Smoking and Schizophrenia

Some of my favorite memories of my mother are of her smoking. She seemed to take great pleasure from her cigarettes, something that was tragically rare in a life of untreated schizophrenia and alcohol addiction. Even now, the smell of cigarette smoke is sweetly nostalgic for me.

Her smoking started during schizophrenia onset

But that doesn't mean I was happy to discover my daughter smoking during the long months of her onset. The overflowing ashtray on the balcony felt like an indictment of my parenting (had I not made the dangers of smoking clear enough?) and also one more threat to Sally's life that was completely out of my control.

Years later, I am able to recognize that my loved ones' decisions about smoking have nothing to do with me and are none of my business. It took me a lot of work around codependence to get there – but I've also learned about the complex interaction between nicotine and people with schizophrenia.

Smoking more common with schizophrenia

So many of our loved ones smoke. The rate for people with schizophrenia is 80-90 percent, or about 3 to 4 times as common as in the general population. It's natural to wish our loved ones would stop, since smoking can impact the effectiveness of treatment and make it more likely they'll develop cardiovascular disease, respiratory disorders, and cancer.

But people with schizophrenia have a compelling reason to use tobacco. Nicotine interacts with neurotransmitter systems in the brain that also play a part schizophrenia. It may also help with neurochemical imbalances and bring relief for negative symptoms and medication side effects. In other words, smoking may do what prescribed medication cannot to make our loved ones feel better.

Worried about the damage to her health

I wasn't thinking about that when Sally was smoking on the balcony, though. All I could focus on was the damage it might be doing. Not only that, I knew from experience with other loved ones that some treatment centers ban smoking, and I feared that Sally might not get the treatment she needed if she couldn't stop.

Time and experience have given me perspective. Now I know that because I'm not the one living with schizophrenia, I can't make the cost-benefit calculation.

Smoking for relief from symptoms

How can any of us say whether the risks outweigh the relief our loved ones might get from their symptoms from nicotine? My guess is that a lot of us might try smoking if we were dealing with brain fog and negative symptoms – or even endless boredom.

There's also the social aspect to consider. At every treatment center and outpatient program, you're likely to find a group of smokers outside during breaks. The value of such social opportunities is enormous, especially given how isolating this condition can be. Nothing proved more beneficial to my daughter's recovery than spending time with her peers.

This makes sense, when I consider how loneliness affects my own life. It makes it much harder to be motivated to work or take care of myself – and feeling connected with others improves nearly every aspect of my life.

Accepting her choice to smoke

Finally, I believe that we must consider the decision to smoke in the context of our loved ones' dignity. As caregivers, we enjoy the right to make choices about our own health. We can spend our nights on the couch, have potato chips for dinner, spark up a joint, or put away a bottle of wine when we feel like it. The people who care about us may register their concerns, but as anyone who has battled an addiction knows, we won't quit until we're ready, no matter what anyone says.

Our loved ones deserve the same agency and respect. Instead of harping on them to quit smoking, I believe clinicians, caregivers and communities should put their efforts into reducing stigma and isolation instead.