Commercial Tobacco Product Use and Behavioral Health Conditions Can Affect Each Other
Nicotine has mood-changing effects that can make it feel for a short time like the symptoms of a behavioral health condition are gone or improved. This can lead to commercial tobacco* use and dependency on nicotine.28
Commercial tobacco smoke can interfere with some medications taken by people with behavioral health conditions.29 This means people taking the medications might not get the full benefit from those medications.30
People experiencing stress can also be more likely to smoke. People with mental health conditions experience many forms of serious stress:
People with mental health conditions are more likely to have stressful living conditions, and to have a low yearly household income.29,30 When people experience severe or long-lasting forms of stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems.31 Having multiple forms of stress has also been associated with current smoking in some adults.32
When analyzed at the state level, only 35-67% of adults believed that people are caring and sympathetic of people with mental health conditions.15 People with mental health conditions might feel pressure to disclose their diagnoses, and they might smoke when faced with the stigma associated with their condition.15
- The prevalence of illicit drug use among adults who smoke cigarettes is three times higher than the prevalence among adults who don’t smoke cigarettes.1
- The percentage of adults who smoke cigarettes and binge drink is nearly twice that of adults who don’t smoke and binge drink.1
- Among adults recently diagnosed with a substance use disorder, nearly two in three currently smoke.33
- Among people in treatment for use of and dependency on an illegal drug, more than 3 in 4 currently smoke.34
Treating tobacco use disorder along with other behavioral health conditions is safe, does not interfere with treatment for other behavioral health conditions, and can help people in recovery have better health and quality of life.
Quitting smoking is associated with decreases in depression, anxiety, and other mental health symptoms.17,35,36
Quitting smoking during treatment for other substances is associated with an increase in long-term sobriety and a reduction in substance use disorder relapse.35
- Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2017 [accessed 2022 Feb 25].
- Center for Behavioral Health Statistics and Quality. (2020). Results from the 2019 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration [accessed 2022 Feb 25].
- Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding Excess Mortality in Persons With Mental Illness: 17-Year Follow Up of a Nationally Representative US Survey. Medical Care 2011;49(6):599–604 [accessed 2022 Feb 25].
- Schroeder S A, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health, 2010;31:297–314 [accessed 2022 Feb 25].
- Richter KP, Arnsten JH. A rationale and model for addressing tobacco dependence in substance abuse treatment. Substance Abuse Treatment, Prevention, and Policy. 2006;1(1):23 [accessed 2022 Feb 25].
- Tam J, Warner KE, Meza R. Smoking and the reduced life expectancy of individuals with serious mental illness. American Journal of Preventive Medicine. 2016; 51(6):958–966 [accessed 2022 Feb 25].
- Apollonio DE, Malone RE. Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill. Tob Control. 2005;14(6):409-415 [accessed 2022 Feb 25].
- Campbell BK, Le T, Andrews KB, Pramod S, Guydish J. Smoking among patients in substance use disorders treatment: associations with tobacco advertising, anti-tobacco messages, and perceived health risks. Am J Drug Alcohol Abuse. 2016;42(6):649-656 [accessed 2022 Feb 25].
- Marynak K, Vanfrank B, Tetlow S, et al. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities—United States, 2016. Morbidity and Mortality Weekly Report, 2018;67(18):519-23 [accessed 2022 Feb 25].
- Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(2):53-59 [accessed 2022 Feb 25].
- Cook BL, Wayne GF, Kafali EN, Liu Z, Shu C, Flores M. Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation. JAMA. 2014;311(2):172–182 [accessed 2022 Feb 25].
- Dickerson F, Schroeder J, Katsafanas E, et al. Cigarette Smoking by Patients With Serious Mental Illness, 1999-2016: An Increasing Disparity. Psychiatr Serv. 2018;69(2):147-153 [accessed 2022 Feb 25].
- Young-Wolff KC, Hickman NJ 3rd, Kim R, Gali K, Prochaska JJ. Correlates and prevalence of menthol cigarette use among adults with serious mental illness. Nicotine Tob Res. 2015;17(3):285-291 [accessed 2022 Feb 25].
- NIH State‐of‐the‐Science Panel. National Institutes of Health State‐of‐the‐Science conference statement: tobacco use: prevention, cessation, and control. Ann Intern Med. 2006;145:839‐844 [accessed 2022 Feb 25].
- Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Association of County Behavioral Health & Developmental Disability Directors, National Institute of Mental Health, The Carter Center Mental Health Program. Attitudes Toward Mental Illness: Results from the Behavioral Risk Factor Surveillance System. Atlanta (GA); Centers for Disease Control and Prevention; 2012 [accessed 2022 Feb 25].
- Prochaska JJ, Hall SM, Bero LA. Tobacco use among individuals with schizophrenia: What role has the tobacco industry played? Schizophr. Bull. 2008;34:555–67 [accessed 2022 Feb 25].
- Prochaska JJ, Smita D, Young-Wolff KC. Smoking, mental illness, and public health. Annual Review of Public Health. 2017; 38: 165-185[accessed 2022 Feb 25].
- Lawn S, Pols R. Smoking bans in psychiatric inpatient settings? A review of the research. Aust. N. Z. J. Psychiatry. 2005;39:866–85[accessed 2022 Feb 25].
- Cummings JR et al. Addressing public stigma and disparities among persons with mental illness: the role of federal policy. American Journal of Public Health. 2013;103(5): 781-5 [accessed 2022 Feb 25].
- Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 327 [accessed 2022 Feb 25].
- Patient Protection and Affordable Care Act, 2010, Pub. L. No. 111-148, 124 Stat. 119 [accessed 2022 Feb 25].
- Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Prev Med. 2005;41(2): 511-20 [accessed 2022 Feb 25].
- Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: A review. Pediatrics 2005;116(6): 1516-28 [accessed 2022 Feb 25].
- U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2022 Apr 28].
- National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Pub. No. 07-6242, June 2008 [accessed 2022 Apr 28].
- Young-Wolff KC, Henriksen L, Delucchi K, Prochaska JJ. Tobacco retailer proximity and density and nicotine dependence among smokers with serious mental illness. Am J Public Health. 2014;104(8):1454-1463 [accessed 2022 Feb 25].
- Robertson L, McGee R, Marsh L, Hoek, J. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine & Tobacco Research. 2015;17(1): 2-17 [accessed 2022 Feb 25].
- Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years With Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62(5):81-7 [accessed 2022 Feb 25].
- Lohr JB, Flynn K. Smoking and schizophrenia. Schizophr Res. 1992;8(2):93-102 [accessed 2022 Feb 25].
- Prochaska JJ. Smoking and Mental Illness—Breaking the Link. New England Journal of Medicine, 2011;365:196-8 [accessed 2022 Feb 25].
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- Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife. Nicotine Tob Res. 2012;14(10):1161-1169 [accessed 2022 Feb 25].
- Weinberger AH, Gbedemah M, Wall MM, Hasin DS, Zvolensky MJ, Goodwin RD. Cigarette use is increasing among people with illicit substance use disorders in the United States, 2002-14: emerging disparities in vulnerable populations. Addiction. 2018;113(4):719-728 [accessed 2022 Feb 25].
- Prochaska JJ, Delucchi K, Hall SM. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of Consulting and Clinical Psychology. 2004;72(6), 1144 [accessed 2022 Feb 25].
- Compton W. The need to incorporate smoking cessation into behavioral health treatment. The American Journal on Addictions. 2018; 27(1):42–43 [accessed 2022 Feb 25].
- Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014; 348:1151. [accessed 2022 Feb 25].
- Vital Signs: Adult Smoking Focusing on People with Mental Illness [PDF - 3.2 MB], February 2013 [accessed 2022 Feb 25].
- Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The N-SSATS Report: Tobacco Cessation Services. September 19, 2013. Rockville, MD [accessed 2022 Feb 25].
- Brown, CH et al. Factors influencing implementation of smoking cessation treatment within community mental health centers. Journal of Dual Diagnosis. 2015;11(2): 145-50 [accessed 2022 Feb 25].
- DiGiulio A, Jump Z, Babb S, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018. MMWR Morb Mortal Wkly Rep 2020;69:155–160 [accessed 2022 Feb 25].
- Smoking Cessation Leadership Center. Fact Sheet: The Tobacco Epidemic Among People With Behavioral Health Disorders. San Francisco: Smoking Cessation Leadership Center, University of California, 2015 [accessed 2022 Feb 25].
- U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. [PDF - 10 MB] Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020 [accessed 2022 Feb 25].
- Davis KC, Duke J, Shafer P, Patel D, Rodes R, & Beistle D Perceived effectiveness of antismoking ads and association with quit attempts among smokers: evidence from the Tips from Former Smokers campaign. Health Communication. 2017; 32(8), 931-938 [accessed 2022 Feb 25].