Smoking Cessation in Patients with Mental Illness

Electronic Cigarettes

Electronic cigarettes are becoming increasingly popular, although their use remains controversial.14 Preliminary evidence suggests that e-cigarettes are likely safer than regular cigarettes and helpful to some smokers as a means of reducing or quitting smoking.13 A prospective 12-month pilot study of e-cigarettes in 14 patients with schizophrenia found sustained 50% reduction in the number of cigarettes smoked daily, and sustained smoking abstinence at week 52 was observed in 14.3% of participants. The researchers concluded, “The use of e-cigarettes substantially decreased cigarette consumption without causing significant side effects in chronic schizophrenia patients who smoke, not intending to quit.”15 Further research is necessary to determine the safety and utility of this treatment.

RELATED: Are E-Cigarettes Masquerading as a Safer Alternative?

Psychosocial Interventions

Behavioral strategies “complement pharmacotherapy by enhancing the smoker’s motivation to quit and teaching quitting skills such as managing relapse triggers.”16 The University of California- San Francisco’s resource guide on smoking cessation in the mentally ill recommends psychosocial modalities, including psychoeducation, counseling, and CBT, in conjunction with pharmacotherapy.17


Individuals with both mild and severe mental illness are frequently interested in and capable of smoking cessation.18 Evidence-based pharmacotherapy and nonpharmacologic interventions provide the best chance for this population to achieve both short- and long-term abstinence.

Resources for Clinicians


  1. Centers for Disease Control and Prevention (CDC). Smoking and tobacco use. (2014) Available at: Accessed: February 7, 2014. 
  2. Lasser K, Boyd JW, Woolhandler S, et al. Smoking and mental illness: A population-based prevalence study. JAMA. 2000;284(20):2606-2610.
  3. Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict. 2005;14(2):106-23. 
  4. Centers for Disease Control and Prevention (CDC). New CDC Vital Signs: Smoking among those with Mental Illness. (2014) Available at: Accessed: February 7, 2014.
  5. Hartz SM, Pato CN, Medeiros H, et al. Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry. 2014 Jan 1. [Epub ahead of print].
  6. Ucar EY, Araz O, Yilmaz N. Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic. Multidisciplinary Respiratory Medicine. 2014;9:9.
  7. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;5:CD009329.
  8. Cahill K, Stevens S, Lancaster T. Pharmacological treatments for smoking cessation. JAMA. 2014;311(2):193-194.
  9. Gibbons RD, Mann JJ. Varenicline, smoking cessation, and neuropsychiatric adverse events. Am J Psychiatry. 2013;170(12):1460-1467.
  10. Thomas KH, Martin RM, Davies NM, et al. Smoking cessation treatment and risk of depression, suicide, and self harm in the Clinical Practice Research Datalink: prospective cohort study. BMJ. 2013;347:f5704.
  11. Anthenelli RM, Morris C, Ramey TS, et al. Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: a randomized trial. Ann Intern Med. 2013;159(6):390-400.
  12. Allen MH, Debanné M, Lazignac C, et al. Effect of nicotine replacement therapy on agitation in smokers with schizophrenia: a double-blind, randomized, placebo-controlled study. Am J Psychiatry. 2011;168(4):395-399.
  13. Tsoi DT, Porwal M, Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database Syst Rev. 2013;2:CD007253.
  14. Meier E, Tackett AP, Wagener TL. Effectiveness of electronic aids for smoking cessation. Curr Cardiovasc Risk Rep. 2013;7(6).
  15. Caponnetto P, Auditore R, Russo C, et al. Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study. Int J Environ Res Public Health. 2013;10(2):446-461.
  16. Modesto-Lowe V, Chmielewska A. Coping with urges to smoke: what is a clinician to do? Conn Med. 2013;77(5):289-294.
  17. University of California- San Francisco. Smoking Cessation Leadership Center. Behavioral Health Resources. (2010) Available at: Accessed: February 9, 2014.
  18. Morris C, Waxmonsky J, May M, et al. Smoking cessation for persons with mental illnesses: A toolkit for mental health providers. (2009) Available at: Accessed: February 9, 2014