Study offers hope for schizophrenia patients who want to quit smoking

A new study by a York University professor is challenging the notion that people with schizophrenia are doomed to high rates of smoking and unable to quit once they’ve started.  

“We’ve found that it is possible to help people with schizophrenia to quit at about the same rate as the general public, even though the overall rates remain twice as high,” says study co-author Joel Goldberg, a professor of psychology in York’s Faculty of Health. “This research is good news for patients and for family members who have pressed for specialized programs to help their relatives quit smoking.” 

Right: Researchers found that it is possible to help people with schizophrenia quit at about the same rate as the general public

The study is the first to examine the prevalence of smoking among schizophrenic outpatients over time. It surveyed participants at the Hamilton Program for Schizophrenia, a community-based psychiatric rehabilitation clinic, in 1995, then followed up with them in 2006.  

In 1995, 63.2 per cent of study participants identified themselves as smokers. In 2006, only 43.4 per cent still smoked – a drop of 31 per cent. Over the same period, the rate of smoking in the general public dropped by 27 per cent.

Goldberg believes the decrease is due to several factors; the increased availability of specialized smoking cessation programs; general societal changes, including the restriction of smoking in hospitals and psychiatric wards; and a potential link with second-generation antipsychotic drugs.

“Nicotine may provide biological reward to the frontal systems of the brain, which are underactive in some people with schizophrenia,” Goldberg says. “We’re now wondering whether the new drugs have a role in mediating this process, and make it easier for some patients to quit smoking.”

He says ongoing research is needed, in part to correct some of the biases – even within the medical community – about the relationship between mental illness and smoking. 

Goldberg recalls a time, decades ago, when he was trained to use cigarettes as a means to reward patients for their good behaviour. “There’s still this notion that it’s not a problem," says Goldberg. "I have been told by health professionals that people with serious mental illnesses should just be left alone to smoke because it’s their only pleasure. Unfortunately, people with schizophrenia are among the last group to get help for nicotine addiction.”

He points out that quitting smoking is perhaps even more critical for those affected by severe mental illness; they’re often on social assistance and spend a large portion of their income on cigarettes. “Disorders like schizophrenia make people vulnerable,” he says. “Anything we can do to help combat that vulnerability is a step in the right direction.”

The study, "Longitudinal rates of smoking in a schizophrenia sample", was co-authored by Jessica Van Exan, a graduate student in York’s Faculty of Health. It will be published in the August issue of the journal Tobacco Control.