Smoking and mental health problems

Patients with mental illness have greater rates of smoking during their lifetime and experience severe social, health and psychological disadvantages, and stigma. This chapter begins by providing a brief update on the neurobiology of nicotine addiction and we present evidence that an imbalance in the brain reward and aversion systems, and specific nicotinic acetylcholine receptor subtypes expressed in these pathways, may lead to dependence. Then, in a special case review, we highlight recent advances regarding the knowledge on the association between nicotine dependence and schizophrenia. Further understanding these mechanistic links, including nicotine-induced improvements in cognitive deficits, might provide new insights into improving smoking cessation success in people diagnosed with schizophrenia. Additionally, we discuss data indicating that smoking cessation does not worsen mental health symptoms or increase other drug and alcohol use. Indeed, smoking cessation interventions should be available within mental health and substance use treatment settings. Treatments for nicotine addiction include psychological interventions and pharmacological agents such as nicotine replacement therapies (e.g. gums and lozenges) or medications such as the partial agonist varenicline. Importantly, the outcomes for smokers with mental illness are enhanced when these approaches are combined and may need to be administered over the long term.