Smoking is believed to be more prevalent among people with depression and schizophrenia because nicotine may temporarily lessen the symptoms of these illnesses, such as poor concentration, low mood, and stress. But it is important to note that smoking cessation has been linked with improved mental health—including reduced depression, anxiety, and stress, and enhanced mood and quality of life.

High cigarette consumption is a particular problem for people with serious mental illness.

According to ASH (Action on Smoking and Health) it is estimated that around 30% of smokers in the UK have a mental health condition, and more than 40% of adults with a serious mental illness smoke.

Smoking prevalence among people with a mental health condition is substantially higher than in the general population. Since the mid-1990s, smoking in the general population in England has fallen from around 27% to around 14.9% by 2017. In contrast, the latest Public Health England data shows that 40.5% of adults with a serious mental health illness (SMI) smoke a figure which has remained steady over the past 20 years.

The correlation between smoking and mental health

Tobacco contains nicotine, an addictive chemical which is quickly absorbed into the bloodstream in its smoked form. Nicotine in turn stimulates dopamine production, a chemical associated with pleasurable feelings.

For smokers with a mental health condition, the association between smoking and feeling relaxed is more pronounced. It is commonly believed that people with a mental health condition use tobacco to self-medicate.

One in every eight people in the world live with a mental health disorder, a full list of disorders can be found here:


The association between smoking and mental health conditions

People with poor mental health die on average 10 to 20 years earlier than the general population, and smoking is the biggest cause of this life expectancy gap.

A third of cigarettes smoked in England are smoked by people with a mental health condition.

Research has found that having a mental health condition is associated with:

  • current smoking
  • heavy smoking and high levels of tobacco dependence
  • desire to quit
  • difficulty remaining abstinent
  • perceived difficulty remaining abstinent

This is the same for all mental health conditions individually, but the strength and significance of the associations vary depending on the condition.

In 2014 to 2015, prevalence in all adults (aged 18+) was 16.4% and prevalence in adults living with:

  • anxiety or depression was 28%
  • a long-term mental health condition was 34%
  • serious mental illness was 40.5%

Evidently, even common mental health conditions, such as anxiety and depression, are associated with a greater likelihood of smoking and of being highly dependent.

*Source Public health England

People with poor mental health are also more likely to live in circumstances of socioeconomic deprivation. This is partly because deprivation plays a role in the causal pathway to developing a mental health condition (the stress-vulnerability model), and partly because living with poor mental health can lead to loss of employment, housing, income and other attributes.

This relationship is also likely to impact on the prevalence of smoking in people with poor mental health because smoking is strongly associated with socioeconomic deprivation and can itself exacerbate socioeconomic deprivation.

See also  The role of vaping nicotine in psychiatry practice

What is Safer Nicotine?

E-cigarettes / vaping products allow the user to inhale nicotine in a vapour. There is no burning. Vaping products have a battery. The battery heats up the coil or atomiser and turns flavoured nicotine liquid into a vapour to be inhaled.

What is Tobacco Harm Reduction?

The concept of tobacco harm reduction (THR) refers to reducing the levels of disease (morbidity) and death (mortality) from tobacco use among smokers. While eliminating exposure to nicotine altogether would result in the greatest reduction of harm, THR recognises that this is not always achievable, and users may not always be able or willing to quit. So THR advocates, as its primary goal, those users switch to using nicotine in its less harmful forms.

People smoke primarily because they are addicted to nicotine, but it is the other toxins in tobacco smoke that cause most of the harm. Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness. This “spectrum of harm” ranges from conventional smoked tobacco (cigarettes) at the top, to medicinal nicotine (nicotine replacement therapy, or NRT) at the bottom.

Tobacco harm reduction provides less harmful alternatives to smoked cigarettes. In practice, this primarily means encouraging smokers to adopt non-combustible nicotine products such as e-cigarettes (vapes) rather than combustible, smoking products such as cigarettes.

How safe are e-cigarettes?

According to the following organisations e-cigarettes / vaping is 95% less harmful than tobacco products.

  • The British Heart Foundation
  • The British Lung Foundation
  • Public Health England
  • NHS Smoke-Free
  • The Royal College of Physicians
  • Cancer Research UK
  • UK Government

While people are calling to ban single use vapes they are a great introduction into vaping to quit smoking, many opting to because of the ease of use. No messing about, just puff and go.

Some people move on to a rechargeable vape and some choose to stick to disposable vapes, there’s no “Right or wrong”. The main benefit is you can still get the nicotine you crave but in a much safer form but ultimately the goal would be to quit altogether but by switching to vaping gives you the opportunity to go at your own speed.

If you fall into the serious mental illness category you can get your dopamine from vaping nicotine without the risk of smoking related illnesses.  It’s important to inform your health worker if you plan to do this as your medication may require adjustment or monitoring.