Statistics show that more than half of people with schizophrenia suffer from nicotine addiction. And they smoke quite a lot – up to 2-3 packs of cigarettes daily. In some countries, for example, in the USA, 90% of people with schizophrenia are smokers. At the same time, the total number of smokers in the states is about 20%. This data suggests that smoking and schizophrenia are closely related. However, until now, there is no exact explanation of this connection. Let us try to look into this question.

Smoking and Schizophrenia

Schizophrenia and Addictions

The causes of schizophrenia are unknown. It is often a genetically determined disease. However, 10% of people with schizophrenia have no predisposition to psychopathology, and many people with the genes for such diseases do not have a single sign that would indicate schizophrenia in their lifetime.

In other words, this pathology is mysterious and unpredictable, which explains the significant number of myths that form around it. Some of them are related to addictions, primarily alcohol and drug addiction. These psychoactive substances strongly affect the psyche and change a person’s personality. Moreover, they may cause hallucinations. That is why they are often associated with schizophrenia.

However, neither drugs nor alcohol cause schizophrenic disorders. Psychoactive substances can only serve as a trigger for the growth of already developed psychopathology, which was “dormant” before manifesting. Simply put, narcotic drugs are not directly responsible for schizophrenia, but they increase the risk of its development.

There is another connection. Many people with schizophrenia have a preference for alcohol and drugs. Cravings arise from a desire to relieve symptoms of schizophrenia such as apathy, anxiety, lack of initiative, and loneliness. Psychoactive substances increase dopamine levels, giving the person a sense of calm and pleasure.

Many people with schizophrenia spend almost a third of their income on cigarettes.

Cigarettes are also a class of psychoactive substances. The person with schizophrenia may be trying to improve his condition with them. But this generates many other problems. We will talk about the consequences later. Let’s consider the main theories that explain the increased interest in smoking in people with schizophrenia.



It is worth stating that theories, which are just systems of ideas and values, do not fully explain the relationship between smoking and schizophrenia. They are either partially confirmed by facts or will be proved or disproved in the future by experiments and studies. Let’s list the most popular theories:

  • Socio-economic: people with schizophrenia have little or no work, so they have a lot of free time, which they spend smoking. In other words, they smoke out of boredom.
  • Personality hypothesis: schizophrenia is connected with a high level of anxiety, which can provoke a person to start smoking if they believe that cigarettes help to cope with stress.
  • Psychological tool hypothesis: much related to the previous one and the concept of stress. People with schizophrenia often cannot cope with their problems on their own. Smoking and cigarettes are a psychological tool for them, supporting or replacing the problem.
  • Self-treatment hypothesis: for many people with schizophrenia, smoking acts as a compensator of cognitive deficit and antipsychotic drugs to cope with the adverse symptomatology of schizophrenia (apathy, abulia, etc.).

However, these theories have many weaknesses. Not only do people with schizophrenia suffer from boredom, but the percentage of smokers among them is much higher. Moreover, there is no exact data concerning the connection between smoking and neuroleptics. The put forward hypotheses only explain the presence of some regularities but do not describe the mechanism of their occurrence.

The incidence of lung cancer among people with schizophrenia is four times higher than among mentally healthy people.

Another important aspect of criticism is All countries have a high rate of smoking addiction. It decreases the importance of socio-economic factors. Many scientists agree that the reason for the vital link between the two phenomena is most likely biological. But it is also difficult to describe with the help of scientific facts, just as it is impossible to explain the mechanism of origin of schizophrenia.


The Facts

If we compare schizophrenic patients with people suffering from other mental disorders in the context of tobacco smoking, we see the following facts:

  • People with schizophrenia start smoking at an earlier age;
  • they smoke a lot of cigarettes a day;
  • they smoke not only frequently but also intensively;
  • They are more inclined to diseases that are the consequence of smoking.

As noted above, smoking in schizophrenia is not the worst addiction. It is not uncommon for people with schizophrenia to become drug addicts and alcoholics. They also usually do not stick to diets and prefer junk, fatty, high-calorie foods. All this leads to somatic diseases that prevent patients from coping with their mental pathology.



The consequences of smoking for people with schizophrenia can be divided into two groups – social and physiological. If we talk about the first ones, first of all, there is the issue of finances. People with schizophrenia often cannot fully work. If they have a disability, they get an allowance, and if they get a job, it is a low-paying one. They end up spending almost a third of their budget on cigarettes. It is especially true in countries where tobacco is very expensive.

Because of the lack of money, a person with schizophrenia cannot spend on healthy pleasures and good food. In addition, he has to live not in the most comfortable conditions because it is too expensive for him to buy or rent a decent place to live. It affects the patient’s emotional state, which hypothetically could lead to another attack.

Physiological consequences are related to somatic diseases. Compared to the general population, life expectancy with schizophrenia is about 80-85%. Smoking reduces this rate, and sometimes quite dramatically. The schizophrenic smoker has a 30% higher risk of cardiovascular diseases and a 60% higher risk of respiratory pathologies. Almost ⅔ of patients die of coronary heart disease.

Can a patient with schizophrenia smoke? There are no direct contraindications. However, smoking is harmful in principle, so all doctors recommend quitting all harmful habits and taking good care of your health. It will help to prolong remission.