Smoking and Schizophrenia: Why Rates Are So High

Smoking is common among people with schizophrenia, and researchers have a few theories about why. One possibility involves nicotine’s relationship with dopamine. Other factors, including schizophrenia symptoms, stress, and social influences, may also play a role.

Understanding these connections can help explain why some people with schizophrenia smoke and why quitting may be challenging.

Smoking and Schizophrenia: The Big Picture

While smoking rates vary across studies, and not everyone with schizophrenia smokes, the overall pattern is clear: Smoking rates are higher among people with schizophrenia than those without.

Studies suggest that roughly 70 percent to 80 percent of people with schizophrenia smoke. One study in Canada found smoking was three to four times more common among this group than in the general population.

People with schizophrenia who smoke are also more likely to smoke heavily and may find it more challenging to quit smoking.

The relationship between nicotine and dopamine may help explain some of these smoking patterns.

Why Smoking May Be More Common in People With Schizophrenia

Researchers have several hypotheses that may help explain why smoking rates are higher among people with schizophrenia. These factors may overlap, and motivations for smoking likely vary from person to person.

Self-Medication Hypothesis

One theory, which researchers are still exploring, is that some people with schizophrenia smoke as a form of self-medication.

Smoking isn’t a treatment for schizophrenia, but some people may feel that it temporarily helps with their schizophrenia symptoms or the side effects of treatment.

Shared Vulnerability Hypothesis

Another theory is that some of the same genetic, environmental, or brain-related factors that may play a role in schizophrenia may also make some people more vulnerable to tobacco use. This is another hypothesis that researchers continue to explore.

Other Factors That May Influence Smoking

Other factors can also influence smoking habits.

For some people, cigarette smoking may become part of a daily routine or a way of coping with stressful situations. For others, being around people who smoke or having easy access to tobacco may motivate them to smoke or to smoke more frequently.

Gender can also play a role. Males are more likely to smoke than females, according to a study in the journal Schizophrenia Research and Treatment.

Researchers have also found that certain social and lifestyle factors are associated with smoking among people with schizophrenia, including:

• Level of education
• Employment status
• Daily caffeine intake
• Use of other substances

There isn’t one answer as to why smoking is common among people with schizophrenia. These factors, along with nicotine dependence, may help explain the higher smoking rates, but they don’t explain every person’s experience.

If you smoke and take antipsychotic medications, it’s important to know that smoking may affect how well your medications work.

Health Risks and Benefits of Quitting

Smoking increases the risk of many serious health conditions, including heart disease, lung disease, diabetes, and several types of cancer.

There is no safe form of tobacco use, including e-cigarettes and vaping. Tobacco use is currently the leading cause of preventable disease and death in the United States.

The good news is that it’s never too late to quit smoking. For most people, the body begins to recover after they quit.

Within minutes, the heart rate begins to return to normal. Within weeks to months, circulation and lung function can improve. Over time, the risks of heart disease, stroke, lung disease, and cancer continue to decrease.

Quitting completely provides the greatest health benefits. Cutting back can be a step toward quitting, but even small amounts of smoking can still harm your health.

If you don’t smoke, try not to start. If you do smoke, consider talking with your doctor or another healthcare professional about quitting. Support and treatment can make quitting easier.

Getting Help To Quit Smoking

Quitting smoking can be difficult, but you don’t have to do it alone. It’s a process, so be patient with yourself, practice self-care, and ask for help when you need it.

Therapy, counseling, and other behavioral support can help manage cravings, identify triggers, and develop strategies for staying smoke-free.

Nicotine replacement therapy and prescription medications that reduce cravings and withdrawal symptoms may also make quitting easier. Depending on your symptoms and overall health, your provider may recommend a nicotine patch, gum, or lozenges to help you through the early stages of withdrawal. Non-nicotine prescription medications, such as varenicline and bupropion, may also be recommended based on your individual needs.

Start by talking to your healthcare provider. Together, you can create a personalized plan that takes into account your:

• Symptoms
• Medications
• Smoking habits and triggers
• Goals for quitting
• Preferences

If you take an antipsychotic medication, tell your healthcare provider when you plan to quit smoking so they can monitor your health and treatment and make adjustments as needed.

Remember, quitting doesn’t have to happen all at once or without support. Work with your provider to find an approach that works for you. If appropriate, they can also refer you to a mental health professional or smoking cessation program.