Why Are There So Many Smokers Among The Mentally Ill?

For years, I’ve been practicing yoga at a studio situated right next to a rehab program for adults with psychiatric illnesses. The harsh irony of so many perky, hard-bodied, coconut-water chugging yogis rushing to their “hour of power” class past the chain-smoking, disheveled mentally ill men and women killing time outside the rehab center always makes me feel sad about the injustices of life. I think about the fact that people with a severe mental illness tend to die, on average, up to 25 years earlier than those in the general population, partly due to smoking-related health problems like lung or heart disease. Sometimes I just want to scream: “Stop smoking and do some yoga!” But of course, things aren’t that simple, and I never say a thing.

Smoking prevalence is much higher among people with a mental illness, the CDC reports. (Photo: R. ZImmerman)

Smoking prevalence is much higher among people with a mental illness, the CDC reports. (Photo: R. Zimmerman)

Today, I went to yoga with Pam Belluck’s excellent The New York Times piece on my mind. The story, about a Louisiana psychiatric hospital considering banning smoking, followed a related story yesterday on new findings that people with mental illness are 70 percent more likely to smoke cigarettes than those without such illnesses.

As I walked to my car after class, I asked a gentleman loitering outside the rehab place how long he’s been smoking. “Forever,” he said, “since birth.” An administrator inside the facility, who didn’t want to be identified, told me “everyone here smokes.” Then, he reconsidered. “Well, almost everybody.”

Indeed the new CDC report paints a grim picture:

Nationally, nearly 1 in 5 adults (or 45.7 million adults) have some form of mental illness, and 36% of these people smoke cigarettes. In comparison, 21% of adults without mental illness smoke cigarettes. (Mental illness is defined here as diagnosable mental, behavioral, or emotional conditions and does not include substance abuse.)

There are other troubling statistics from the report:
–31% of all cigarettes are smoked by adults with mental illness.
–40% of men and 34% of women with mental illness smoke.
–48% of people with mental illness who live below the poverty level smoke, compared with 33% of those with mental illness who live above the poverty level.

Here’s a bit of Belluck’s story. Maybe the trend is finally starting to turn?

Until recently, Louisiana law required psychiatric hospitals to accommodate smokers — unlike rules banning smoking at most other health facilities. The law was changed last year, and by March 30, smoking is supposed to end at Louisiana’s two remaining state psychiatric hospitals.

After decades in which smoking by people with mental illness was supported and even encouraged — a legacy that experts say is causing patients to die prematurely from smoking-related illnesses — Louisiana’s move reflects a growing effort by federal, state and other health officials to reverse course.

But these efforts are hardly simple given the longstanding obstacles.

Hospitals often used cigarettes as incentives or rewards for taking medicine, following rules or attending therapy. Some programs still do. And smoking was endorsed by advocates for people with mental illness and family members, who sometimes sued to preserve smoking rights, considering cigarettes one of the few pleasures patients were allowed.

New data from the Centers for Disease Control and Prevention shows that the nearly 46 million adults with mental illness have a smoking rate 70 percent higher than those without mental illness, and consume about a third of the cigarettes in the country, though they make up one-fifth of the adult population.

People with psychiatric disorders are often “smoking heavier, their puffs are longer and they’re smoking it down to the end of the cigarette,” said William Riley, chief of the Science of Research and Technology Branch at the National Cancer Institute. With some diagnoses, like schizophrenia, rates are especially high.

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