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 illnesscan take heart from her success.
“It’s often been assumed they can’t quit,but with close monitoring and supportit’s perfectly safe,” says Debra Scharf,a tobacco reduction specialist withAlberta Health Services.
People living with mental illnessare three to four times more likely tosmoke than the general populationand they smoke 50 per cent of Canada’scigarettes, notes Scharf, who leadssmoking cessation groups at a mentalhealth clinic in Edmonton. “They alsosmoke more heavily, so they’re highlyaddicted. Yet surveys show that theirdesire to quit equals that of the generalpopulation. And they are so happy whenthey do. They have more money, morefreedom to try new things. Their healthimproves. And their self-esteem goes up.
It’s amazing to see.”Not that quitting is easy.
And it is made all the tougher whensomeone who wants to quit is surroundedby people who continue to smoke, saysKim Barnes, a recreation therapist withAddiction and Mental Health, AlbertaHealth Services, in Red Deer.
Researchers are piecing together reasons why tobacco use and mental illness are so closely linked. For example, geneticfactors associated with schizophreniaalso contribute to nicotine dependence.
Childhood trauma is correlated with
both adult depression and increased
substance abuse, including smoking.
Individuals living with depression andother psychiatric disorders may usenicotine to mask the side effects ofmedication—or to manage theirsymptoms.
For all those reasons and more,smokers with mental illness have notbeen encouraged to quit, Scharf says.
In hospitals, psychiatric units were thelast to send smokers outdoors, andnurses rewarded good behaviour withcigarettes. Doctors brought the topic upfar 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