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Nicotine is a highly addictive substance — so addictive, in fact, that use of quit-smoking aids such as patches or gum can cause an addiction. It’s no wonder, then, that people who are coping with mental ill-health put ‘quit smoking’ at the bottom of their to-do list.
What they don’t know is that ceasing smoking can aid their mental health.
Today, 31 May, is World No Tobacco Day, organised by the World Health Organisation. It’s a good time to look at some of the myths about tobacco use, smoking, and their relation to mental illness.
“Compared with the general population, people with mental illness have higher smoking rates, higher levels of nicotine dependence, and a disproportionate health and financial burden from smoking,” say Greenhalgh and their cowriters for the Cancer Council Victoria.
“Australian men with mental illness live 15.9 years less and women live 12 years less than those without mental illness, and most of the excess morbidity and mortality is attributable to smoking-related illnesses such as cardiovascular disease, respiratory disease, and cancer.”
According to SANE, 32% of people with mental illnesses smoke, compared with 18% of the general population.
That Australians with mental illness live shorter lives is a tragedy. That these reduced life expectancies are related to smoking is devastating.
Pitfalls like these related to tobacco use are often cited in quit smoking campaigns, but these negative motivations can prompt feelings of helplessness and hopelessness. This World No Tobacco Day we thought we’d look for positive motivation – and found that many of the positives around quitting smoking are related to mental health.
“Quitting smoking could make my mental health worse”
Many people worry that the stress of quitting will adversely affect their mental health. As Greenhalgh and other researchers have discovered, this is not borne out by the evidence. In a multitude of studies, participants experienced improved mental health after quitting.
“Many mental health workers also believe that smoking cessation will exacerbate mental illness,” Greenhalgh writes. “However, recent evidence suggests that the reverse is true; quitting smoking for at least six weeks actually improves mental health, mood, and quality of life, both among the general population and among people with a psychiatric disorder.”
“Getting healthy after smoking is a long process”
The health benefits of quitting smoking kick in remarkably quickly – in fact, the first benefit happens within 20 minutes. A person’s heart rate and blood pressure drop within 20 minutes of their last cigarette. The carbon monoxide that smoking builds up in blood also recedes quickly, reaching normal levels within 12 hours.
“Smoking relieves stress”
It’s true that most smokers feel a relaxing effect from smoking. However, the immediate relief smokers feel is because their withdrawal symptoms go away, not because their stress levels decrease.
Nicotine has a very short half-life of just two hours and causes a very brief ‘rush’. Nicotine also only takes a few seconds to reach the brain after inhaling or ingestion. Once the high of the nicotine is gone, the body is left craving the dopamine hit again, so the next cigarette comes as immense relief.
In terms of actual stress relief, smoking contributes to stress both physically, increasing blood pressure, and mentally, forcing the smoker to plan their day around their next cigarette break.
“Smoking helps me cope with my mental health condition”
In studies on the subject, smoking and tobacco use have been shown to be a contributing factor to suicidal ideation, attempts and death. One study showed that smoking contributed to 21% of participants’ suicidal behaviours.
Smoking is also related to increased metabolism of some psychotropic drugs, meaning that for some people, smoking reduces the effectiveness of their medication and leads to a need for higher doses.
“People with mental health conditions are less motivated to quit”
There is no difference in motivation to quit smoking between people with mental health conditions and people who don’t. People who live with mental health conditions tend to experience higher levels of nicotine dependence, so quitting is more of a struggle.
“Smoking isn’t a mental health issue”
As stated above: considering it contributes to the early mortality of people with mental health conditions, smoking is very much a mental health issue. Part of the problem is that many mental health service providers do not have smoking cessation training, and some wrongly believe the myths stated above.
Mental Health Victoria recommended that smoking cessation services be provided within mental health care settings as part of our submission to the Victorian Government’s 2022-23 State Budget.
No-one expects people to walk away from tobacco use without help. In Australia, Quit.org.au is a good place to start.
Accompanying their World No Tobacco Day campaign, WHO has launched Florence, an AI who helps people quit tobacco use.
Through a series of questions, Florence develops an understanding of a person’s relationship with tobacco. She then creates a personal quit plan tailored to the individual.
“Tobacco is extremely harmful and there is no safe level of exposure to it,” says WHO. “Research has proved that more than half of tobacco users are eventually killed by it. Currently, seven million tobacco users die every year.”