Smoking and people with Mental Health Needs
Chat Issue Autumn 2006
The issues around smoking are well known and often covered on television and in newspapers. There are, however, other problems to consider for patients with mental health problems that are rarely mentioned. This article will include some of these problems as well as the more general concerns. Hopefully, it will help patients understand a little more about these problems and help explain why it is so much harder for people with mental health problems to stop smoking.
One of the chemicals in tobacco smoke, nicotine, affects brain chemicals in a similar way to drugs such as amphetamine and cocaine. It increases reaction times and improves concentration but also reduces anxiety, low mood, agitation and anger. It is also physically addictive and withdrawal symptoms occur when you stop which are very unpleasant.
Smokers tend to have higher rates of depression, anxiety, drug and alcohol problems. People with personality disorders have high levels of smoking but those who suffer from an illness known as schizophrenia have the highest levels of smoking of all. A study of people with schizophrenia showed that 92% of males and 82% of females smoked. It also showed that 59% tend to smoke high tar brands compared to 1% of the general population.
There are good reasons for this. In the brain, nicotine acts on chemicals that increase enjoyable experiences in a similar manner to eating, drug use and even sex! However, people who suffer from schizophrenia have unpleasant symptoms which are called negative symptoms such as lack of enjoyment, tiredness and tend not to mix with other people, all making life quite miserable at times. Smoking reverses these symptoms temporarily by changing chemicals levels around. Unfortunately, because it is temporary you need to keep smoking to keep it happening. It also helps to filter out background noises so concentrating on conversations or telly etc. is easier.
It is not surprising that with all these changes happening in the brain, put simply, people feel better when they smoke! This makes it much harder for people with such illnesses to give up smoking. It is hard enough for anyone (and I know!) but for people with these kind of problems it must be a nightmare!
As always, there is a downside. Heavy smoking and high tar brands can cause all sorts of problems, e.g:-
- 2-4 times more likely to have heart disease
- Doubles chances of a stroke
- 10 times more likely to get circulation problems
- 10 times more likely to get liver disease
- Sexual problems such as impotence (unable to get an erection) or becoming sterile
- These are just some examples as well as any number of kinds of cancer such as lung, bladder, kidneys, pancreas etc.
There are also other problems for people on medication for mental health problems as nicotine lowers the amount of medication in your body by up to 50%! Obviously, this makes it much harder to control the problems and higher doses of drugs need to be used.
Most people with mental health problems such as schizophrenia smoke between 30 and 40 cigarettes a day. This also makes stopping harder as patches only help for those who smoke 20 a day. Other things are needed as well as patches if you are trying to stop or it will likely be too hard. It is also important to plan when you are going to stop with your doctor because if you stop on your own, your medication levels may double in your body and may make you very unwell.
If you do want to stop you can speak to me or your team doctor and we will do everything we can to help. We can get some items e.g. patches, lozenges prescribed but some you will need to buy yourself, e.g. inhalators or chewing gum. Remember – it will still be cheaper than smoking and your health will begin to improve immediately!
We know it is very difficult but it is better than suffering the problems it will definitely cause eventually. Give it some thought – you can do it.