Cigarette Smoking, Addiction, and Mental Health

By P. Casey Arrillaga, LCSW, LCDC

Nicotine use has a lot of crossover with mental health issues and with other addictive drugs. It is used in many forms, the most common being through smoking cigarettes. Nicotine is found in the leaves of the tobacco plant, which is a member of the nightshade family. As we’ll see, it could be said to be the deadliest nightshade of all.

Tobacco has been used in North America since at least 900 C.E. but possibly as far back as 600 C.E. It spread quickly to Europe when explorers took it back to their homelands, creating a financially lucrative trade in the process. Tobacco use hit an all-time high in the United States in the mid-20th century when the popularity of cigarette smoking surged due to a combination of aggressive advertising and the inclusion of cigarettes in military rations in both world wars.

Nicotine is easily the deadliest drug in the world in terms of the sheer number of people it kills each year. As much as we hear about various drug epidemics, nicotine leaves them all in the dust. In the U.S. alone, the CDC estimates 480,000 deaths per year are because of smoking, making up 1 out of every 5 fatalities. Alcohol pales in comparison at 88,000 deaths in the U.S. each year, and opioids including prescription pills and heroin combined come in a distant third with 30,000 U.S. deaths each year. While each of the opiate overdoses is a tragedy, for every one of them, 16 times as many die from smoking. Worldwide, about 6 million people each year are killed by cigarette use.

Since efforts to discourage smoking started in the 1960’s, cigarette use has gone down considerably. In the U.S., the percentage of people who smoke has dropped from 42% in 1965 to 15% in 2015. Because of population growth, the total number of smokers has declined more slowly, and there are still about 40 million people who smoke cigarettes in the U.S.

To complicate matters, while cigarette smoking has declined, vaping (“e-cigarette” use) has been growing exponentially, especially among adolescents. Although the terrible effects of inhaling smoke are avoided, nicotine dependence and its impact on the adolescent brain are very much in play. One of the most alarming of these impacts is that the earlier an adolescent uses nicotine, the more likely they are to use other drugs, including alcohol, and even find those drugs more rewarding than they would have otherwise.

In an upsetting twist, surveys show that those who smoke are disproportionately part of one or more disadvantaged groups, such as people with less education and/or less money. Unsurprisingly, people with less money also tend to have worse outcomes from smoking and are several times more likely to die from smoking-related causes. Marginalized groups such as Native Americans or LGBTQ+ people are much more likely to smoke. Military members also smoke are higher rates, and within this group, the lower the rank, the more likely they are to use cigarettes.

Smoking and Mental Health

Sadly, one of the groups with considerably higher smoking rates is people with mental health issues. The more profound the mental health issue, the more likely they are to smoke. Smoking rates are progressively higher for people with phobias, dementia, ADD/ADHD, serious psychological distress, bipolar disorders, and are highest for those with schizophrenia. People in this last group smoke at almost triple the rate of people without any mental health issues.

One thing that complicates analysis of all this is that people with mental health issues often fall into one or more of the other disadvantaged groups. For instance, people who are in the lower income groups are not only more likely to develop mental health problems, they are probably going to have worse outcomes from those problems. Both of these things mean they are also more likely to smoke and more likely to have other compulsive and addictive behaviors going on.

Smoking and Other Addictions

This leads into a discussion of how smoking and other nicotine use interact with other addictions. The most obvious interaction is that there is a lot of crossover between cigarette smoking and other drug use. Smoking is also strongly associated with compulsive gambling. Research shows that the vast majority of people with an alcohol problem smoke. Nicotine use also seems to make people more likely to compulsively use cocaine and/or methamphetamine. Some scientists argue that there are certain personality traits that people with drug and/or gambling addictions share in common, such as having high neuroticism, low agreeableness, and low conscientiousness.

It should surprise no one that people who smoke cigarettes are more likely to smoke marijuana and to become addicted to both. Similarly, it has been found that adolescents who vape nicotine are also more likely to vape THC as well. More research is needed in this area, especially as vaping becomes more and more popular, and is increasingly thought of as harmless by the teens who do it.

The Bottom Line

Since it seems that people who are under more stress and have fewer social advantages are more likely to smoke and suffer the terrible consequences, simply encouraging people to stop will usually not be enough. The most effective thing may be to get them help for some of the other issues they face. For instance, if you or someone you love are struggling with addiction and/or mental health issues, getting professional treatment for those issues may give an advantage in quitting smoking as those issues lessen. In this way, getting help for those other issues may turn out to be a lifesaving move in more ways than one.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”. His books, podcast, videos, etc. can be found at CaseyAuthor.com