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Chapter 3

Tobacco use in schizophrenia

This chapter examines why tobacco use is so common among people with schizophrenia and how it impacts both the condition and its treatment. It also discusses the challenges of quitting and the resources available to support smoking cessation.

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Fast Facts

High tobacco use rates in schizophrenia and other mental disorders aren’t just a coincidence – they are rooted in shared genetic and brain chemistry factors.

Although smoking may seem to provide temporary relief in some situations, it can worsen the course of schizophrenia and damage physical health, complicating the overall management of schizophrenia.

Both smoking and quitting smoking can interact with schizophrenia medication by affecting how the body processes it – smoking speeds up the metabolism of some drugs, making them less effective, while quitting can increase drug levels and the risk of side effects. Therefore, it is important to talk to the doctor to ensure proper medication adjustments.

Quitting smoking is a big step for people with schizophrenia and tobacco use disorder. It lays the basis for gradual improvements in both physical and mental health.

Given the overlap in meaning among some terms, which can lead to terminological ambiguity, this chapter adopts the following operational definitions to ensure clarity and consistency for readers.

Tobacco use — any consumption of nicotinecontaining products derived from tobacco, whether combustible, heated, or smokeless.

Smoking — the inhalation of smoke from combusted tobacco products (e.g., cigarettes, cigars, or pipes).

Tobacco Use Disorder (TUD) — the DSM- 5 / ICD-11** diagnosis describing a compulsive, harmful pattern of tobacco consumption.

Comorbid schizophrenia — schizophrenia that co-occurs with at least one additional diagnosable condition, in this chapter specifically TUD.

**DSM-5 and ICD-11 are the shared “rulebooks” doctors use worldwide to label and describe health conditions so everyone speaks the same medical language.

Subchapter 1.

Why is tobacco use so common among people with schizophrenia?

Subchapter 2.

How does tobacco use affect schizophrenia?

Subchapter 3.

What are the health risks of tabacco use for someone with schizophrenia?

Subchapter 4.

Why is quitting smoking harder for people with schizophrenia?

Subchapter 5.

Can tobacco use interfere with schizophrenia medications?

Subchapter 6.

What resources are available for quit smoking in schizophrenia?
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