Defending the mentally ill who smoke

I hate cigarette smoke and have also been sympathetic to health plans that want to exclude smokers or charge them much higher premiums. Yet a new government report reminded me of the connection between mental illness and smoking and was a reminder not to rush to judgment.

The CDC/Substance Abuse and Mental Health Services Administration (SAMHSA) report indicates that about 30 percent of all cigarettes are smoked by the mentally ill. Compared with the overall population more mentally ill people smoke and those who do smoke more per person. The mentally ill are less likely than others to quit successfully.

I wrote about this very topic in 2007, when the estimate was the the mentally ill were smoking almost half of all cigarettes. The two points I discussed then are worth raising again.

First, there must be a reason why almost every schizophrenic smokes. Probably because smoking helps them feel less crazy. It’s still probably worth encouraging some mental health patients to quit but it’s not probably not so clear cut.

Second, if the mentally ill are smoking almost half the cigarettes they’re probably also paying about half the cigarette taxes. It’s been popular in recent years to jack up the cigarette tax to pay for social programs. Is it really fair to have the mentally ill pick up a disproportionate share of the tab?

February 6, 2013

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