Tobacco use is the greatest preventable cause of death and medical disability in the United States. Tobacco kills and contributes 
significantly to the development of killers like heart disease and cancer. Yet its deadly impact is preventable. When people stop smoking, their risk of death and disability drops steadily and progressively.
The CDC estimates that approximately 450,000 people die prematurely in the USA, and more than 8 million Americans are medically disabled by use of tobacco (the consequences of smoking to the lungs, heart, blood vessels, and organs that develop cancer). If you think that is just someone else’s problem (and don’t calculate the economic costs to society) then consider that inhaling other people’s smoke (second-hand smoke) has recently been shown to increase the risk of adult onset diabetes and of impaired mental functioning. It is the tars and byproducts of inhaled tobacco smoke that cause lung damage and serious health consequences. In fact, when nicotine is absorbed but not inhaled (like with patches, gum and nicotine “inhalers” which deliver nicotine through the skin and membranes of the mouth and throat) it is not a dangerous drug, even when used for long periods. (1,2)
Women smoke a little less than men and Asians smoke significantly less than Caucasian, African-Americans and Hispanics (in the US). Native Americans greatly exceed all these groups. But there is one group that blows away the others (hard to resist that pun): people with a mental illness or heavy users of alcohol or drugs. These individuals consume near to half the cigarettes smoked in this country! Among individuals with mental illness or with alcohol and drug problems over 70 percent smoke (compared to about one in five of the general population – whose smoking rates have dropped from 50 percent 50 years ago). About one in two people with depression and anxiety conditions smoke – twice the rate of the general population. Three out of four people with alcohol and drug problems smoke – a rate comparable to people with bipolar disorder or schizophrenia. Notably, these individuals report a desire to quit at the same rate as do others (70 percent).
There are a number of good reasons to explain the huge disparity in smoking between people with mental and substance use problems and the rest of those who light up. The nicotine in tobacco has been shown to improve mental concentration and can improve mood, especially in depressed individuals. Smoking is well known as a way of coping with stress, and the greater the stress the greater our need to combat it. The pleasure of smoking is no small factor (Freud did get it right when he wrote that the pleasure principle warrants respect), particularly in people whose mental states find it hard to engage in and feel the pleasures of relationships, work and play. What’s more, quitting takes support from friends and families and quit rates are increased by medications prescribed by doctors – both resources that are often limited in people with these conditions. Finally, doctors have not done such a good job of asking about smoking, and offering to help.
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