Tobacco And Schizophrenia: The Link You Haven't Heard About

When you hear the term 'lung cancer,' what's the first risk factor that comes to mind?  Smoking--tobacco to be specific.  Yet fully 12% of lung cancer patients worldwide (28% in the UK & 20% of U.S. lung cancer cases in women) are never-smokers, which is more than the percentage of schizophrenics who don't smoke.  

With all the attention cannabis has gotten in regards to causing psychosis, you'd think it was a foregone conclusion.  Likewise, the "kid takes acid once, permanently believes he's an orange" scare stories have been shoved in our faces by the media since the swinging '60s.  What you undoubtedly HAVEN'T been told is that the link between cigarette smoking and schizophrenia is stronger than that of either cannabis or psychedelics, and it may be more than just correlation.   In fact the link is stronger than the link between lung cancer & smoking, statistically speaking.  It may just be correlation, but that's one helluva suspicious correlation.

Smoking is often associated with anxiety, but schizophrenia?



Correlation:  Nearly All Schizophrenics Smoke Tobacco

Schizophrenia is a devastating illness with no known cause or cure

Considered by most mental health professionals to be the most severe mental illness in the DSM, schizophrenia is a persistent, often worsening disorder of thought that causes both "positive" (i.e. in addition to what is considered normal) symptoms such as hallucinations, delusions & disorganized speech and "negative" (an absence of normal abilities) symptoms:  flat affect, catatonia & social withdrawal.  Its cause has long eluded experts, with infections & autoimmune causes recently getting attention.  

It's long been known that schizophrenics have higher rates of smoking tobacco than the general population--much higher.  Statistics vary but a 2006 study published in Perspectives in Psychiatric Care stated that over 90% of schizophrenics smoked tobacco. The number generally given today is "between 80-90%": an outrageously high number compared to the TWELVE PERCENT of non-schizophrenic adults who smoked in 2020.  

I first heard of this statistic way back in an Abnormal Psych class in the early 2000s & always found it suspicious.  Anecdotally, I know a lot of heavy smokers with severe mental illness--psychotic disorders like schizophrenia, Bipolar I/Schizoaffective disorder (my late grandma) & whatever tf is wrong with my mom (half joking).  She was a 3-pack-a-day smoker for 19 years & had a friend who kept up with her in that department but never managed to quit.  The friend developed severe hyperthyroidism late in life before going insane & being permanently placed in a home for severely mentally ill/demented adults where she resides to this day.  

But it took a team of researchers in Israel to officially make the connection and, according to their study, this may be a causation rather than correlation situation.  Worse yet, quitting smoking may not be sufficient to lower risk, as heavy smokers who smoked 20 cigarettes per day for 15 years but had quit for 17 years were still twice as likely as never-smokers to develop schizophrenia.

In other words, cigarette smoking may be the CAUSE of schizophrenia rather than something schizophrenics do to self-medicate as was always believed.

Causation:  (Neuro)Toxic Tobacco

Some of the more than 4,000 chemicals in cigarettes

While it's not known exactly how cigarettes might cause schizophrenia in some smokers, several theories exist.  One is that nicotine, an atypical stimulant, releases dopamine--the primary neurotransmitter implicated in psychotic disorders like schizophrenia.  One fact I haven't seen mentioned is that tobacco also contains a number of neurotoxic heavy metals such as lead, mercury, aluminum, zinc, cadmium, copper & nickel.  Certain brands & batches contain higher concentrations than others but all have dangerous levels (there are no safe levels of lead or mercury in humans).  Over time these substances build up in the body, causing metabolic disturbances that could in theory trigger mental illness in those genetically predisposed to it. 

And that's the other thing: not every smoker develops schizophrenia, so there's clearly a genetic factor at play.  But you can't know whether you have it until it happens to you, and by then it's too late.  


Truth:  Another Casualty of the Drug War

Why nobody ever questioned whether cigarette smoking might play a causal role in schizophrenia is not really a mystery.  Legal drugs like alcohol, tobacco and caffeine are not considered "real" drugs like pot, psychedelics, opioids or crack.  Hence the common and infuriating phrase "drugs and alcohol" which is a bit like saying "food and pizza pies".  These substances ARE drugs: they affect brain function directly, have major addictive/withdrawal/overdose potential and can cause physical disease just like any street drug when abused.  The only difference is the social acceptance factor.  

What's NOT acceptable is the dangerous lie that smoking somehow "calms" people with this horrific condition or that it actually treats it to a degree, a lie that's still being spread by reputable institutions to this day.  The only reason nicotine--a stimulant--"calms" ANYONE is because withdrawals begin shortly after the last dose and cause feelings of anxiety, tension & irritability that are only relieved by ingesting more.  There's no logical reason that a dopamine-releasing substance would improve a disease like schizophrenia and these irresponsible "experts" should know that.  The myth that smokers just have an "oral fixation" and the widespread acceptance of smoking in drug treatment centers exists for the same reason--denial of the addictive nature of nicotine, a drug as hard to quit as heroin or cocaine according to the Surgeon General way back in 1988.  

Even if there were a grain of truth to the absurd claim that smoking tobacco somehow alleviated schizophrenia symptoms, is it responsible to report it considering how deadly the drug is in every other possible way?  Would the media ever dream of reporting this positive effect if the drug that helped schizophrenics was, say, MDMA or heroin or even cannabis instead of a legal/taxed drug like tobacco?

No.  Of course they wouldn't.  Because they've got a War on (Some) Drugs to conduct.  

And smoking tobacco doesn't help treat schizophrenia, it's merely alleviating nicotine withdrawal symptoms caused by the last time the patient smoked so it's a moot point.  It's also raising blood pressure, heart rate, risk for about 13 types of cancer, emphysema, COVID, tuberculosis, autoimmune disease, COPD, asthma, heart attack, stroke, gum disease/tooth loss, macular degeneration, Type II diabetes & peripheral artery disease.  To name a FEW.  There's gotta be a safer way to "calm the minds" of these struggling souls so they can think clearly. 

Why not just say what you really mean:  that the chances of a schizophrenic patient ever quitting nicotine are next to 0 because the withdrawal would cause a dangerous worsening of their symptoms?  Even mentally healthy/non-schizophrenic people can become extremely irritable & out of touch with reality during nicotine withdrawal.  (I'm lucky my grandma was around when my mom quit or I might've ended up like one of Andrea Yates' kids.  No, I'm not exaggerating.  I still tease her about it to this day but yikes).  Symptoms of nicotine withdrawal may include anger, impulsivity, trouble sleeping, vivid dreams, physical restlessness/indeliberate movement, anxiety, depression, headache, weight gain, mood swings, extreme nicotine cravings & difficulty concentrating.  And that's in a mentally stable person--imagine what that would do to someone struggling with schizophrenia.  That's to say nothing of the effects of some of the meds prescribed for nicotine withdrawal like Chantix.

If you wouldn't advise a schizophrenic patient to self-medicate with meth or cocaine, you shouldn't encourage them to do so with nicotine.  Schizophrenia shaves an average of 14.5 years off a person's life expectancy--the illness is the SECOND leading risk factor for dying of COVID, bested only by advanced age.  Schizophrenics have higher rates of cardiovascular disease... might these things be a result of smoking?  Nobody's claiming it's the ONLY factor that shortens life or causes schizophrenia, but when 80-90% of any population smokes, that's damn near all of them & it's unforgivable to overlook the possible connection in both directions--cause AND effect.  When you consider the Reefer Madness-level reporting on cannabis and psychosis, the negligence is even more unforgivable.



Scapegoating Grass

Dramatic photo from a NY Post article on cannabis & schizophrenia

Marijuana is a mild hallucinogen that alters time perception, memory, pleasure, sensory perception, appetite & movement so of course it could worsen psychotic symptoms.  Paranoia & anxiety are commonly reported side effects of cannabis, and extreme stress is a common trigger of first-episodes of mental illnesses including schizophrenia so it's even possible that heavy cannabis use could trigger a 1st psychotic episode in schizophrenics. 

But marijuana lacks the addictive potential of tobacco & is rarely used as compulsively (i.e. "chain-smoked").  It also has not been linked to the serious health risks of tobacco, thus even if it DID trigger or worsen psychosis it would be far easier to quit and wouldn't add to the overall health burden/life shortening effect seen in schizophrenics (cancer, heart disease, emphysema/COPD).  The fact that schizophrenic people often are poly-drug users makes it hard to tell WHICH drug caused which problem, but the Israeli study was the first to elucidate that many patients started smoking cigarettes BEFORE the onset of their illness, therefore the claim that it's a habit they picked up in the psych ward or on the streets that they incidentally found helpful for controlling their symptoms is false.  THE CHICKEN (smoking) CAME BEFORE THE EGG (schizophrenia) which points to it being more cause than effect. 


Now What?

My big question is, how many researchers & journalists have noted this connection & just let it slide in order to cover for tobacco companies or not ruffle any feathers within that industry?  Can it really be that only myself and a handful of scientists in Israel thought to ask whether the excessive rates of smoking among schizophrenics might be due to the habit CAUSING the disorder? 

Doubtful, but stranger things have happened.  In any case, this story should be much bigger than it is.  If a preventable (already dangerous) habit could be identified as the cause of a disorder as life-destroying as schizophrenia that costs society around 281.6 billion annually, not only could we prevent many cases outright, it would open up untold pathways for new research into a treatment or cure.  Lord knows the meds we've got now are woefully inadequate and add to the overall life-shortening effect in psychotic patients due to side effects like increased appetite/weight gain, diabetes, tardive dyskinesia & brain atrophy.  The real question is whether the psychiatric industry truly WANTS a cure and is willing to change with new information.  Every time a study comes out that paints the profession or their golden goose (psych meds) in a bad light, they shoot it down with some knee-jerk nonsense.  If 80-90% (or even 40-50%) of cases of schizophrenia could be prevented by simply not smoking, that would cut into antipsychotic prescriptions immensely, affecting somebody's bottom line. 

It also goes back to the tenet that mental health IS physical health.  Not everything is caused by childhood trauma & can't, in fact, be helped by magical--err, POSITIVE--thinking or crying it out in therapy.  Mental health professionals need to start asking about possible biological causes for severe mental illnesses like schizophrenia & bipolar disorder--things like head trauma, heavy metal poisoning, maternal substance abuse or teratogen exposure, early malnutrition, birth complications/oxygen deprivation, infections & other things that might've actually damaged the brain (as opposed to the mind/psyche).  The overly simplistic neurotransmitter hypothesis isn't very promising & is hard to test, as almost every drug that works on the dopamine system also affects multiple other neurotransmitters. 

The smoking/schizophrenia link is very tentative at this point but definitely worth a deeper look.  The fact that the story isn't headlining 60 Minutes or PBS Newshour is curious indeed, especially when none of these outlets misses an opportunity to link psychotic disorders with illegal drugs like cannabis every time a new piece of 'evidence' trickles out.  (Props to The Conversation for delving into the cognitive effects of smoking.  Anything that constricts blood vessels or cuts off oxygen to that degree cannot be great for brain health long-term).

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