3.1 Why is tobacco use so common among people with schizophrenia?
If you’ve noticed that many people with schizophrenia smoke, you’re not alone. Individuals with schizophrenia are far more likely to smoke than the general population. But why? The reasons are complex and interconnected with both biological and psychological factors.
From a scientific standpoint, it is important to understand the difference between simply using tobacco and having Tobacco Use Disorder (TUD). TUD is recognized globally as a mental health disorder by major medical classifications like DSM-5 and ICD-11 (WHO), meaning it’s considered a condition that affects the brain.
People with mental disorders smoke much more than the general population – between 2 to 4 times as much.
This trend is even more pronounced among those with severe mental disorders, where Tobacco Use Disorder (TUD) rates are especially high
For instance, as many as 70-85% of people with schizophrenia and 50-70% of those with bipolar disorder struggle with TUD
Despite their desire to quit for reasons like health and family, individuals with mental disorders face big challenges. They’re more likely to relapse, especially when dealing with stress and negative emotions, even after successfully quitting for over a year.
These findings show how closely mental health and smoking are connected, making it clear that people need personalized support to manage both their well-being and tobacco addiction successfully.
A strong link
There is a strong connection between Tobacco Use Disorder (TUD) and other mental health conditions, like schizophrenia, indicating that they may share common brain mechanisms.
In the human brain, there are complex systems and circuits— like the opioid, cannabinoid, and nicotinic cholinergic systems—that evolved to support our survival.
However, when these systems malfunction, as seen in many mental disorders, they can increase the risk of developing addictive behaviors like nicotine addiction.
People smoke primarily for nicotine, which they find in tobacco. Interestingly, variations in a specific brain nicotine receptor can predict severe and compulsive smoking behaviors.
These genetic differences not only make it harder for some individuals to quit smoking, but also increase their likelihood of relapse after attempting to quit.
The theories of tobacco useschizophrenia connection
Scientists have proposed several ideas to explain why smoking rates are so high among people with schizophrenia.
Theory 1 – Self-Medication
One popular theory suggests that individuals with schizophrenia might use tobacco as a form of self-medication to manage their symptoms.
Theory 2 – Shared Genetics
Another theory is that there might be a shared genetic link, meaning the same genes could increase the risk for both smoking and developing schizophrenia.
Theory 3 – Smoking as a Contributing Factor
Lastly, some researchers believe that smoking itself could potentially contribute to the onset of schizophrenia.
Understanding these factors helps explain why quitting smoking can be especially challenging for individuals with mental health disorders and highlights the importance of personalized approaches to help them overcome nicotine addiction.
Tobacco as self-medication
One major reason why people with schizophrenia smoke more than the general population is that nicotine can act as a form of self-medication, offering temporary relief from symptoms such as stress, agitation, and cognitive difficulties.
Some potential benefits of nicotine use in this context include:
Improved cognition and mood – Nicotine interacts with brain receptors that enhance attention, learning, and memory.
Reduction of stress and agitation – Many smokers report that nicotine helps them feel calmer.
Possible mitigation of medication side effects – Some studies suggest that nicotine can reduce the severity of some side effects from antipsychotic drugs.
Regulation of appetite and metabolism – Nicotine influences hormonal control of appetite and energy use, though this is less relevant to schizophrenia.
While nicotine might offer short-term benefits, it is not a safe or sustainable treatment. Long-term smoking leads to serious health risks, making it a problematic coping strategy.
Cognitive deficits and nicotine’s effects on the brain
Schizophrenia is often accompanied by neurocognitive deficits (NCDs) – problems with reaction time, memory, attention, and sensory processing. These challenges affect up to 80% of people with schizophrenia and tend to remain stable throughout life.
Nicotine appears to have a strong connection to these cognitive issues:
Research shows that certain brain chemicals, like dopamine, glutamate, and GABA, are linked to cognitive impairments in schizophrenia.
Nicotine interacts with these brain systems, temporarily improving cognitive function.
Both human and animal studies demonstrate that nicotine use increases when individuals face cognitive challenges. This suggests that smoking may be reinforcing itself – people continue to smoke because it helps them stay sharp.
Importantly, many people with schizophrenia who struggle with cognitive difficulties are also more likely to start and continue smoking. This indicates that the need to manage cognitive deficits may be a significant reason why smoking is so common among them.
The cycle of smoking and its risks
One of the reasons smoking is so difficult to quit is because nicotine creates a cycle of dependence:
• Cognitive abilities tend to decline when smokers quit, leading them to crave another dose of nicotine to restore mental sharpness.
• This reinforcement loop keeps people smoking, especially those who rely on nicotine for cognitive or emotional relief.
• The long-term consequences are severe, including high rates of smoking-related illnesses like heart disease and lung conditions, which affect people with schizophrenia at higher rates.
While nicotine might offer temporary benefits, its dangers far outweigh them.
