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Common Myths about Smoking and Behavioral Health

Posted by Gary Tedeschi, PhD

May 9, 2017 12:02:13 PM

Older Man_Web.jpgMay is Mental Health Month and a good time to revisit some of the common myths about smoking and behavioral health.

People with behavioral health conditions (mental illness and substance use disorders) smoke at higher rates than those without behavioral health conditions.  Alarmingly, people with mental illness and substance used disorders are dying up to 25 years earlier than the general population. The major causes of death are often smoking related cancer, heart disease, and lung disease.1,2

Unfortunately, there are still misconceptions that smokers with behavioral health conditions are not interested in smoking cessation and lack the ability to quit.  There are also concerns that these smokers will experience increased psychiatric symptoms when they quit.3 As a result, providers may not include smoking cessation in their treatment plans.  Instead, they focus primarily on behavioral health symptom management.

The reality is that people with mental illness and substance use disorders want to quit smoking and can quit successfully. Health care professionals can play an essential role in this process. Providers can bolster a broad health and wellness philosophy for patients by seeing tobacco cessation as a key component of behavioral health treatment and recovery.

Myths and Facts About Smokers with Behavioral Health Conditions

Here are some common myths and facts about smokers with behavioral health conditions.

Myth #1: Persons with mental illness and substance use disorders don’t want to quit.

Fact: The majority of persons with mental illness and substance use disorders want to quit smoking and want information on cessation services and resources.

Several research studies indicate that the majority of persons with behavioral health conditions want to quit smoking and want information on cessation services and resources. 4, 5, 6 


Myth #2:  Persons with mental illness and substance use disorders can’t quit smoking.

Fact:  Persons with mental illness and substance use disorders can successfully quit using tobacco.

There is a growing body of literature indicating that this clientele can quit.  For example, results from a large, internationally run randomized controlled trial showed that smokers with behavioral health conditions can quit successfully using nicotine patches, Zyban, or Chantix, compared to placebo, with no significant increase in neuropsychiatric adverse events.7


Myth #3:  Smoking cessation worsens psychiatric symptoms.

Fact:  Smoking cessation can improve psychiatric symptoms.

This myth has historical ties to the tobacco industry, which directly funded, or monitored, research supporting the idea that individuals with behavioral health conditions (schizophrenia in particular) were less susceptible to the harms of tobacco and that they needed tobacco as self-medication.  Fortunately, research has been emerging to debunk this myth.8,9


Myth #4:  Smoking cessation will threaten recovery for persons with substance use disorders.

Fact:  Smoking cessation can enhance long-term recovery for persons with substance use disorders.10

Research has shown that smoking cessation can encourage and support recovery.  For example, a systematic review of 17 studies found that concurrent tobacco cessation treatment with individuals in addictions treatment was associated with 25% increased abstinence from alcohol and illicit drugs six months or longer after treatment. 6

Increasingly, these myths about smoking and behavioral health are giving way to the facts. This is important for a clientele who will benefit greatly from an integrated treatment approach that includes smoking cessation as a priority focus.

For More Information

For more information about smoking and behavioral health, please visit our website or explore our free CE Courses on a variety of smoking and behavioral health issues.


1 Colton, C. W. & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3(2).

2 Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry, 72(4), 334-341.

3 Prochaska, J. J. (2010). Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? Drug and Alcohol Dependence, 110(3), 177- 182.

4 Prochaska, J. J., Rossi, J. S., Redding, C. A., Rosen, A. B., Tsoh, J. Y., Humfleet, G. L., . . . Hall, S. M. (2004). Depressed smokers and stage of change: Implications for treatment interventions. Drug and Alcohol Dependence, 76(2), 143-151. doi:DOI: 10.1016/j.drugalcdep.2004.04.017

5 Prochaska, J. J.,Reyes, R.S., Schroeder, S.A., Daniels, A. S., Doederlein, A., & Bergeson, B. (2011). An online survey of tobacco use, intentions to quit, and cessation strateies among people living with bipolar disorder. Bipolar Disorders, 13(5-6), 466-473. doi:10.1111/j.1399-5618.2011.00944.x

6 Joseph, A. M., Willenbring, M. L., & Nugent, S. M. (2004). A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment. Journal of Studies on Alcohol, 65(6), 681-691

7 Anthenelli, R. M., Benowitz, N. L., West, R., St Aubin, L., McRae, T., Lawrence, D., ... & Evins, A. E. (2016). Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. The Lancet, 387(10037), 2507-2520.

8 Prochaska, J. J., Hall, S. M., Tsoh, J. Y., Eisendrath, S., Rossi, J. S., Redding, C. A., . . . Gorecki, J. A. (2008). Treating tobacco dependence in clinically depressed smokers: Effect of smoking cessation on mental health functioning. American Journal of Public Health, 98(3), 446-448. doi:10.2105/AJPH.2006.101147

9 Evins, A., Cather, C., Deckersbach, T., Freudenreich, O., Culhane, M., Olm-Shipman, C., . . . Rigotti, N. (2005). A double-blind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. Journal of Clinical Psychopharmacology, 25(3), 218-225. doi:10.1097/01.jcp.0000162802.54076.18

10 Prochaska, J. J., Delucchi, K., & Hall, S. M. (2004). A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of Consulting and Clinical Psychology, 72(6), 1144-1156. doi:10.1037/0022-006X.72.6.1144

Free CE and Materials: Tobacco Cessation and Behavioral Health

Posted by Kristin Harms

May 26, 2015 4:54:00 PM

ShatteredLivesImage 288x256People with mental illness and substance use disorders want to quit smoking and can quit successfully.  And mental health professionals can help. 

Until a few years ago, it was not common for people with mental illness or substance use disorders to be treated for their tobacco dependence. People with behavioral health conditions have only recently been identified by tobacco control and cessation professionals as a priority, even though their smoking rates are 2-4 times higher than in the general population (Lasser et al., 2000).

The 2006 Morbidity and Mortality in People with Serious Mental Illness report issued by the National Association of State Mental Health Program Directors, found that persons with serious mental illness die, on average, 25 years earlier and suffer increased medical co-morbidity.  They often die from tobacco related diseases and are more likely to die from these diseases than from alcohol use.

The need to help this clientele quit tobacco is clear.  Some strongly held myths have stood in the way of progress in this area.  Fortunately, a growing body of research is debunking these myths, making way for new interventions. 

The California Smokers’ Helpline has developed the following free resources to help you learn more about smokers with mental illness and substance use disorders and how to help them. Fact Sheet: Tobacco Cessation for Smokers with Mental Illness or Substance Use Disorders.

  • Slide Presentation: Tobacco Cessation and Behavioral Health
  • Online CE Training: Tobacco Cessation and Behavioral Health. Continuing education credits available to physicians, nurses, physician assistants, MFTs, LCSWs, and NAADAC certified counselors.
Download Materials Now!

Four Myths About Smokers With Behavioral Health Conditions

Posted by Kirsten Hansen

Mar 14, 2012 2:23:00 PM

describe the imagePeople with mental illness and substance use disorders want to quit smoking and can quit successfully.  And mental health professionals can help.  Until a few years ago, it was uncommon for people with mental illness or substance use disorders to be treated for their tobacco dependence, even though their smoking rates are 2-4 times higher than in the general population.

The 2006 Morbidity and Mortality in People with Serious Mental Illness report issued by the National Association of State Mental Health Program Directors, found that persons with serious mental illness die, on average, 25 years earlier and suffer increased medical co-morbidity.  They often die from tobacco related diseases and are more likely to die from these diseases than from alcohol use.

The need to help this clientele quit tobacco is clear.  Some strongly held myths have stood in the way of progress in this area.  Fortunately, a growing body of research is debunking these myths, making way for new interventions. 

  • Myth #1: Persons with mental illness and substance use disorders do not want to quit smoking. Research argues that the majority of persons with mental illness and substance use disorders want to quit smoking and want information on cessation services and resources. Among hospitalized psychiatric patients who smoke, one study found that 79% were not only interested in quitting, but agreed to participate in a clinical study to help them quit (Prochaska, Hall, & Hall, 2009).  
  • Myth #2: Persons mental illness and substance use disorders are unable to quit smoking.  In fact, a review of 24 studies, the recorded quit rates of patients with mental illness or addictive disorders were similar to those of the general population.
  • Myth #3: Smoking cessation worsens psychiatric symptoms. On the contrary, smoking cessation can actually improve psychiatric symptoms.  This myth has historical ties to the tobacco industry which has directly funded, or monitored, research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self-medication.  One randomized trial found that actively depressed smokers who quit reported a significant decline in depression symptoms and a reduction in alcohol use compared with participants who continued smoking (Prochaska et al., 2008).
  • Myth #4: Smoking cessation can threatens recovery for persons with substance abuse issues.  Smoking cessation can actually enhance long-term recovery for persons with substance use disorders. A systematic review of 17 studies found that concurrent tobacco cessation treatment with individuals in addictions treatment was associated with 25% increased abstinence from alcohol and illicit drugs six months or longer after treatment (Prochaska, Delucchi, & Hall, 2004).  

Clinicians are encouraged to talk with their patients and offer them assistance in quitting.  Many of the treatment strategies that work for smokers without behavioral health issues (e.g., cessation pharmacotherapy and behavioral counseling) can work for this clientele as well.

The California Smokers' Helpline has developed a free toolkit for you to help your patients quit smoking. To download the kit now, click below:

Download Materials Now!




About this Blog

The California Smokers' Helpline offers free, evidence-based tobacco cessation services in multiple languages to help smokers quit. We also offer free training and resources to health professionals to increase their knowledge and capacity for tobacco cessation.

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For more information about our free training and resources for health professionals, please contact the Helpline Communications Department at (858) 300-1010 or cshoutreach@ucsd.edu.

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