Tobacco & mental health: A justice issue

People with a serious mental illness die 25 years earlier than their peers due to physical health conditions … that are related to smoking.

While people with a mental health condition make up only about 20 percent of the population, they smoke 40 percent of all cigarettes. They’re 2 to 4 times more likely to use tobacco as the general population, and 2.5 times more likely to be diagnosed with cancer.


Tobacco industries have targeted vulnerable populations for decades, funneling marketing dollars to low-income neighborhoods, communities of color, LGBTQ populations and people who are homeless or mentally ill.

In the 1980s and ’90s, tobacco companies preyed on people receiving inpatient treatment by providing free or low-cost cigarettes to patients. They made donations to organizations that provided services to people facing homelessness and mental illness, and in some cases, even sent employees to volunteer.

But perhaps just as damaging was the way the tobacco industry worked over time to influence the perception of tobacco among behavioral health professionals. From as early as the 1950s, the tobacco industry funded research into topics that could have exonerated tobacco from its role in cancer or other illnesses, including psychosomatic illness. As an article in a medical history journal put it: “The widespread acceptance of psychosomatic medicine led many to believe that personality was the best predictor of chronic illness.”

In the ’60s and ’70s, they funded research on whether tobacco could help with stress or as a medical treatment for emotional illnesses. The relationships built between the tobacco industry and underfunded psychiatric researchers served another purpose: it lent credibility and helped shape the attitudes and beliefs among mental health providers – some that continue even today.

Some of those long-held myths include:

  • People with a mental illness or substance use disorder can’t quit. They can quit at rates similar to the general population.
  • People with a mental illness or substance use disorder don’t want to quit. They want to quit at rates similar to the generation population, about 7 out of 10.
  • Quitting tobacco would increase stress, especially in early recovery from another substance or an acute psychiatric condition. Quitting tobacco actually improves behavioral health outcomes and helps people feel better.
  • Quitting tobacco is a lesser priority compared to other substances or psychiatric conditions. More people die of smoking-related illnesses than mental health disorders or other substances.

Perhaps it’s because of these myths that behavioral health professionals do not engage their clients on quitting tobacco as often as their physical health counterparts – even though people say they expect to be advised by their health professionals to quit.

But there are many compelling reasons behavioral health professionals should be the ones most involved in helping their clients quit. For starters, it’s likely they’re the clinician the client sees most often. Behavioral health providers typically have the network to support comprehensive care for quitting – links to prescribers, pharmacists, case managers and psychosocial supports. They regularly hold hope for clients while helping them meet their own goals for health. And, they’re better able to identify legitimate mental health needs during the quitting process.

People with mental illness and addiction have long been marginalized in society. But this vulnerable group has been singled out by tobacco companies – with little protection from their service providers – and in some cases, even complicity. Though the roots are deep and complex, it brings us now to a point where their life expectancy is as much as 25 years shorter than their peers. It’s an injustice that must be rectified, and behavioral health providers can play a key role.

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