Why do schizophrenics smoke so furiously?

We see lots of patients from a couple of residential homes in our neighborhood standing around smoking. Several of them draw on the smokes so hard their cheeks suck in and the cigs look half way in their mouths. And they puff frequently. Is that “style” a reflection of meds they take? Or is it somehow symptomatic of schizophrenia? I believe that type of smoking is typical of schizophrenics. But why?

They are self medicating, Nicotine is able to relieve some of the symptoms of schizophrenia.

The conventional wisdom in the halfway-house facility I was in was that nicotine offsets some of the physical side effects of neuroleptic drugs – that it dampens the involuntary rhythmical movements and the restlessness.

But it could just be cultural.

That’s my understanding. Nicotine helps damp some of the symptoms. I can’t speak to the “style” of smoking mentioned in the OP, which may just indicate how desperate some of them are for the fix.

My father was schizophrenic and a chain smoker. He smoked before he had symptoms of schizophrenia, but smoked continuously in his later years. (He died of lung cancer at 68.)

Another segment of intense smokers are ADD/ADHD sufferers: Along with intense coffee/caffeine consumption, Attention Deficit sufferers self medicate with stimulants to “wake up” the under-performing Left Pre-frontal Cortex.

Some people can’t function without a coffee and cigarette.

That also shows up in traumatic brain injury sometimes.

I had a nephew who suffered a severe brain injury. Post-accident, he actually did some research on his own and uncovered evidence that in some cases nicotine improves brain function. So he deliberately took up smoking. Um… yeah, it did seem to help (although it certainly didn’t fix everything).

My sister-his-mother (me and her are estranged and have been for many years now) wasn’t happy (my siblings and I are all anti-smoking) but sort of came to a place where she decided that improving his brain function for better quality of life now might outweigh dying of cancer later, at a younger age than he might otherwise have shuffled off the mortal coil.

As it turns out, my nephew dropped dead at age thirty for causes unrelated to smoking. So yeah, in that particular case there might have been more benefit than detriment. But sure as hell that doesn’t apply to 99.99% of people smoking.

If nicotine DOES improve brain function maybe there’s a better way to administer it than smoking, but no one seems interested in working on that end of the problem.

:confused: What about gum and skin patches?

That’s a good question.

I’ve been told inhaling gets the nicotine to the brain rapidly, delivering a kind of rush. It sure felt that way when I smoked. Perhaps a patch or gum won’t stop a schizophrenic from smoking anyway to get that rush.

I’ll note that I haven’t seen confirmation of the rapid delivery rush mechanism through inhalation, that feeling could be a Pavlovian like response in expectation of the nicotine cravings going away.

Smoking is well known among schizophrenics. But do people, not necessarily schizophrenic, try injecting nicotine intravenously to get a better rush, like they do with cocaine hydrochloride?

This is fascinating! I had no idea smoking had health benefits! (Of course, I understand the caveats … just because it provides some benefit doesn’t mean the net effect is beneficial. But still.)

Perhaps nicotine could be delivered via inhaler, like asthma medications, Advair, etc.

There’s actually a wiki page on Schizophrenia and tobacco smoking.

Re: inhalation - as it happens, e-cigarettes have been widely regulated as non-medicines. That has a good side for general access etc, but it makes developing nicotine as a medicine to treat schizophrenics almost impossible - who’s going to pay for a “medical nicotine inhalation device” when you can buy a cheap e-cigarette? And so how do you run any research into the potential benefits of inhaled nicotine if you can’t fund studies by future sales of your “medical nicotine inhalation device”? (I’m oversimplifying. It could be done of course, but there’s no clear path forwards).


Isn’t this the kind of study that the CDC would fund? That is, one in which there’s not a big profit incentive for doing the research, but there’s a potential for substantial public benefit due to a more solid understanding of the effects of nicotine on schizophrenics?

I don’t want to wander too far off topic here, but - Yeah, I said I was oversimplifying. I’m not familiar with the fine detail of CDC funding. I’m assuming that the CDC (and other similar-ish organisations in other countries) are all in the situation where they have limited funds and competing priorities - am I wrong about that? So it just makes the way forward more difficult. What’s the favoured outcome? That a fortune of public money is spent demonstrating that (if it’s successful) there would be a medical benefit to introducing a “medical nicotine inhalation device” to help treat schizophrenics? But no such device is available - and there isn’t any real prospect of one being developed due to the existence of the e-cigarette (and arguably the existence of the original analog cigarette as well). Would the CDC fund research to get to such a messy outcome?

In a way, maybe this is somewhat analagous to what’s going on with CBD in the US at the moment (and others on this board know WAY more about that than I do). Maybe watching that situation closely will suggest a way forward.


I’m guessing that people have tried that - once. The stimulant effect would probably be powerful enough to kill the person almost instantly.

Some people with schizophrenia and Tourette’s syndrome find that smoking reduces the severity of their symptoms. Research is being done into this.