Smoking and Mental Health

The smoking rate in the UK is now at an all-time low, largely thanks to vaping. In 2011, over 20% of the UK population were smokers. But by 2023, that proportion had dropped to 11.9%. This is fantastic news!

Unfortunately, the smoking rate amongst those suffering from mental health problems, remains stubbornly high.

Partly as a result of the high smoking rates, people with mental health conditions have high mortality rates compared to the general population. Their life expectancy is reduced by 10-20 years.

Why do those with mental health conditions smoke?

Tobacco contains nicotine which is an addictive chemical absorbed quickly into the bloodstream. Nicotine then stimulates dopamine production, a chemical associated with pleasurable feelings.

Smokers light up regularly to ensure the steady release of dopamine. When the nicotine content in their blood drops, smokers begin to crave another cigarette and this feeling is stressful. This is one of the reasons why it is so difficult to quit smoking.

For smokers with a mental health condition, the association between smoking and feelings of pleasure is stronger. Smokers with a mental health issue tend to be more heavily addicted to smoking. It is even harder for them to quit.

The prevalence of smoking amongst those with mental health conditions has fallen in recent years which is good news but remains unacceptably high.

Could vaping help?

The more severe the mental health condition concerned, the more likely someone is to be a smoker.

Clinical trials and studies indicate that vaping can help reduce smoking rates among individuals with mental health conditions, 

Key findings from research and trials include:

• Increased Quit Rates: One large UK population survey found that e-cigarettes were strongly associated with increased quit success rates among smokers with mental health problems, similar to the general population. A secondary analysis of the ASCEND trial suggested e-cigarettes may be as effective and safe as nicotine patches, while being more acceptable to patients with mental illness.
• Smoking Reduction: A trial found that providing e-cigarettes to smokers with serious mental illness who were not willing to quit resulted in substantial reductions in both the number of cigarettes smoked daily and carbon monoxide levels in the blood.
• Safety and Acceptability: Studies generally have not found evidence that e-cigarettes adversely affect mental health symptoms like depression and anxiety when used for cessation, and participants with mental health conditions reported high levels of acceptability and compliance with e-cigarette use as a cessation aid.
• Addressing Health Inequalities: Given that people with mental health conditions have higher smoking rates and are at greater risk of smoking-related diseases, e-cigarettes are seen as a potential tool to help address these health inequalities.
• Current Research: Fully powered randomized controlled trials are currently underway (e.g., the ESCAPE trial) to further assess the effectiveness and cost-effectiveness of providing e-cigarette starter kits to people with mental illness treated in the community.