” When I first started smoking, I thought I was cool. Then I stopped. When I picked up smoking several years later, it was a way to get high. Then I stopped. It wasn’t until I found myself in recovery that I really started smoking like a chimney. My parents were concerned and frankly annoyed my this new habit. There was a sense of relief however, when they discovered in their NAMI class (National Alliance on Mental Illness) that this was commonly seen in people who have mental disorders and addiction. So I went on their website and found the article that explains it all! So if your a smoker, you may relate to this bit of text! It does focus on mental illness but a lot of the information can be useful to all.” -Peace, Robyn
Smoking and Mental Illness
People living with mental illness have a very high rate of smoking. A study by The Journal of the American Medical Association reported that 44.3 percent of all cigarettes in America are consumed by individuals who live with mental illness and/or substance abuse disorders. This means that people living with mental illness are about twice as likely to smoke as other persons.
A positive note is that people who live with mental illness had substantial quit-rates, which were almost as high as the group without mental illness. NAMI has led many changes in our mental health system─getting access to the tools to quit smoking is a way to improve the quality and quantity of life. Improving lives is a new advocacy pursuit.
The Connection between Mental Illness and Smoking
There is no one single, certain reason why so many people who live with mental illness smoke. It may be a combination of brain effects, psychological effects and the social world in which we live.
From a brain-based perspective, research is being done to determine if and how nicotine is involved in some of the brain’s memory functions. If nicotine is a factor, then this could explain why so many people living with an illness like schizophrenia or other illness involving cognitive deficits may smoke. Even though smoking is thought to enhance concentration and cognition, the effects are short in duration.
Researchers and the medical community have a great deal to learn about how smoking impacts the brains of those living with mental illness. It is known that people diagnosed with schizophrenia often smoke before the onset of symptoms and that they smoke more often and inhale more deeply than smokers without schizophrenia.
While we still have a lot to learn about why people smoke, there is plenty of information to support the serious health risks of smoking. So while there may be good reasons why you were attracted to smoking, the key is to figure out ways to increase rates of quitting. Nicotine isn’t a health problem on its own, but when smoked and combined with hundreds of other chemicals that are present in cigarettes the practice of smoking is toxic.
Psychologically, all addictions soothe cravings. People often find themselves relaxed and less tense when their addiction is fed. This is true of cigarette smoking. Smoking can also be part of a social norm, one where people in your social circle all hang out and smoke. Some people who live with mental illness learned to smoke in a hospital or in group-living settings. These examples help illustrate how the mental health culture needs to move forward to reduce the tie between socialization and smoking.
Facts About Smoking
People die from smoking-related illnesses. Every year, smoking kills about 200,000 people who live with mental illness. Smoking harms nearly every organ of your body and diminishes your overall health. Smoking is a leading cause of cancer and of cancer-related death.
Smoking also causes heart disease, stroke and lung disease. With the increased risk of heart disease from second-generation atypical antipsychotic medications (SGAs), individuals living with mental illness must try to quit.
Inhaled cigarette smoke is made up of 4,000 chemicals, including cyanide, benzene, ammonia and carbon monoxide to name a few. There is no safe tobacco product, so switching to a smokeless or chew product will not eliminate your risk of smoking-related diseases.
People are finally waking up to the fact that smoking is a true health hazard, and people need to quit in order to live longer. More psychiatric facilities are going smoke-free, and NAMI is advocating for access to smoking cessation in outpatient settings.
State mental health commissioners and state medical directors are committed to changing the way the public mental health culture relates to smoking. Check out their toolkit (http://www.nasmhpd.org/general_files/publications/NASMHPD.toolkitfinalupdated90707.pdf) to see what policy changes and strategies they are using to create a healthier mental health system environment.
Smoking’s Effects on Symptoms and Medications
Research shows that people living with mental illness do not have worse symptoms after they quit. It is understandable that this is a concern with quitting smoking. Quitting is hard work, and it may take many efforts to be successful. Be sure to get support, talk with your doctor, set a quit date and explore the tools for success (Link to tools for success section) that are available to help you quit.
If you are a smoker and you quit, you can usually get the same treatment results from lower doses of psychiatric medications. Smoking increases the breakdown of medicines in your body, so smokers need to take higher doses to get the same results as someone who does not smoke. Without cigarettes you may need to take less medication. An additional benefit is that a dose reduction will likely reduce side effects of medicines, such as weight gain and other side effects.
“According to Medline Plus, an addicts diet prior to recovery not only effects ones overall health but can lead to many diseases and disorders of the body and mind.”
The impact of different drugs on nutrition is described below.
Opiates (including codeine, oxycontin, heroin, and morphine) affect the gastrointestinal system. Constipation is a very common symptom of abuse. Symptoms that are common during withdrawal include:
These symptoms may lead to a lack of enough nutrients and an imbalance of electrolytes (such as sodium, potassium, and chloride).
Eating balanced meals may make these symptoms less severe (however, eating can be difficult due to nausea). A high-fiber diet with plenty of complex carbohydrates (such as whole grains, vegetables, peas, and beans) is recommended.
Alcoholism is one of the major causes of nutritional deficiency in the United States. The most common deficiencies are of pyridoxine (vitamin B6), thiamine, and folic acid. A lack of these nutrients causes anemia and nervous system (neurologic) problems. Korsakoff’s syndrome (“wet brain”) occurs when heavy alcohol use causes a lack of enough thiamine.
Alcohol intoxication also damages two major organs involved in metabolism and nutrition: the liver and the pancreas. The liver removes toxins from harmful substances. The pancreas regulates blood sugar and the absorption of fat. Damage to these two organs results in an imbalance of fluids, calories, protein, and electrolytes.
Other complications include:
- High blood pressure
- Permanent liver damage (or cirrhosis)
- Severe malnutrition
- Shortened life expectancy
Laboratory tests for protein, iron, and electrolytes may be needed to determine if there is liver disease in addition to the alcohol problem. Women who drink heavily are at high risk of osteoporosisand need to take calcium supplements.
Stimulant use (such as crack, cocaine, and methamphetamine) reduces appetite, and leads to weight loss and poor nutrition. Abusers of these drugs may stay up for days at a time. They may be dehydrated and have electrolyte imbalances during these episodes. Returning to a normal diet can be hard if a person has lost a lot of weight.
Memory problems, which may be permanent, are a complication of long-term stimulant use.
Marijuana can increase appetite. Some long-term users may be overweight and need to cut back on fat, sugar, and total calories.
Nutrition and psychological aspects of substance abuse
When people feel better, they are less likely to start using alcohol and drugs again. Because balanced nutrition helps improve mood and health, it is important to encourage a healthy diet in people recovering from alcohol and other drug problems.
However, people who have just given up an important source of pleasure may not be ready to make other drastic lifestyle changes. It is more important that people avoid returning to substance abuse than that they stick to a strict diet.
“We can take back our health and our life by following some simple guidelines…”
- Stick to regular mealtimes
- Eat a low-fat diet
- Get more protein, complex carbohydrates, and dietary fiber
- Vitamin and mineral supplements may be helpful during recovery (this may include B-complex, zinc, and vitamins A and C)
People with substance abuse are more likely to relapse when they have poor eating habits. This is why regular meals are so important. People who are addicted to drugs and alcohol often forget what it’s like to be hungry and instead think of this feeling as a drug craving. They should be encouraged to consider that they may be hungry when cravings become strong.
During recovery from substance abuse, dehydration is common. It is important to get enough fluids during and in between meals. Appetite usually returns during recovery. People in recovery are often more likely to overeat, particularly if they were taking stimulants. Eat healthy meals and snacks and avoid high-calorie foods with low nutrition (such as sweets), if possible.
The following tips can help improve the odds of a lasting and healthy recovery:
- Eat nutritious meals and snacks.
- Get physical activity and enough rest.
- Reduce caffeine and stop smoking, if possible.
- Seek help from counselors or support groups on a regular basis.
- Take vitamin and mineral supplements.