In 2015, Richard Pruen spent time staying in a mental health hospital ward in England.
“One thing that was evident when I was in hospital for treatment was that almost everyone smoked,” he told Filter. “It was clear that this was the norm, and little or no effort was made to help people with mental illness quit—it was just accepted, there was no advice or anything.”
Help available in such facilities in England has since improved. But with a continuing backdrop of extremely high smoking rates among people with mental health conditions, a new study represents important reassurance.
People with histories of mental health conditions, the research showed, are likely to find that various smoking cessation aids work just as well for them as they do for the general population.
The study, published on June 4, involved a cross-sectional survey of 5,593 people who tried to stop smoking in the past year, of whom 2,524 had had one or more diagnosed mental health conditions.
“We wanted to understand whether the effectiveness of smoking cessation aids available in England differed according to the user’s history of mental health conditions,” lead author Sarah Jackson told Filter.
The researchers found that people with mental health histories were more likely than other respondents to try certain tools to quit smoking. These included vapes (38.8 percent, versus 30.7 percent), prescription NRT (4.8 percent, versus 2.7 percent) and websites (4.0 percent, versus 2.2 percent).
That speaks to the applicability of vapes, in particular, for this key group.
“There was little evidence to suggest that the user’s mental health affected the effectiveness of any aid.”
Other quit methods used by participants included in-person or over-the-phone behavioral support, the medication bupropion, written self-help materials, nicotine pouches, Allan Carr’s “Easyway” method and hypnotherapy.
But among all respondents, three methods led to “significantly higher odds of quitting successfully” than the rest, based on self-reported abstinence from cigarettes. Those three were vapes, the medication varenicline and heated tobacco products.
In addition, “there was little evidence to suggest that the user’s mental health affected the effectiveness of any aid,” said Dr. Jackson, a behavioral scientist at University College London.
The United Kingdom’s smoking rate has declined to just under 13 percent. But high prevalence among people with serious mental health conditions—around 40 percent—has persisted for decades, leading to disproportionate smoking-related disease and deaths. Mind, a leading British mental health charity, has said it’s “vital” that cessation programs “are adapted to take mental health into account.”
Jackson said people with mental health conditions may “tend to be more dependent” on cigarettes, making it harder to quit. Yet, “after we account for any differences in dependence and other characteristics that might affect people’s choice of treatment, there is no clear evidence that any cessation aid is more or less effective for people with a history of mental health conditions.”
Richard Pruen, now 48, is one person who can be glad of that. He told Filter that his diagnoses include ADHD, autism spectrum disorder and schizophrenia.
Jackson mentioned how people with mental health conditions “may smoke to regulate their symptoms,” and that certainly matches Pruen’s experience.
Pruen described “accidentally” quitting his 60-a-day cigarette habit. He tried vaping, and “without noticing,” switched entirely.
“I have treatment-resistant paranoid schizophrenia,” he said, “so the symptoms are not entirely treated by medications, even the sedating ones.”
“I use nicotine as treatment for ADHD,” he added. “It is a stimulant but unlike any other I can think of, it reduces anxiety. Prescription drugs work, but then benzodiazepines are needed for the side effects. Nicotine helps without the serious downsides.”
People with schizophrenia are about three times more likely to smoke than the general population. But there are ways to use nicotine without the serious downsides of smoking.
Pruen described “accidentally” quitting his 60-a-day cigarette habit in 2009, after smoking was banned in the vehicle he drove for work. He tried vaping, initially only when he couldn’t smoke. But “without noticing,” he ended up switching entirely.
He’s experienced major benefits since. He soon found he’d regained the ability to walk upstairs without difficulty, and the asthma he’d had since childhood is now listed as a “past” condition in his medical records.
But it was his 2015 hospital stay that began Pruen’s advocacy for mental health patients’ access to safer nicotine products.
“I spent most of my time [there] advocating for safer alternatives and for staff to make sure patients got either a vape or NRT,” he said.
His conversations with health care managers and other staff led to the trust that ran the facility adopting a new policy: keeping nicotine vapes on hand to offer to patients, and immediately informing new arrivals of the available options.
“Things have improved, especially with vaping as a replacement for cigarettes in mental health units. But still, there is a lot more to do.”
Pruen is now part of a group of people with lived experience of both smoking and mental health conditions. They meet up to discuss how to help in an “overlooked” area. Their work has included informing various charities—plus the Care Quality Commission, England’s independent regulator of health and social care—about best practices for mental health units.
“Things have improved, especially with vaping as a replacement for cigarettes in mental health units,” Pruen said. “But still, there is a lot more to do.”
Jackson’s research affirms these efforts. “Our findings should reassure people with mental health conditions who want to stop smoking—and health professionals advising patients with mental health conditions about their smoking—that their condition need not affect the choice of smoking cessation aid,” she said.
“Nicotine reduces symptoms, that’s why vaping is key to this population, they find it useful,” Pruen said. “Smoking does all the damage. Nicotine without smoking is important for this group.”
Quitting cigarettes, whatever your age, greatly reduces your chances of cancer and other life-threatening diseases. The relationship between smoking and mental health—whether related to the many chemicals in cigarette smoke, or to people’s awareness of the risks of smoking—is more complex.
But the UK’s National Health Service states that smoking cessation “boosts mental health,” and one study associated it with “reduced depression, anxiety, and stress and improved positive mood and quality of life,” comparing the observed effects to those of antidepressants.
“My father died of cancer 10 years ago; his smoking habit didn’t help,” Pruen said. “He was a fireman, because he liked helping people. So in his memory, I’m not going to give up on saving lives either.”
Photograph via Picryl/Public Domain