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Behavioral Health

Smoking & Behavioral Health: A Dangerous Link

The impact of smoking on those with behavioral health concerns cannot be underestimated. Smoking rates of those with behavioral health disorders, which includes psychiatric disorders and substance abuse disorders, are two to four times higher than that of the general population.

As a segment of the population who is particularly exposed to the dangers of tobacco abuse, these individuals are a priority in efforts toward prevention in our state and the development of policy, prevention and treatment. For more information about smoking risks and behavioral health, read the Behavioral Health Fact Sheet.

Challenges of Behavioral Health

Tobacco abusers can be those who have schizophrenia, depression or anxiety disorders, and current smokers may have had some kind of mental health diagnosis in their history. They may use tobacco to self-medicate or to reduce symptoms, adding unique challenges to their efforts to quit. Mental illness certainly creates a vulnerability to smoking addiction, and individuals with psychiatric symptoms experience brief symptom reductions related to immediate nicotine absorption.

Compounding this challenge is the widely held belief that smoking is the one “joy” that a person with a behavioral health concern has to hold onto, or that smoking is an enjoyable “choice.” Also, those with behavioral health issues may be part of other groups that are at a unique risk, such as those who are unemployed or living in poverty, have peers who smoke, or are part of the mental health system where smoking is tolerated. Disruptions in thinking and coping related to the mental illness add to their vulnerability as well.

In terms of physical health, there are more reasons for concern. Those with behavioral health problems experience the health consequences of smoking more often. They tend to begin smoking earlier, smoke more, and extract more nicotine and tar from the cigarettes they smoke. On average, those with a major mental illness lose 25 years of normal life span due to the health effects of tobacco.

Quitting’s Role in Recovery

Historically, the issue of mental illness and smoking has been ignored almost entirely. In the not too distant past, it was not unusual to “reward” patients with cigarettes. And, smoking has largely been tolerated in the face of other treatment concerns or considered to be a necessary part of having a mental illness or addiction. However, it is essential to understand that smoking inhibits psychiatric recovery in many ways, including leading to the ultimate barrier, death.

Recovery from a mental illness requires holistic recovery in which quitting must be a part. Reducing the burden some will have in battling multiple health issues while in the midst of personal recovery from mental illness is a goal all mental health services should set.

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Those with Mental Health Disorders Can Successfully Quit.

Treatment can no longer be ignored for those with behavioral health concerns. Stigmas about mental health can be devastating in efforts to apply effective public health and clinical treatment approaches to the leading cause of death for this population. Although those with behavioral health disorders often require more attempts at quitting, they can successfully quit – and they can do so without increasing their risk of other addictive behaviors.

Furthermore, although it is a common belief that patients enjoy smoking, it is not true that they are not interested in quitting. In fact, they often want to quit and are interested in quitting support programs but are less likely to attempt to quit without direct support, and less likely to be part of a support group.

The CMBHTCC: Created as part of the Healthy Maine Partnership of Greater Waterville, the Central Maine Behavioral Health Tobacco Treatment Collaborative serves to address barriers of effective treatment to smokers with behavioral health diagnoses and encourage support and advocacy.

It is important for health care providers and professionals to understand this unique population and effectively present them with treatment options so they can quit tobacco use for good. Professionals and health care workers may visit our Providers page for more information.

Additional Links About Smoking & Behavioral Health

Publications & Research

American Medical Association Study of Mental Illness and Smoking - Data from the National Comorbidity Survey examines the association between type and severity of mental illness and the likelihood of smoking and quitting, and provides a source for optimism surrounding their ability to quit.

New Jersey Division of Mental Health Services'  Learning About Healthy Living: Tobacco and You manual.

Smoking and Mental Illness – A report from the Superintendent of Maine’s Riverview Psychiatric Center.

Smoking and Schizophrenia

Tobacco-Free Living in Psychiatric Settings



NAADAC Policy Statement on Nicotine Dependence

Technical Report on Smoking Policy and Treatment in State Operated Psychiatric Facilities


Community & Outreach

National Association of State Mental Health Program Directors

The Smoking Cessation Leadership Center – Through a partnership with The Mental Health Partnership for Wellness and Smoking Cessation, the Center provides advocacy, information, publications, toolkits, and resources about issues surrounding tobacco use and mental health for professionals.

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