Smoke 'Em if You've Got Mental Illness

This seems like a weird topic for an op-ed, but the factoids are interesting:

The facts about smoking and mental illness are stark. Almost half of all cigarettes sold in the United States (44 percent) are consumed by people with mental illness. This is because so many people who have mental illnesses smoke (50 to 80 percent, compared with less than 20 percent of the general population) and because they smoke so many cigarettes a day -- often three packs. Furthermore, smokers with mental illness are much more likely to smoke their cigarettes right down to the filters.

I'd like to see this demographic analysis drill down deeper. I imagine the mentally ill population differs from the general population in various ways that may correlate with an increased propensity to smoke.

Photo by Flickr user paszczak000 used under a Creative Commonse license

Comments

It's called self-medicating.

Jesus, is this going to be the latest brain-dead crusade, to prevent on-the-wagon alcoholics from smoking at Alcoholics Anonymous meetings? Tobacco will likely kill you in the end, but in the meantime, smokers can function a lot better and be much less of a burden on the rest of us than can alcoholics and drug addicts, so if people with addiction problems are substituting cigarettes for alcohol or cocaine, they are doing the rest of us a favor.

Posted by Steve Sailer | November 18, 2007 2:07 AM

When you say "factoids", are you referring to the absolute lack of any links directing us to the statistical information for his claims? 50% of smokers are mentally ill? Where'd that come from?

What's with this tendency for people to belittle and demonize smokers? It's bigotry, plain and simple. People are people, with all their foibles and shortcomings. When you quit looking down your nose at everyone that isn't just like you and join the human race, maybe I'll come back to your site.

Put THAT in your pipe and smoke it.

Posted by marydem | November 18, 2007 2:32 AM

No, look at it again. Fifty percent *of cigarettes* are smoked by people with mental illness, but they purportedly smoke many more cigarettes than those who are not mentally ill.

I wonder what definition of "mentally ill" is being used here. How long will it be until anybody who smokes is considered "mentally ill"?

Posted by Swift Loris | November 18, 2007 2:49 AM

Steve Sailer makes a great point. I don't know if I've met any recovering alcoholics/drug addicts who didn't smoke (they've all been coffee addicts as well). If it gets them through the day, let them do it. They're paying more in taxes than non-smokers in their income bracket, so in a sense, they are subsidizing lower taxes for everyone else.

Posted by Fred | November 18, 2007 2:50 AM

I've dated two women with mental health issues (in and out of the facilities on relatively equal terms), and both of them smoked like chimneys. Anecdata, I know, but if it helps them, I'm all for it. There are worse things than dying at 60.

Posted by foolishmortal | November 18, 2007 3:29 AM

50,000 of which are from exposure to secondhand smoke

Yeah, right, "it is estimated" - until the Surgeon General presents us with 50.000 death certificates of otherwise healthy non-smokers reading "cause of premature death: lung cancer", I call BS.

Posted by novakant | November 18, 2007 4:34 AM

foolishmortal,

Where do you find your dates?

Posted by Fred | November 18, 2007 4:42 AM

My sister works with this population. I've been on a few outings and my anecdotal observation is in 100% agreement with the finding that the mentally ill smoke like chimneys. My guess is at some point any number of mental illnesses sometimes present compulsion or restless behavior as a symptom, you try cigarettes, and then you get hooked on cigarettes. Joe Depression sells more cigs than Joe Camel ever did.

As for the writer of that op-ed, Steven A. Schroeder is a professor at the University of California at San Francisco, where he directs the Smoking Cessation Leadership Center, methinks he has more of an anti-smoking agenda than a desire to help the mentally ill.

I think public health measures are the great achievement of the modern world but it's folly to devote your life to prohibiting people from undertaking voluntary self-destructive behaviors in a world where there are endless involuntary risks to be mitigated. More potable water please and fewer crusades against the Oreo cookie.

Smoke 'em if you got 'em mentally ill! Then enjoy yourself a cookie with some transfats and try the best you can to cope with the real problem in your life - mental illness.

Posted by joejoejoe | November 18, 2007 5:15 AM

Steve Sailer makes a great point. I don't know if I've met any recovering alcoholics/drug addicts who didn't smoke (they've all been coffee addicts as well). If it gets them through the day, let them do it.

Actually, this gets to one of my problems with AA. I don't think a person who gets clean and sober but remains addicted to tobacco has done anything about his or her underlying problems. It's a cosmetic fix.

In this sense, AA can be a bit of a parlor trick. These people need to see psychiatrists, they need to be in deep therapy, and they have demons that go far beyond their addiction to alcohol. They have addictive personalities. AA doesn't do anything about that; it just gets them off alcohol (and it often doesn't even succeed in doing that).

Most people would say that someone who quit alcohol and used cocaine or even pot to get through the day was not really sober. They certainly have not addressed their underlying problems that drive them to drink, and are thus of great risk of relapsing. Why should tobacco use be seen any differently? If you can't resist a cigarette, you aren't really sober, no matter how sanctimonious you are about not drinking. Save the sanctimony until you don't smoke either.

Posted by Dilan Esper | November 18, 2007 5:46 AM

Obviously the same was not true 60 years ago. Maybe a lot of this has to do with people with mental illness not responding to the kind of anti-smoking efforts which have been successful in the last 20 years.

Posted by neil | November 18, 2007 5:55 AM

Three packs a day! You'd be crazy to smoke that much.

Posted by southpaw | November 18, 2007 6:12 AM

So the excuse for tobacco prohibition is going to be protecting the mentally ill.

It certainly seems to be persuasive to Matthew Yglesias, one of America's young movers and kickers. It's also a novel excuse..at least for the United States.

And the beauty of it is that you have to provide less reasons to violate the rights of someone who is mentally ill in order to get away with it...not that you really need to provide much excuse nowadays.

Soon, "being willing to smoke" will be considered to be a sign of mental illness in and of itself-perhaps it will be considered a suicidal tendency, because smoking kills, don't you know. Then, when people are caught in possession of tobacco, they won't be handled by the criminal system (with those pesky appeals, and Constitutional rights), but will instead be treated for their mental illness.

Posted by Nemo Ignotus | November 18, 2007 6:30 AM

Almost half of all cigarettes sold in the United States (44 percent) are consumed by people with mental illness. This is because so many people who have mental illnesses smoke (50 to 80 percent, compared with less than 20 percent of the general population) and because they smoke so many cigarettes a day -- often three pack.

I gently call bullsh*t on these two sentences.

Let C=number of cigarettes sold, X=number of people with mental illness, and assume the US population is 300 million. Grant here that all smokers smoke the same amount (since the cigarette consumption for non-mentally ill smokers isn't given.)

The author is asserting that:

.8•X•.44C=.2•(300,000,000)•.56C (We can cancel the C's, which gives us:)

.352•X=3,360,000

and thus X (mentally ill people)=9,545,455 (rounding up.) Are there nine and half million people in the US who qualify as mentally ill? That's three percent of the population.

Posted by James Gary | November 18, 2007 7:09 AM

I don't know if this is the study that the article's stats are based on, but here's an abstract if anyone is curious.

Posted by Royko | November 18, 2007 7:17 AM

Are there nine and half million people in the US who qualify as mentally ill? That's three percent of the population.

The current prevalence estimate is that about 20 percent of the U.S. population are affected by mental disorders during a given year. This estimate comes from two epidemiologic surveys: the Epidemiologic Catchment Area (ECA) study of the early 1980s and the National Comorbidity Survey (NCS) of the early 1990s. Those surveys defined mental illness according to the prevailing editions of the Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-III and DSM-IIIR). The surveys estimate that during a 1-year period, 22 to 23 percent of the U.S. adult population—or 44 million people—have diagnosable mental disorders, according to reliable, established criteria. In general, 19 percent of the adult U.S. population have a mental disorder alone (in 1 year); 3 percent have both mental and addictive disorders; and 6 percent have addictive disorders alone. Consequently, about 28 to 30 percent of the population have either a mental or addictive disorder (Regier et al., 1993b; Kessler et al., 1994). Table 2-6 summarizes the results synthesized from these two large national surveys.

link

The source appears to be from around 2000, but nevertheless . . . I think what we have here is a premature bullshit call.

Posted by southpaw | November 18, 2007 7:35 AM

.8•X•.44C=.2•(300,000,000)•.56C

Also, where does the author assert this?

[(mentally ill US people who smoke)*(cigarettes they consume) ]

equals . . .

[(all US people who smoke) * (56% of the cigarettes they consume)]

I missed that part.

Posted by southpaw | November 18, 2007 8:00 AM

Three packs a day! You'd be crazy to smoke that much.

John Wayne managed 5 packs a day, Romy Schneider 3, as did I for several years. Check out Les Choses de la Vie (great movie) or Good Night and Good Luck.

Not that it's a good thing, but it's not a totally crazy thing either.

Are there nine and half million people in the US who qualify as mentally ill? That's three percent of the population.

That number doesn't strike me as outrageously high, unless you set the threshold for "mental illness" at something like psychosis. Depression, alcoholism, bulimia, anorexia, self-harming - there you have it. I think 3 % is actually quite low.

Posted by novakant | November 18, 2007 8:30 AM

Les Choses de la Vie" link fixed

Posted by novakant | November 18, 2007 8:34 AM

All right, I confess!!! Steve Sailer's presence on this planet has caused me to self-medicate!

"Are there nine and half million people in the US who qualify as mentally ill? That's three percent of the population."

This suprises you?

Posted by Rihilism | November 18, 2007 8:41 AM

That number doesn't strike me as outrageously high, unless you set the threshold for "mental illness" at something like psychosis. Depression, alcoholism, bulimia, anorexia, self-harming - there you have it. I think 3 % is actually quite low.

Well, Royko's link actually sets the percentage at more like 28%--no jokes about the GOP's present approval rating, please--and that's what causes me to raise an eyebrow: "mental illness" is not defined at all in the linked op-ed piece.

(Plus, I can't resist a giggle whenever the "Robert Wood Johnson Foundation" is mentioned--I always wonder if they fund erectile-dysfunction studies. (It's only too bad it's not the "Richard Wood Johnson Foundation."))

Posted by James Gary | November 18, 2007 8:52 AM

What isn't touched on here is the demographics of smokers regarding their party affiliation or political leanings. The mentally disturbed aspect along with my suspicion more smokers are Republicans or lean Right explains a lot.

Posted by steve duncan | November 18, 2007 9:47 AM

Dilan - speaking as someone who's life has been repeatedly wrecked by mental illness as alcoholism, stuff it.

I can't believe you'd write what you did and disparage others as being sanctimonious. I smoke, sometimes I smoke more and sometimes I smoke less, but smoking is a whole lot better than the alternative.

No, I'm not sanctimonious about not drinking, but I can't stand bullshit like what you wrote. You obviously have no clue about these issues.

Posted by justinb | November 18, 2007 10:31 AM

Steve, I'd be willing to bet that I know more people with diagnosed mental illness and substance abuse problems. A fair portion of them don't vote and don't care, but those that do are overwhelmingly liberal. Anecdotal, yes, but that's all I've got :)

Posted by justinb | November 18, 2007 10:48 AM

Dilan Esper,

If you don't think that going from being a drinking alcoholic (who probably already smoked) to a recovering alcoholic/smoker is a huge improvement, you're not being realistic. Alcoholics who drink are far more destructive to themselves and to others than recovering alcoholics who drink: they get in fights, they crash cars, they do worse damage to their bodies, and usually die younger, often taking others with them.

Psychiatry is certainly no panacea either. It's expensive, it goes on forever, it doesn't always prevent relapses either, and it often substitutes one drug for another.

The reality is that life is pretty shitty for a lot of people who don't have Matt's ambition, intelligence, or talent, and smoking is one of their pleasurable consolations. Cigarettes are to them what an iPhone is to Matt. Let them smoke.

Posted by Fred | November 18, 2007 11:13 AM

Let's all remember that Matt is fully in support of taxing cigarette smokers. Loves it for SCHIP. Loves it for other programs.

Who cares if it's self-medicating by (mostly poor) people in distress?

"Compassionate Matt" - I think not.

Posted by Quiddity | November 18, 2007 11:16 AM

Hell, isn't smoking prima facia evidence of mental illness? Or is it just the symptom...

Posted by McKingford | November 18, 2007 11:27 AM

"Let's all remember that Matt is fully in support of taxing cigarette smokers."

I have no problem with that -- it's one of the only ways to counter-balance the extreme progressiveness of our federal tax code. I'd be in favor of a national lottery for the same reason.

Posted by Fred | November 18, 2007 11:30 AM

Regarding dilan's comment:

It seems odd not to regard getting an alcoholic to stop drinking as somehow not a success. I'll take even temporary behavioral change over "solving" some sort of mystical "underlying problem" any day. Sure, it's better to neither smoke nor drink, but saying stopping drinking while still smoking is only "cosmetic"? That's just silly.*

Regarding the whole issue:

"You'd have to be crazy to smoke that much!" Yep. Who said marketing doesn't work?

In my big picture -- and no, I don't smoke. Anything -- it's the corporations that are at fault: These anti-human legal persons regard us, real embodied persons, as "human resources" whose flesh is to be seeded with desiring machines and then harvested for profit. Stimulating nicotine addiction in the crazed is a particularly vile and obvious example of this dynamic, which goes on constantly. Anyone else remember The Space Merchants? Popsie to Crunchies to Starrs to Popsie?

Which is why we need to either overturn the idea that corporations are legal persons (with "rights" of free speech and so forth) or impose a corporate death penalty, so that corporate persons that murder -- as the R.J. Reynolds, et al, have surely done -- can be abolished, their executives held accountable, and their assets seized and dispersed.

NOTE Oddly, or not, the Paultards seem to be perfectly OK with corporate personhood, which, if I'm correct, tells you everything you need to know about who--and what--would end up with the real power in their brave new world.

NOTE * I realize that if George Bush, dry drunk, had solved his "underlying problems" (that, or kept drinking) the world would be a lot better off today. But my comment refers only to the health, spiritual and otherwise, of the alcoholic and their immediate circle.

Posted by lambert strether | November 18, 2007 11:37 AM

The key thing to remember here is that mentally ill people are people who can't cope with life as we live it in the US today.

By this standard, Rush Limbaugh is not mentally ill, but someone who throws a shoe through the telly when he hears Rush is mentally ill.

As for Dilan Esper's idea that our bloodstreams should be as free of pollutants as the apes of the jungle- well, those apes sniffed out almost every stimulant known to us, and considering that cannabinoids turn out to be a major neurotransmitter substance, did a pretty good job at it.

Nicotonic acid is also a neurotransmitter and, considering society's limited interest in cleaning up the human wreckage it creates, those smokers may not be so dumb after all.

Posted by serial catowner | November 18, 2007 11:41 AM

Rush Limbaugh is not mentally ill, but someone who throws a shoe through the telly when he hears Rush is mentally ill.

Yes, that is in fact the case.

Rush limbaugh being a radio personality only aids the diagnosis.

Posted by southpaw | November 18, 2007 11:46 AM

What's with this tendency for people to belittle and demonize smokers?

Because you smell bad and your nicotine-and-various-additives stink becomes pervasive by its very presence? That's enough for me.

Posted by James F. Elliott | November 18, 2007 11:55 AM

In addition to demographic and socioeconomic factors, which undoubtedly play a role, in my time on psychiatric rotations I've heard an additional explanation. Most of this surplus smoking I've witnessed is among the schizophrenic and severely bipolar populations, not among your run of mill Depression patients. These are the patients most likely to use antipsychotics, which at least currently tend to block dopamine receptors in the brain. One of the major side effects of these medications can be Parkinsonian symptoms (Parkinson's disease is due to a decreased number of dopaminergic cells). Cigarettes (and basically any addictive substance) increase dopamine availability either by increased release or slower degradation so there's some thought cigarettes may help with side effects of the medications.

Posted by MidwestMedStudent | November 18, 2007 12:25 PM

From my experience working in a few mental hospitals, I've also noticed that the smoking-mental illness correlation is strongest with the patients who were sickest, most chronic and on the strongest drugs (basically talking here about chronic schizophrenics, who tended to have long-term stays as opposed to addicts who generally had short-term stays). The first few times I was assigned to keep an eye on things in the patient lounge area, I was shocked by the extent of the nicotine cravings of many of the patients - I'd worked alongside many nicotine addicted co-workers before (waiters and theater people tend to be smokers), but nothing had prepared me for this. Some of these same chronic patients also dosed themselves on sugar way beyond any the most avid non-hospitalized sweet tooth possessor I've ever seen - I once saw one of them dump over 20 packets of sugar into one *small* cup of coffee.

It seemed to me that the sugar and nicotine craving came out of the need to stimulate and support cognitive processing severely hampered both by their illness itself and the drugs used to treat it. The biochemistry of schizophrenia and its treatment is not well-understood - there might be a more benign fix than nicotine that out there, but until we find it, I'm with like the guy with the two girlfriends who smoked like chimneys. I think it would be cruel to jerk the nicotine crutch away before we really understand the biochemistry behind the craving, and most likely, counterproductive as well.

Posted by ananke | November 18, 2007 12:36 PM

That's enough for me.

what a soup nazi

Posted by novakant | November 18, 2007 12:52 PM

Smoking helps alleviate both the symptoms of mental illness and the side effects of some medications. Alcohol is another way to self medicate for mental illness. These methods may not be particularly effective, but they do constitute a valid explanation for for why people with mental illness seek out alcohol and nicotine.

That's a simpler explanation than suggesting that a demographic analysis will reveal other correlations. Of course, those correlations may exist--but I suspect the primary correlation is the one suggested by Occam's razor.

None of the above implies that smoking is a symptom of mental illness; it's a coping mechanism. Mental health professionals have (justifiably) focused their efforts on helping patients combat mental illness, rather than on getting their patients to give up smoking. If they can do both, that's great--but let's not rule out the possibility that smoking actually improves the quality of life for some people. Nor should we treat people with mental illness as though they are children who need to be protected from making choices about smoking.

Posted by Robert C. | November 18, 2007 1:32 PM

Steve Sailer nailed the issue in the first post, its self-medication.

Nicotine is both an antidepressant and a stimulant so its helpful at relieving symptoms of depression, anxiety and ADHD (the drug Welbutrin has a similar effect-- its marketed for smoking cessation drug as Zyban).

It would be nice if there wasn't such a stigma about mental illness (as exhibited above by Marydem and Dila). Its a big part of why so many people who do irrational things or are clearly unhappy don't seek psychiatric help. Instead, they self-medicate with cigarettes, booze or street drugs.

Posted by beowulf | November 18, 2007 3:40 PM

Given the link, maybe nicotine patches might help? I agree with the self-medication aspect--we still know so little about how the body's systems interact with medications and other stuff in the environment.

So--would nicotine patches provide the same effect, or is it the social aspect of smoking that provides reassurance?

Posted by grumpy realist | November 18, 2007 10:52 PM

Dilan Esper-

Actually, this gets to one of my problems with AA. I don't think a person who gets clean and sober but remains addicted to tobacco has done anything about his or her underlying problems. It's a cosmetic fix.

Are you a moron? Smoking is unhealthy, but it doesn't get you drunk or cause car accidents.

Why are we so sanctimonious about smoking? Why don't they demonize anal sex the same way? It certainly is an unhygienic, disease-spreading behavior, but for some reason it is P.C. while smoking isn't.

[Note: I'm not advocating for anal sex to be outlawed or anything, just pointing out the hypocrisy in all of the anti-smoking whining].

Posted by Glaivester | November 19, 2007 1:28 AM

Dilan - speaking as someone who's life has been repeatedly wrecked by mental illness as alcoholism, stuff it.

I can't believe you'd write what you did and disparage others as being sanctimonious. I smoke, sometimes I smoke more and sometimes I smoke less, but smoking is a whole lot better than the alternative.

No, as long as a recovering alcoholic smokes, it indicates he or she hasn't dealt with the underlying susceptibility to addictions.

And yes, the people who I have known who are in 12 steps were quite sanctimonious about how proud they were that they've been sober for X number of days, while smoking like a chimney.

They are both bad for you-- and you need to get rid of them both instead of keeping one and pretending you've changed anything.

Posted by Dilan Esper | November 19, 2007 2:57 AM

It would be nice if there wasn't such a stigma about mental illness (as exhibited above by Marydem and Dilan).

Actually, I don't stigmatize mental illness at all. I just think that people should get into real treatment-- for all their problems-- and not substitute one addiction to another.

As I said, would anyone accept the "sober but smoking" people's arguments if it was "sober but snorting coke" or "sober but smoking pot" instead? It's only because people don't think of nicotine as a dangerous drug that smoking gets treated differently. But a "sober" smoker is not sober; he or she still has an addiction and still needs real treatment of the underlying issues.

Posted by Dilan Esper | November 19, 2007 3:02 AM

Are you a moron? Smoking is unhealthy, but it doesn't get you drunk or cause car accidents.

But smoking = addiction to nicotine, and sobriety indicates recovering from one's addictions. Again, if it was cocaine or pot, nobody would buy the claim of sobriety.

Addiction to nicotine is still addiction, and addiction to ANYTHING means the illness has not really been treated and alcohol consumption can return at any time.

Posted by Dilan Esper | November 19, 2007 3:05 AM

I remember listening to someone on the radio discussing the "voices" heard by schizophrenics and he claimed that smoking had a tendency to diminish the voices' frequency. For what that's worth as a factoid, true or not.

Posted by The Critic | November 19, 2007 10:18 AM

Dilan, you really need to address the psychological issues underlying your addiction to jacking off.

Posted by tps12 | November 19, 2007 11:28 AM

Dilan Esper voices a very common American notion: drugs are drugs, and they're all equally evil. It's nearly as common as the inverse notion: legal drugs are 100% OK and non-dangerous, and illegal drugs are totally evil. The fact is, it's better to smoke all day than drink all day. I could give a shit what your root psychological traumas are. If you're smoking all day instead of drinking all day, you've improved your condition.

I'll also add that I don't entirely trust this study. It hints at something the anti-smoking fascists would love to argue: smoking means you're mentally ill.

Posted by too many steves | November 19, 2007 11:53 AM

I can easily believe at least 3% of our population is seriously mentally ill, and some 20-25% is mentally ill at some point. I remember a study which suggested that Americans of European descent had twice the severe mental illness rates of the populations from which they had come, a finding which reflected the propensity of communities to kick out their mentally ill. Everyone always wants the homeless to move on...

As for smoking, I've heard smokers tell me that cigarettes smooth out their moods. The more violent the mood swings, I imagine, the more this quality would be appreciated.

Posted by Diana | November 19, 2007 2:36 PM

Dilan Esper voices a very common American notion: drugs are drugs, and they're all equally evil. It's nearly as common as the inverse notion: legal drugs are 100% OK and non-dangerous, and illegal drugs are totally evil. The fact is, it's better to smoke all day than drink all day. I could give a shit what your root psychological traumas are. If you're smoking all day instead of drinking all day, you've improved your condition.

That's not my view at all. To get a little deeper in the weeds here, you have to remember that AA doesn't consider it an improvement if you go from binge drinking every 3 days to binge drinking every 3 weeks. And rightfully so-- any episode of binge drinking means you still aren't able to manage your addictions.

Well, continuing to smoke ALSO means you are still unable to manage your addictions. Part of the reason this is so important is because relapses are EXTREMELY common in 12 step programs.

I don't claim that smoking is as bad as drinking. I do claim that people who can't handle alcohol can't handle cigarettes either, and that any treatment that allows them to blithely kill themselves with one addiction isn't doing anything about the personality traits that lead to the other one.

Posted by Dilan Esper | November 19, 2007 3:08 PM