Schizophrenia and the Motivation for Smoking

By Forchuk, Cheryl; Norman, Ross et al. | Perspectives in Psychiatric Care, April-June 2002 | Go to article overview

Schizophrenia and the Motivation for Smoking


Forchuk, Cheryl, Norman, Ross, Malla, Ashok, Martin, Mary-Lou, McLean, Terry, Cheng, Stephen, Diaz, Kristine, McIntosh, Elizabeth, Rickwood, Ann, Vos, Sandra, Gibney, Cynthia, Perspectives in Psychiatric Care


PROBLEM. People with mental illness are twice as likely to smoke than people without a mental illness.

METHODS. Data were collected through interviews with individuals who smoke and have been diagnosed with schizophrenia (N = 100). The research design included a descriptive, correlational design that described and examined the relationships among psychiatric symptoms, medication side effects, and reasons for smoking; and a qualitative analysis of the subjective experience of smoking.

FINDINGS. A positive relationship was found between the age of onset of smoking and the onset of schizophrenia. Subjects reported they smoked primarily for sedative effects and control of negative symptoms of schizophrenia. Subjects also reported smoking related to addiction. Most indicated they would like to quit smoking or at least cut down on the number of cigarettes.

CONCLUSIONS. Among people with schizophrenia, the motivation to smoke is related to their schizophrenia.

Search terms: Motivation, qualitative research, quantitative research, schizophrenia, smoking

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Lasser et al. (2000) found in a nationally representative U.S. sample that individuals with a mental illness are approximately twice as likely to smoke than are people without a mental illness. Individuals with schizophrenia tend to smoke. Studies over two decades have consistently found that between 74% and 90% of those with schizophrenia smoke (Benowitz, 1999; de Leon, 1996; Glynn & Sussman, 1990; Goff, Henderson, & Amico, 1992; Hughes, Hatsukami, Mitchell, & Dahlgren, 1986; Kramer, 2000; O'Farrell, Connors, & Upper, 1984). Smoking rates of individuals with schizophrenia are higher than for the general public (Glassman, 1993; Lasser et al.; Lyon, 1999), and higher than for other individuals with psychiatric problems (de Leon; Lyon). Although there has been some speculation about why this is so, very little is understood from the perspective of the person with schizophrenia who smokes. Understanding the issue of motivation is critical to assisting these people to quit smoking. De Leon reported that individuals with schizophrenia had great difficulty in quitting smoking, and only 8% were successful compared with 45% of the general U.S. population. The high incidence of smoking and difficulty in quitting smoking places a vulnerable population at high risk for other physical problems.

Smoking as a Health Concern

The single most important cause of cancer is smoking (Austoker, Sanders, & Fowler, 1994). Lung cancer alone remains the leading cause of cancer deaths (Statistics Canada, 2001).

A much higher risk of cancer is associated with smoking cigarettes than with other forms of tobacco. Risk of developing lung cancer is associated with duration of smoking and number of cigarettes smoked. Therefore, the more cigarettes smoked over a longer period of time, the higher the risk an individual faces for developing lung cancer. Individuals who smoke 10 cigarettes a day reduce their life expectancy by an average of 2 to 3 years. Individuals who smoke 20 cigarettes a day reduce their life expectancy by 5 to 7 years, and those choosing to smoke 40 cigarettes a day are reducing their life expectancy by 8 to 10 years. Risk of cancer can be reduced by quitting smoking. After 10 years, a person who quit smoking may be at the same risk for cancer as someone who is a lifelong nonsmoker (Austoker et al., 1994).

Smoking and Schizophrenia

Previous authors have suggested that the reason for the high prevalence of smoking among people diagnosed with schizophrenia is that there may be unique motivators for smoking (Benowitz, 1999; Desai, Seabolt, & Jann, 2001; Farnam, 1999; Forchuk, Norman, Malla, Vos, & Martin, 1997; Glassman, 1993; Lohr & Flynn, 1992; McEvoy & Brown, 1999). Lohr and Flynn conducted a literature review related to schizophrenia and smoking. …

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