown of a number of medicines used to treat mental illnesses. Those affected include some anti-depressants, anti-psychotics, anxiolytics and opiates. When smokers with mental illness stop smoking it is important that their physician closely monitors their medication usage as blood levels of certain medicines may increase often within a few days. So what looks like symptoms getting worse due to stopping smoking could actually be due to side effects of medication requiring a dosage adjustment.

The biggest myth you still hear is that people with mental illness need to keep smoking because it helps with their psychiatric symptoms. As tobacco-related illnesses including cancer, heart disease and lung disease are among the most common causes of death in this population group, there is absolutely no excuse not to promote smoking cessation. Patients with mental illnesses want to quit, they can quit and they should be afforded the opportunity to stop smoking with access to help in quitting smoking. Evidence shows that the best ways to quit smoking include behaviour change therapy, stop smoking medication and support.

Because smoking is often used as a way of coping, smokers need to find other ways of dealing with stress. People who do quit smoking get a real boost to their confidence and feel a great sense of achievement. Stopping smoking also improves a person’s overall appearance and hygiene with stained teeth and fingers and the smell of tobacco smoke disappearing. Stopping smoking may require a reduced dose of psychiatric medicine which means less side effects and a decrease in costs. This together with the huge savings from not purchasing cigarettes means there is more money to spend on essentials and things they perhaps couldn’t afford to purchase before.

Quitting smoking is the single most important thing anyone can do to improve their health. Making changes takes time and effort and progress may be slow but a tobacco cessation programme combining support, behaviour change techniques and nicotine replacement therapy has been proven as the best way to quit smoking. GoSmokeFree is a smoking cessation programme that combines these three important components and triples a smokers chances of successfully quitting smoking.

For more information on the GoSmokeFree Smoking Cessation Programme visit or email

Resources: – triple your chances of successfully quitting smoking

This article contains opinions and facts and references to other information sources. You should always consult a registered healthcare professional for any personal advice.

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