By Sandra Kiume

Smoking causes many problems, in terms of death, disease, cost, and other risks, but in recent years a strong stigma has also developed. Through anti-smoking campaigns and government bans, attitudes toward smokers have become downright hostile – even to the point of suggestions that smokers not be able to access medical treatment like surgeries. What is the impact of this stigma?

To begin with, smokers are given poorer performance ratings on the job than non-smokers, and lung cancer victims have fewer resources than other types of cancer patients. Non-smokers also tend to prefer hanging with and dating non-smokers, in a clear social divide along smoking lines. But what’s maybe most disturbing is that people with mental illnesses, already heavily stigmatized, are made into pariahs.

Compared to the general population with a smoking rate of about one in five, in schizophrenia the rate is estimated as high as 90% , and in bipolar disorder some estimates go to 70%. There may be a self-medicating antipsychotic and antidepressant effect involved, but research is still tentative. Other contributing factors include low socio-economic status, mood and anxiety , poor coping skills, and neurological vulnerability . But one troubling big reason that smoking persists in mental health consumers is socializing and rewards in psych wards and hospitals, with a culture centred on boredom-relieving tobacco reinforcing the addiction.

Adding to that, a recent study on bipolar disorder, suicidality and having ever smoked (in this group of 399 people, the rate was 38.8%) finds links with “earlier age at onset of mood disorder, greater severity of symptoms, poorer functioning, history of a suicide attempt, and a lifetime history of comorbid anxiety and substance use disorders. Smoking may be independently associated [not a cause, a correlation] with suicidal behavior in bipolar disorder.” 47% had made an attempt.

Is it possible worse outcomes are connected to being a social leper? The most severely ill people may be doing themselves a further disservice, limiting support, friends and positive relationships in the community when they can’t afford to be isolated. Support is vital.

It’s hard to quit, many say the toughest addiction of all to beat. But nowadays reasons to quit are even more compelling, especially with a concurrent serious mental illness. The handful of studies looking at smoker patients [free PDF] conclude that the needs of smokers with serious mental illness are unique and require a different approach than the usual self-help booklets and nicotine patches. Integrated concurrent disorders treatment with psychotherapy and motivational techniques (possibly Zyban or naltrexone mixed in too) in mental health settings is more effective. In the community, frequent contact with telephone counsellors has also been helpful.

On one of many quit-smoking web sites reasons for quitting include “yo...