udy Smith proudly stopped smoking
two and a half years ago, four decades
after her first puff. “I’m not going
to start again; I’d have a hard time
gasping for air,” says Smith (not her real
name), who has schizophrenia and lives
in a supported living home in Red Deer.
Smokers living with mental illness
can take heart from her success.
“It’s often been assumed they can’t quit,
but with close monitoring and support
it’s perfectly safe,” says Debra Scharf,
a tobacco reduction specialist with
Alberta Health Services.
People living with mental illness
are three to four times more likely to
smoke than the general population
and they smoke 50 per cent of Canada’s
cigarettes, notes Scharf, who leads
smoking cessation groups at a mental
health clinic in Edmonton. “They also
smoke more heavily, so they’re highly
addicted. Yet surveys show that their
desire to quit equals that of the general
population. And they are so happy when
they do. They have more money, more
freedom to try new things. Their health
improves. And their self-esteem goes up.
It’s amazing to see.”
Not that quitting is easy.
And it is made all the tougher when
someone who wants to quit is surrounded
by people who continue to smoke, says
Kim Barnes, a recreation therapist with
Addiction and Mental Health, Alberta
Health Services, in Red Deer.
Researchers are piecing together reasons why tobacco use and mental illness are so closely linked. For example, genetic
factors associated with schizophrenia
also contribute to nicotine dependence.
Childhood trauma is correlated with
both adult depression and increased
substance abuse, including smoking.
Individuals living with depression and
other psychiatric disorders may use
nicotine to mask the side effects of
medication—or to manage their
For all those reasons and more,
smokers with mental illness have not
been encouraged to quit, Scharf says.
In hospitals, psychiatric units were the
last to send smokers outdoors, and
nurses rewarded good behaviour with
cigarettes. Doctors brought the topic up
far less often than with other patients.
But that’s changing, and for good reason,
she adds. “Smokers with mental health
concerns have more chronic physical
disabilities related to smoking and
die years younger than the general
For clients in Scharf’s quit-smoking
sessions, “the number one reason they
want to quit is cost,” she says. Indeed,
Smith was spending $600 a month on
Given the complex mix of reasons why individuals with mental health concerns smoke, quitting typically takes longer
than the norm and requires months
of counselling, support and close
monitoring, Scharf says: “You have to
really watch them during withdrawal.”
Nicotine replacement therapies (NRTs)
and some prescription medications
can be the key to quitting, Scharf says.
“It’s not a magic bullet, but decreasing
the intensity of the craving allows the
person to go longer without smoking
and practise new behaviours.”
Scharf’s cessation group includes four
people who’ve quit smoking. “We meet
them where they’re at and give them a
little bit of information so they’re on the
right track,” she says. “I believe every one
of them can quit; that’s really helpful
for them. The group teaches each other
after awhile, and the successes are
That’s also true at Smith’s home.
Mental and physical health improves
with quitting, Barnes says, and one
person’s success inspires others to
follow suit. “The positive encouragement
the tenants give each other is a powerful
motivator. It gives them a stronger will
— Cheryl Mahaffy
are working to find
why tobacco use and
mental illness are
so closely linked