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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  • Seriously Speaking

    women that are smokers and mentally ill is a very bad combination today.

  • TeeDee126

    Cyndy; Yours is the only comment I read fully. I’m sorry to the other commenters. It’s late, and I just saw this….but your remarks are so insightful and engaging. You sound like the kind of person every troubled individual needs. Please don’t give up on those you’re interested in helping…

  • http://profiles.google.com/shava23 Shava Nerad

    Although this is CommonHealth there is no mention of what nicotine does as a drug in the human body. It needs to be broadcast in any article that addresses smoking. Nicotine is a neurotoxin developed by the tobacco plant to deter insects from chewing on its leaves. It is so powerful that before the development of chlorinated pesticides it was one of the most popular and successful pesticides in the world, and is still used by some organic gardeners.

    However, in mammals, nicotine works as an addictive drug instead. It bonds with the limbic system, the seat of emotional regulation, and replaces receptors that would make a person feel pleasure and comfort, particularly in the aftermath of the relief of stress. Just as a person who is addicted to opiates, which mimic pain relief, ca n not relieve pain or rest without the drug once addicted, nicotine addicts ca n not be unstressed or relaxed, or just experience simple abiding pleasure without a regular infusion of the chemical. Perhaps this will make you more compassionate to those who try to quit. Consciously or not, most of us have bought in to the minimization of the tobacco companies. Nicotine is as seriously addictive as heroine and likely harder to kick than alcohol.

    Apologies for format/spelling, but the Android interface won’t let me scroll and correct – if I can I will come back later when I’m at my PC and edit.

  • http://www.facebook.com/futo.buddy Futo Buddy

    i seem to remember some studies that showed that the dopamine released by smoking was helpful for schizophrenia. it makes them happy let them do it

  • Alex

    So many of these people are on multiple medications they can barely move. Have a heart!

  • alexafleckensteinmd

    So many mentally ill people smoke. And so many mentally ill people eat the wrong foods. It is a first step to disallow smoking in mental hospitals. The next step should be to serve healthy fare in hospitals – not only in psychiatric hospitals. So many diseases are linked to inflammatory foods like gluten, dairy and processed foods (AGEs – Advanced Glycation End products).

    Alexa Fleckenstein M.D., physician, author.

  • Cyndy

    I am a yoga teacher and have a dear friend who has lived with mental illness her whole life. We go way back to a time when we were ballet dancers in NYC and yes, back then we both puffed away to keep the ultra thin bodies our profession demanded.
    I’ve been thinking a lot about her lately, as I heard from a relative that she recently had another episode that landed her back ” in hospital” as they say in the UK. She has been living there for the last 25 or years because when first diagnosed she could not afford her medications in this country. Her parents were living in London and she was able to move there and get work, so that she could get the medicine and care she needed and has never left.
    A few years back I invited her to a yoga retreat in the Puglia region of Italy. It was a memorable trip for both of us, to reconnect because we love each other dearly. She started practicing yoga before the trip and easily became proficient during the stay, taking full advantage of the beautiful scenery, healthy food, restful and spiritual pace of life. I saw her face brighten as she once again moved her body and felt the benefits. She also has a gorgeous singing voice and was laughing and singing when we had our evening entertainment sing-alongs. She did however still smoke, which really surprized me.
    When I first walked up to her flat i could smell the cigarette. I can’t abide that smell and always notice it on people’s clothes even if they are fleetingly walking by me. My friend knew I would be aghast that she was still smoking and insisted that I take her room that she had aired out. She was of course, understanding that she could not smoke on the premises of the yoga ashram. We would go on long walks and she would have cigarette, but happily was able to drastically cut back on how many she was having, because so many other things were in place to support her being happy and rested and relaxed.
    She just blossomed back into the sixteen year old girl that I first met when we shared a roach infested, studio apartment together many, many years ago. I wish I could lift the desire for the cigarettes from her and have tried to support her by sending her a wonderful book on yoga for depression. She is a fighter who has been knocked down many, many times by her illness. She explained why so many people who live with mental illness smoke. That it smooths out all the side effects of the drugs they depend on to stay on an even keel. I have often thought that it is the ritual of lighting the cigarette and the long, slow drags that has the calming effect. I hope she can substitute the long, deep breathing of a yoga practice to stay in balance, but I know it’s not as easy as one thinks.
    I recently started teaching yoga to veterans with PTSD. They have been one of the most appreciative and focused students I have ever taught. When I first went to the local Vet’s center to speak to someone about teaching to that community, I was overwhelming by the smell of smoke. It’s not easy, but it can be done. I’m trying to bring yoga to those who need some enlightenment from their history. I will do my best to help them all. My best friend is always in my heart and she is a strong woman. I will never stop supporting her in her journey toward a smoke free, peaceful now.

  • jtilbe

    It’s called self medication. They crave the nicotine. Perhaps it provides some small respite from their symptoms, or more likely from the side effects of the medication they are prescribed.

    I worked at a state hospital in the early 1980′s. The happiest time on the ward was smoking time. Coffee was extremely popular too.

  • http://www.facebook.com/people/Harold-Maio/1398619703 Harold Maio

    http://commonhealth.wbur.org/2013/02/smoking-mentally-ill#respond

    —Why Are There So Many Smokers Among ‘The’ Mentally Ill?

    Looking at the entire demographic, we are
    probably no different from others.

    —people with mental illness are 70 percent more likely to smoke cigarettes than those without such illnesses.

    I sincerely doubt it, one would have to know precisely who was studied to draw a conclusion. Most of us do not self-identify as having illnesses.

    —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.

    Sounds like a very specific and far smaller demographic to me. None of the people with schizophrenia with whom I am acquainted smoke, all do, however, have doctoral degrees.

    I am not sure how “mentally ill people” got to be perceived as such a narrow
    demographic. We earn to the millions, hold every university degree, and every professional, white and blue collar job. We resemble the demographic “women” in our diversity. It amuses people to see us narrowly. I am 75, it once amused us to women and African Americans narrowly. We apparently amuse easily.

    —A good story: Find out why so many people are amused by “the” mentally ill, and not by “the” Jews, “the” Blacks. (Well, not any longer.)

    Each time I write that suggestion, pictures flash in my mind, of Nazis “amusing” themselves in newsreels tormenting Jews on the streets, flashes of Americans in newsreels “amusing” themselves at the expense of African Americans.
    We have a new caricature to play with. We are having fun.

    I recall two very special research projects, each one conducted before one of the world wars we fought: Could Black men serve as soldiers in combat? The results of both research projects was they could not. The likely all white research was what I term “pre-search”, the answers already in place.

    Harold A. Maio, retired
    Mental Health Editor

    khmaio@earthlink.net

  • http://www.facebook.com/people/Harold-Maio/1398619703 Harold Maio

    Why Are There So Many Smokers Among ‘The’ Mentally Ill?
    Looking at the entire demogrpahic, we are probably no different.