Smoking kills – we all know that and the number of people smoking in the UK has declined rapidly from 51 per cent in 1974 to 19 percent today. Health campaigns, like No Smoking Day on March 8, have successfully helped to reduce the prevalence of smoking in the UK.
But the decline in smoking among people with mental health issues has not kept up with this rate of reduction and has hardly changed over the past 20 years. In fact, 32 percent of people suffering with depression and anxiety smoke and they smoke more heavily than other smokers. Of the 10 million smokers in the UK, more than 3 million have a mental health condition.
Health experts have long identified poor mental health with shortened life expectancy. Suffering from depression and anxiety can shorten a person’s life by more than 10 years and the main reason for this, according to a 2016 report, is the impact of years of heavy smoking.
There is no evidence that smokers with mental health issues do not want to give up smoking, but they certainly face greater barriers to quitting. Whist quitting smoking does not increase feelings of anxiety and depression (often it can improve symptoms), addiction, dependence, years of using smoking as a form of self-medicating against stress, and a lack of targeted support can make it particularly challenging for a person experiencing mental health issues to quit cigarettes.
Smoking and depression
People with depression are known to have lower levels of the natural chemical dopamine which when released in the brain triggers positive happy feelings. Nicotine in cigarettes stimulates the release of dopamine so can give smokers a short-lived high. But smoking also prompts the brain to switch off the natural supply of dopamine so the supply decreases in the long-term and people have to smoke more.
Smoking and anxiety
Rather than helping people relax, smoking actually raises levels of tension and anxiety. Nicotine has an immediate and short-lived feel-good factor but this quickly fades and gives way to withdrawal symptoms which mirror the symptoms of anxiety.
Smoking and stress
Many people use smoking as a stress-buster and turn to cigarettes as a way of dealing with the symptoms of stress. Smoking may help people cope in the short-term but does not address the underlying causes of stress and may bring greater health problems in the long-term.
Tips for quitting smoking successfully and permanently
Going ‘cold turkey’ and stopping smoking overnight is the least successful way to give up for the long-term. Success is more likely when people plan ahead.
- Think about the advantages of quitting – Improved physical health, fresher breath, better concentration, more money in your pocket. Write them down – these will boost your motivation.
- Find alternative ways to cope with stress – Alcohol and cigarettes are commonly used to cope with stress but there are other healthier ways. Ideas include:
- taking regular exercise;
- eating a balanced diet;
- taking part in meditation, breathing exercises or acupuncture;
- talking to friends and family, or a counsellor, can also make it easier to cope with stressful events or situations. Identifying sources of stress is a good step on the way to dealing with it.
- Counselling – Talking therapies are available to help people trying to quit smoking. Cognitive Behaviour Therapy (CBT) can help to change habitual behaviour. The NHS offers free support (in groups and on the telephone) to people wanting to quit smoking. People with mental health issues are likely to benefit from the emotional support and practical help of experts.
- Getting support from family and friends – If you have smokers around you, encourage them to quit with you or ask them not to offer you cigarettes or smoke near you.
- Pick a good time to quit – You are less likely to be successful if you are feeling unstable, experiencing a crisis or going through a big change, like moving house or changing job.
- Prepare for withdrawal – Symptoms of withdrawal may include irritability, headaches, nausea, anxiety, cravings or drowsiness. Remember that cravings can be short-lived and symptoms can be reduced by drinking more water or fresh fruit juice, eating high-fibre foods and reducing caffeine and sugar in your diet.
- E-cigarettes – These are electronic devices that allow people to inhale nicotine through a vapour. They are cleaner and act as an alternative to smoking a cigarette.
- Medication – Many people now successfully quit smoking with the help of medication.
- Nicotine Replacement Therapy (NRT). Treatment takes the form of nicotine patches gum and sprays, which administer nicotine in a safe form in order to reduce cravings. Smokers are twice as likely to quit using NRT than if they had no treatment.
- This is medicine that makes the taste of smoking less enjoyable and helps reduce withdrawal symptoms. Smokers are three times more likely to quit when using Varenicline but it does have side effects, including anxiety, depression and mood swings.
- This is thought to have an impact on addictive behaviour and can be prescribed by GPs. However, it can cause some potentially serious side effects.
If you suffer from mental health issues and want to quit smoking, speak to your doctor first. You can also call the NHS Smokefree Helpline on 0300 1231044, open Monday to Friday 9am-8pm and Saturday to Sunday 11am to 4pm.
Employers have a responsibility to provide a smoke-free workplace to their employees but can also take positive steps to support employees who want to quit smoking. Teaming colleagues up to support each other in quitting smoking as well as organising outside help from health professionals can boost your employees’ chances of success.
- Support No Smoking Day and other national initiatives. Put up posters and sponsor individuals who are trying to give up smoking.
- Invite health professionals to offer advice, guidance and assessments to employees who want to quit.
- Give time and space to individuals to undertake counselling during office hours.
- Be open and flexible to the needs of employees who wish to give up smoking.
- Develop a smoking cessation policy in discussion with employees and their representatives as part of your workplace smoke free policy.
Fit for Work offers free, online work-related health advice and guidance to anyone looking for advice and support about an existing case of sickness absence, or about issues that may result in sickness absence. Employed people who have been off work due to illness for four weeks or more can be referred for a telephone assessment with a Fit for Work case manager in order to identify all the obstacles preventing the person from returning to work. The Fit for Work case manager can also provide recommendations about how the obstacles can be addressed and to potentially enable an early return to work. Visit the Fit for Work website or call the free telephone advice line on 0800 032 6235 (English) or 0800 032 6233 (Welsh). There is a separate service running in Scotland (0800 019 2211).