Commercial Tobacco Product Use and Behavioral Health Conditions Can Affect Each Other

At a glance

  • Nicotine has mood-changing effects that can make it feel for a short time like the symptoms of a behavioral health condition are gone or improved.
  • Treating tobacco use disorder along with other behavioral health conditions is safe, does not interfere with treatment for other behavioral health conditions, and can help people in recovery have better health and quality of life.
Man sitting in a chair, looking out the window in contemplation

Overview

  • Nicotine has mood-changing effects that, for a short time, can make it feel like the symptoms of a behavioral health condition are gone or improved. This can lead to commercial tobacco use and dependency on nicotine.A1
  • Commercial tobacco smoke can interfere with some medications taken by people with behavioral health conditions.2 As a result, a person might not get the full benefit of taking those medications. As a result, the person might not get the full benefit of taking those medications.3

People experiencing stress can also be more likely to smoke. People with mental health conditions experience many forms of serious stress. For example,

  • People with mental health conditions are more likely to have stressful living conditions, and to have a low yearly household income.23 When people experience severe or long-lasting forms of stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems.4 Having multiple forms of stress has also been associated with current smoking in some adults.5
  • Only 35-67% of adults believed that people are caring and sympathetic of people with mental health conditions when analyzed at the state level.6 People with mental health conditions might feel pressure to disclose their diagnoses, and they might smoke when faced with the stigma associated with their condition.6

People who smoke often use other substances or have other substance use disorders.

  • The prevalence of illicit drug use among adults who smoke cigarettes is three times higher than the prevalence among adults who don't smoke cigarettes.7
  • The percentage of adults who smoke cigarettes and binge drink is nearly twice that of adults who don't smoke and binge drink.7
  • Among adults recently diagnosed with a substance use disorder, nearly 2 in 3 currently smoke.8
  • Among people in treatment for use of and dependency on an illegal drug, more than 3 in 4 currently smoke.9

Treating tobacco use disorder along with other behavioral health conditions is safe, does not interfere with treatment for other behavioral health conditions, and can help people in recovery have better health and quality of life.

  • Quitting smoking is associated with decreases in depression, anxiety, and other mental health symptoms.101112
  • Quitting smoking during treatment for other substances is associated with an increase in long-term sobriety and a reduction in substance use disorder relapse.11
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. "Commercial tobacco" means harmful products that are made and sold by tobacco companies. It does not include "traditional tobacco" used by Indigenous groups for religious or ceremonial purposes.
  1. Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years With Mental Illness—United States, 2009–2011. MMWR Morb Mortal Wkly Rep. 2013;62(5):81-7. https://pubmed.ncbi.nlm.nih.gov/23388551. Accessed Feb 25, 2022.
  2. Lohr JB, Flynn K. Smoking and Schizophrenia. Psychiatr Danub. 1992;8(2):93-102. https://pubmed.ncbi.nlm.nih.gov/19794359/. Accessed, Feb 25, 2022.
  3. Prochaska JJ. Smoking and Mental Illness—Breaking the Link. N Engl J Med. 2011;365:196-8. DOI: 10.1056/NEJMp1105248.
  4. McEwen BS. Stress, Adaptation, and Disease. Allostasis and Allostatic Load. Ann N Y Acad Sci. 1998;840:33-44. DOI: 10.1111/j.1749-6632.1998.tb09546.x.
  5. Slopen N, Dutra LM, Williams DR, Mujahid MS, Lewis TT, Bennett GG, et al. Psychosocial Stressors and Cigarette Smoking Among African American Adults in Midlife. Nicotine Tob Res. 2012;14(10):1161-1169. DOI: 10.1093/ntr/nts011.
  6. Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Association of County Behavioral Health & Developmental Disability Directors, National Institute of Mental Health, The Carter Center Mental Health Program. Attitudes Toward Mental Illness: Results from the Behavioral Risk Factor Surveillance System. Centers for Disease Control and Prevention; 2012. Accessed Feb 25, 2022. https://sprc.org/online-library/attitudes-toward-mental-illness-results-from-the-behavioral-risk-factor-surveillance-system/.
  7. Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2017. Accessed Feb 25, 2022. https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables.
  8. Weinberger AH, Gbedemah M, Wall MM, Hasin DS, Zvolensky MJ, Goodwin RD. Cigarette Use is Increasing Among People With Illicit Substance Use Disorders in the United States, 2002-14: Emerging Disparities in Vulnerable Populations. Addiction. 2018;113(4):719-728. DOI: 10.1111/add.14082.
  9. Prochaska JJ, Delucchi K, Hall SM. A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery. J Consult Clin Psychol. 2004;72(6), 1144. DOI: 10.1037/0022-006X.72.6.1144.
  10. Prochaska JJ, Smita D, Young-Wolff KC. Smoking, Mental Illness, and Public Health. Annu Rev Public Health. 2017; 38: 165-185. DOI: 10.1146/annurev-publhealth-031816-044618.
  11. Compton W. The Need to Incorporate Smoking Cessation into Behavioral Health Treatment. Am J Addictions. 2018; 27(1):42–43. DOI:10.1111/ajad.12670.
  12. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in Mental Health After Smoking Cessation: Systematic Review and Meta-Analysis. BMJ. 2014; 348:1151. DOI: 10.1136/bmj.g1151.