Why are smoking rates higher amongst people with mental health issues?

ASH Scotland
3 min readMay 9, 2019


Jim O’Rorke looks at the latest Scottish Health Survey data, and why we need better information on smoking behaviours amongst people with mental health issues.

The IMPACT guidance pack for professionals supporting people with mental health issues

The Scottish Health Survey was published by the Scottish Government last week. It aims to provide reliable information on the health, and factors related to health, of people living in Scotland that cannot be obtained from other sources. It looks at different health conditions, estimates health risk factors, compares geographical regions and subgroups of the population and monitors trends and progress toward health targets. The good news is that the summary document is a modest 12 pages long! I recommend you have a read, https://www.gov.scot/Publications/2018/09/3173/downloads

We here at ASH Scotland, of course, went straight to the figures for smoking prevalence rates which reported 18% of adults smoked in 2017, down from 21% in 2016 and 28% in 2003. Cue (non-alcoholic) celebrations! (There’s a whole chapter on alcohol in the survey). This figure is now lower that in Wales (19%) and Northern Ireland (20%) but more than in England (15.5%). The figure of 18%, if looked at by gender, is made up of 20% of the adult male population and 16% of the adult female population. So one fifth of the entire male adult population of Scotland still smokes tobacco, so still quite a way to go, but steady progress none-the-less.

This particular survey does not give the smoking prevalence rate amongst people with mental health problems. The last figure we have is that it was about 40% of all those who experienced mental health problems.

So whilst figures for the general population show a steady reduction, figures for people with mental health problems remain stubbornly high. Why is this? Probably because people use smoking tobacco as a coping mechanism. Nicotine stimulates the release of Dopamine in the brain. Dopamine is neurotransmitter (a messenger between brain cells) and its release gives individuals a feeling reward that helps reinforce certain behaviours. The reward effect soon wears off and the behaviour reinforcement part soon kicks in, and another cigarette is lit. The smoking prevalence rate for severe mental health problems is around 70% and in my experience (as a drug and alcohol worker) the rate was near 90% for people with addiction problems. Again, these figures show very little change over time.

So with these high prevalence rates would it surprise you to know that people with severe and enduring mental health problems are just as motivated to stop smoking as the rest of the population? Generally, around 70% of all people who smoke would like to stop smoking. So what’s going wrong? Here’s my own personal take on this.

· Nicotine is as addictive as Cocaine and Heroin so once hooked, it is hard to give it up.

· The Dopamine stimulated by Nicotine gives a very temporary relief to worries and feelings of stress, so people experience it as helping them cope.

· Ironically people addicted to Nicotine soon start to experience withdrawal symptoms, just like with any other drug or alcohol; anxiety, stress, trembling. And like any other drug or alcohol a hit of the substance you’re addicted to helps cope with withdrawal.

· In the west we tend to medicate people with mental health problems to control the effects of a person’s condition and help them cope better. Ironically tobacco smoke renders many mental health medications less effective.

I guess the theme here is that many people with mental health problems choose smoking to help them cope and in the absence of anything else, many people will stick with what they know.

ASH Scotland’s IMPACT Project has trained over 200 Support Workers and volunteers, who work with people with mental health problems, about the adverse effect of smoking tobacco on mental health and mental health medications. The mission of the project is to get information about smoking and mental health to the 40% of people with mental health problems who still smoke. The project has moved into a new phase of training new trainers around Scotland so look out for IMPACT training in your area in 2019.



ASH Scotland

Our vision is that everyone has the right to good health and to live free from the harm and inequality caused by smoking.