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Should You Quit Smoking If You Struggle With Mental Health?

Research shows quitting can be good for your symptoms

by Rachel Crowell
June 26, 2019 | Health

In the mid-1950s, tobacco companies noticed something — smokers with schizophrenia were less likely to get lung cancer, research suggested. And yet, people diagnosed with this mental illness were "a group known to smoke heavily,” researchers wrote in a 2017 Annual Review of Public Health article.

“If the finding could be substantiated, perhaps it would allay concerns of smoking causing lung cancer," which would be good PR for tobacco companies.

But it was far from the truth.

In reality, at the time, "smokers with schizophrenia were not living long enough to get cancer; instead, they were dying from tuberculosis and syphilis and institutionalized in settings less likely to detect their cancer," the researchers wrote.

Even today, there are misconceptions about the relationship between smoking and mental health.

Those misconceptions sometimes influence the recommendations psychiatrists and other mental health providers make to their patients about smoking cessation.

And the stakes of following misinformation are high. In the U.S. alone, smoking is linked to more than 480,000 deaths each year, according to the Centers for Disease Control and Prevention. That’s about one in every five fatalities. The CDC also states that the life expectancies of smokers are 10 or more years shorter than those of non-smokers.

Harmful misinformation

Judith Prochaska is an associate professor of medicine at Stanford University’s Prevention Research Center and studies the link between smoking and mental illness.

As a clinical psychology intern working on an inpatient psychiatry unit, Prochaska was "struck by the high smoking prevalence and the general lack of clinical attention to treating this addiction,” she said.

refuse smokes illustration. quit smoking.
Understand what the journey to non-smoking might look like. It might not be linear. You might not get it the first time you try — and that’s OK.

“I had clinical supervisors who suggested that smoking was the least of their worries, that patients with mental illness needed to smoke to manage their psychiatric symptoms and that patients with mental illness may be at lower risk for tobacco-related diseases," Prochaska said. "None of those beliefs bore out to be true. I saw an area that needed attention from a research, educational and clinical perspective."

Has someone – maybe even a psychiatrist or therapist – ever told you that it might actually be a bad idea for you or a loved one to quit smoking because that can make mental health problems worse?

The self-medication hypothesis is the idea that people with mental illnesses smoke to lessen their symptoms. And research to back up this idea has been funded by tobacco companies, Prochaska found in her research.

“I examined the extent to which the tobacco industry has worked to support a self-medication hypothesis for smoking in psychiatry,” Prochaska said.

Here are some of the other things Prochaska and her research team uncovered:

  • Smoking can exacerbate depression, anxiety disorders and schizophrenia. It can even increase the frequency of hallucinations or delusions in people with schizophrenia.
  • Smoking can change how psychiatric medicines are metabolized. The result? People have lower levels of the medicines in their blood than they need, leading to the need for higher doses of their medications.
  • Smoking is linked to higher odds of suicide, but quitting appears to reduce those odds.
  • There is a relationship between exposure to secondhand smoke and the development of depression, generalized anxiety disorders, ADD/ADHD and conduct disorder.
  • The mental health benefits of smoking cessation include: reduced depression, anxiety and PTSD symptoms, decreased stress and better mood and quality of life. Also, smokers who are receiving treatment for other substance use disorders are 25 percent more likely to stay sober from alcohol and drugs if they quit.

[ICYMI: How to Help Someone With an Addiction: Compassion]

Want help quitting?

If you have a mental health provider, let them know that you’re interested in quitting, Prochaska advised.

You might encounter the belief that smoking cessation isn’t a high priority in your mental health treatment, but don’t forget that what you want matters.

“Though its foothold has greatly declined, the self-medication hypothesis lives on in some clinical settings,” Prochaska said.

Understand what the journey to non-smoking might look like. It might not be linear. You might not get it the first time you try — and that's OK.

To maximize quitting attempts, she recommends combining cessation medications with counseling or support from healthcare providers, 1-800-QUIT-NOW (a toll-free number that connects people with quit lines in the U.S.) and online programs like the ones at

There are also apps that provide free, personalized help. offers QuitGuide and quitSTART.

QuitGuide can help you understand the patterns behind your smoking and developing the skills you need to become – and stay – a non-smoker. It can track your cravings by time of day and location. When you log a craving, it also sends you a motivational message.

quitSTART provides you with tailored tips, inspiration and challenges. It allows you to drop a pin to show the places that make you want to smoke. It awards you badges for smoke-free milestones, helps you get back on track if you smoke and even has games and challenges that you can use to distract yourself from cravings.

“Keep trying,” Prochaska said. “Do not give up. It takes most people multiple attempts before they are successful with quitting smoking.”

Rachel Crowell
Rachel Crowell is a Midwest-based writer exploring science and math. Follow Rachel on Twitter at @writesRCrowell. Reach Rachel at [email protected]
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