- ADVERTISEMENTSmoking and Mental Health: Five Things 

Every Health Care Provider Should Know

Providers who care for people with mental health conditions have an important role 

to play in reducing tobacco use among people with mental health conditions. There 

are five things that every provider should know before their next clinical encounter. 

1. Cigarette smoking is more common among adults with mental health 

conditions than in the general population. People with mental health conditions 

smoke at rates that are at least two times higher than the general population.1 They 

may also smoke more heavily and frequently, compared to those without mental 

health conditions. The Centers for Disease Control and Prevention estimates that 

nearly one third (31%) of all cigarettes consumed in the United States are smoked by 

people with mental health conditions.1 The disproportionately high rates of smoking 

in this population are likely due to a combination of biological, psychological, and 

social factors that work together to create a unique vulnerability for tobacco 

dependence.2 While the underlying causal mechanisms are not yet fully understood, 

one thing is clear - tobacco use among persons with mental health conditions can be 

prevented, and those who currently smoke can quit. 

2. Smokers with mental health conditions get sick, become disabled, and 

die early from smoking-related diseases. The high rates of smoking among 

people with mental health conditions have devastating health consequences. 

Smoking-related diseases such as cardiovascular disease, lung disease, and cancer 

are among the most common causes of death among adults with mental health 

conditions.3 Despite the heavy disease burden, smoking cessation interventions are 

not routinely offered within mental health care settings. A US national survey of 

mental health treatment facilities found that only about one-quarter provided services 

to help patients quit smoking.4 There is a growing recognition among healthcare 

providers that the integration of tobacco dependence treatment into mental health 

care is an important part of mental health recovery and wellness. Many providers 

and facilities have made progress in reducing smoking in their facilities and among 

their patients; others are just now beginning to address tobacco use.5

3. Many smokers with mental health conditions want to, and are able to quit 

smoking. A common misconception among health care providers is that smokers 

with mental health conditions either cannot or will not give up smoking.6 However, 

research has shown that adult smokers with mental health conditions—like other 

smokers—want to quit, can quit, and benefit from proven smoking cessation 

treatments. In clinical studies, adults with mental health conditions are just as likely 

to want to quit smoking as those without such conditions.7 People with mental health

conditions may face unique challenges in quitting smoking and may benefit from 

additional services, such as more intensive counseling and/or longer use or a 

combination of cessation medications. But with support, they can, and do quit 

smoking successfully.8,9

4. Quitting smoking will not interfere with mental health recovery, and may 

have mental health benefits. Another common misconception among some 

providers is that smoking has mental health benefits and helps patients cope with 

their psychiatric symptoms.6 But research suggests otherwise; smoking is not an 

effective mental health treatment strategy. On the contrary, smoking is associated 

with poor clinical outcomes, such as greater depressive symptoms, greater 

likelihood of psychiatric hospitalization, and increased suicidal behavior. 10,11

Furthermore, smoking can complicate treatment by accelerating the metabolism of 

certain psychiatric medications, resulting in the need for higher doses to get the 

same therapeutic benefit.6 A large body of clinical research has shown that patients 

can quit without worsening their psychiatric symptoms, if they are given the 

appropriate support (e.g., behavioral counseling, cessation medication, and 

monitoring).8,9 Evidence also suggests that quitting smoking is associated with 

mental health benefits. In several clinical and epidemiological studies, smoking 

cessation has been associated with significant reductions in depression and anxiety, 

lower rates of re-hospitalization, and lower rates of suicide.10,11,12,13,14 A recent 

systematic review found that smoking cessation was associated with marked 

improvements in mental health over time, whereas continued smoking was 

associated with little change over the same period.15

5. Providing smoking cessation assistance is an important part of mental 

health treatment. Providers who care for people with mental health conditions are 

well positioned to help patients successfully quit tobacco use and enjoy the mental, 

emotional, and physical benefits of a tobacco-free life. Smoking cessation 

treatments work, and it’s important to make them available to all people who want to 

quit, including people with mental health conditions. Providers can do their part by 

making tobacco cessation part of an overall approach to treatment and wellness. 

• Ask patients if they smoke cigarettes or use other forms of tobacco; if they do, 

 strongly advise them to quit.

• Assist patients who are ready to quit by offering proven quitting treatments, 

 including tailored cessation assistance. 

 - Refer patients interested in quitting to the ‘I’m Ready to Quit!’ page on the 

 Tips website, 1-800-QUIT-NOW, www.smokefree.gov, or other resources.

 - Provide counseling, support, and stop-smoking medicines. 

• Monitor and adjust mental health medicines as needed in patients trying to quit 

 smoking. 

• See www.cdc.gov/tipsmentalhealth for more information and free downloadable 

 tools to help patients quit smoking.

- Learn more about how to help people with mental health conditions quit 

 smoking: http://www.ctri.wisc.edu/providers-behavioral-health.htm

- Download free smoking cessation guides and toolkits designed for providers 

 who care for patients with mental health conditions:

 https://smokingcessationleadership.ucsf.edu/behavioral-health/resources/toolkits

 - Watch a brief video with step-by-step instructions for offering smoking cessation 

 assistance in health care settings: https://www.youtube.com/watch?v=3VvhA1xl0pY

1. Centers for Disease Control and Prevention. (2013). Vital signs: Current cigarette smoking among adults aged ≥ 18 years with mental illness—United States, 2009–2011. 

Morbidity and Mortality Weekly Report, 62(5), 81–7. 2. Ziedonis, D., Hitsman, B., Beckham, J. C., Zvolensky, M., Adler, L. E., Audrain-McGovern, J., Breslau, N., et al. (2008).

Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine & Tobacco Research, 10(12), 1-25. 3. Druss, B. G., Zhao, L., Von 

Esenwein, S., Morrato, E. H., & Marcus, S. C. (2011). Understanding excess mortality in persons with mental illness: 17-Year follow up of a nationally representative US survey. 

Medical Care, 49(6), 599-604. 4. Substance Abuse and Mental Health Services Administration. (2014). The National Mental Health Services Survey (N-MHSS) data spotlight 

report, November 25, 2014. http://www.samhsa.gov/data/sites/default/files/Spot148_NMHSS_Smoking_Cessation/NMHSS-Spot148-QuitSmoking-2014.pdf. Accessed January 

15, 2016. 5. Christianson, B. (in press). Measuring the integration of tobacco policy and treatment into the behavioral health care delivery system: How are we doing? Journal of 

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Siru, R., Hulse, G. K., & Tait, R. J. (2009). Assessing motivation to quit smoking in people with mental illness: a review. Addiction, 104(5), 719-733. 8. Tidey, J. W. & Miller, M. 

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Williams, J. V., Hill, J. C., Lavorato, D. H., & Patten, S. B. (2012). Persistent heavy smoking as risk factor for Major Depression (MD) incidence: Evidence from a longitudinal 

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Spitznagel, E. L., Grucza, R. A., Salyer, P., et al. (2014). Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders. Psychological Medicine, 

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