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The Comorbidity Between Mental Illness and Tobacco Use

A large percentage of people with mental illness smoke cigarettes, an unhealthy habit with numerous negative health consequences. People with mental illness are twice as likely to smoke as those without mental illness. A 2015 nationally representative survey revealed that close to 31% of participants with mental illness have smoked a cigarette in the past month, which is 66% higher than the rate among those without mental illness. Tobacco use has a strong correlation with many mental and behavioral disorders, particularly depression and schizophrenia. Up to 80% of participants with schizophrenia are smokers, a rate that is 5 times higher than that of the general population.

Relationship Between Smoking and Mental Illness

One reason for the common comorbidity between mental illness and tobacco use is that smoking may reduce or assist individuals in coping with the symptoms of their mental illnesses. Symptoms such as sadness, stress, and difficulty concentrating may be alleviated with tobacco use, which helps explain why individuals with mental illnesses are less likely to quit smoking compared to those without mental illness. Inflated rates of smoking and resistance to quitting in those with schizophrenia may contribute to the shorter life expectancy and higher prevalence of cardiovascular disease among those with schizophrenia.

The Link Between Nicotine and Schizophrenia

Current research highlights the connection between schizophrenia and nicotine and their impact on the brain. This research helps to explain the high rate of smoking among those with schizophrenia. Abnormalities in particular circuits of the brain may predispose individuals to schizophrenia and intensify the rewarding impacts of drugs like nicotine. This inclination could also contribute to why it may be more difficult for these particular individuals to quit smoking. Both nicotine and clozapine, a medication that acts like nicotinic acetylcholine receptors, are productive in helping those with schizophrenia to maintain their treatment.

The dorsal anterior cingulate cortex (dACC) is a brain region that regulates decision-making, planning, ability to focus, and impulse control. This circuit is impaired among anyone with schizophrenia, regardless of whether they smoke. Researchers have looked into the connections between the dACC and several other brain areas involved in memory, emotion, and reward and have found that they are weaker among individuals with schizophrenia compared to those without the disorder. Most of these various neural circuits are less active among individuals with intense nicotine use disorders, implying that the brain circuit is impaired in both schizophrenia and nicotine dependence.

A decreased level of nicotinic acetylcholine receptors is a neurobiological indicator of schizophrenia. Nicotinic acetylcholine receptors are involved in memory and cognition, which are naturally activated by acetylcholine, a neurotransmitter, but can also be initiated by nicotine. Fortunately, researchers are developing medications that specifically stimulate receptors to counteract the cognitive impairments associated with schizophrenia without the addictive threat of nicotine or the fatal health consequences of smoking. Knowing why and how individuals with schizophrenia use nicotine can contribute to new ways to care for those with both schizophrenia and nicotine dependence.

Mental Health and Smoking Cessation

There is an immense need for progressive and positive treatments for both schizophrenia and nicotine dependence. Individuals with comorbid disorders are encouraged to quit tobacco use to preserve their mental health. There are other outlets for these individuals and opportunities to obtain care. Bupropion is a medication that assists people with schizophrenia to abstain from smoking without any prominent psychotic symptoms. Introducing motivational incentives along with bupropion medication can help prevent relapse during the initial phase of smoking termination.

At Boardwalk Recovery Center, we get to the root of substance use and encourage overall well-being by promoting healthy lifestyle choices and educating clients on what different drugs do to the body.

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