Nicotine's correlation with mental illness: An interview with Dr John Allan

Thursday, December 13, 2018

Associate Professor John Allan spoke with ABC Radio Brisbane about smoking and mental illness.


How often in a stressful situation if you're out socially would you hear someone say 'I need a cigarette'. Alright times are changing and you don't hear it anywhere near as much as you might used to. But for some smokers, they say that it is a form of relaxation for them. New data though, disputes that. Plus there has been links made between smoking and poor mental health. Dr. John Allan is the Executive Director of Mental Health Alcohol and Other Drugs with the Queensland Health Department. He's been looking through the stats.

There's been a steady decrease in smoking, as you know, so we're at the lowest smoking levels we have ever been in terms of the general population, down around 12-14 per cent. 

And is there any proportion of the population where smoking rates are actually on the rise, bucking that trend?

Well, there are some unfortunate trends for say for young women, for example, are smoking more often also for people who actually suffer from serious mental illness or people who are homeless, the smoking rates have not actually changed that much from the levels we had quite a long, you know, number of years. So 30 or 40 per cent of people with mental illness for example smoke cigarettes.

And why is there that link?

Well I think there's a couple of links, everybody's really well aware of the physical problems of smoking cigarettes, like lung cancer and heart disease and so on. But it's quite a myth out there were people think that smoking cigarettes actually relieves anxiety or helps to cope stressful times worse. In fact, that's actually the opposite.

So this is what happens when you take a drag of a cigarette, effectively, you're talking about that the bodily response and what happens on a neurological level?

Yeah, so what happens at the neurological level when you take nicotine - it's a stimulant. So it makes your body feel a little bit better, makes your heart race you get that same thing as like adrenaline fight or flight, you feel that lift. But it actually means that you have this sort of surge of anxiety through your body. And then, of course, when the nicotine wears off, because nicotine wears off very, very quickly, in about 30 seconds or so you actually have a withdrawal from that. And so the withdrawal from that is actually part of the anxiety so you feel this let down. And of course, that doesn't get relieved again for a very short time as it does when you have that next cigarette. So you're going from that little bit of feeling the addiction, to the let down, the anxiety, the depression of the let down, and come down and then you're going back. Cigarettes are you know incredibly addictive.

Yeah, it was going to say that's what makes the smoking incredibly addictive and breaking the habit so incredibly difficult. So how, like the research that there is around mental health and smoking, it sounds like there is a bit of a correlation there. Is there a strategy that we should be employing in Queensland to try to break that or what what do you think we should be doing in that regard?

Look I think cigarettes are difficult because two reasons - one is that the nicotine itself is quite addictive and so from a physical point of view it's an addiction. There's also issues about people being addicted to the habits of smoking like you know having smoked in situational as you mentioned in your introduction, having a cigarette when you feel stressed, for example, as an immediate reaction to that, rather than taking different ways of doing it. So there are quite good ways of quitting smoking. And everybody's actually capable of quitting smoking, even people with quite serious mental illness are also capable of quitting smoking. And usually to quit smoking it's a combination of things like nicotine replacement, so you'll see patches and gums and all those things, you can also use some particular medications to decrease the craving but also having psychological support and counselling. So normally, those things work better, if there's actually some support. So we know that if you have the right kind of support, even when you start using the patches or the medication, you can improve your chances of quitting by two or three times with the right kind of psychological support and counseling which is why we have Quitline and things like that.

Dr. John Allan is with you on ABC Radio, Brisbane, he's the Executive Director of Mental Health Alcohol and Other Drugs at Queensland Health, we're talking about tobacco smoking here. And I have seen some market research along the lines of almost one in two regular smokers saying that they continue the habit to deal with stress. John, you're effectively telling me that smoking can add to that stress. So  it is quite the cycle to break that we're talking about here.

I think people mistake some of those withdrawal things for ongoing stress. So you know, that withdraw from having a cigarette, you feel a bit anxious and worried, you think that's the ongoing problem. Whereas in fact, it's really about mistaking some of those early withdrawal symptoms for an ongoing process. You know the thing that is really important is that people who have got an established mental illness so for example, if you've had depression, anxiety, or something, often people think they've got to keep on smoking or the symptoms will come back when they give up. But in fact, we've done some work and looked at all the data and in fact people actually don't get worse from the mental illness when they give up smoking they actually have a better mental health outcome when they give up smoking. So again, that's, you know, one of those myths and there's also some early work now that suggests that smoking is actually contributory to the psychosis. So there's been a lot of association between people who smoke cigarettes, and then develop psychosis, there's now some work around the physiological aspects of that, to look at the way that that effects brain chemicals and could possibly lead to psychosis as well. So there's all kinds of reasons why you should be not smoking.

So you're saying that if someone has a mental illness, for instance, say is depressed, and is a regular smoker, that if they're worried about quitting smoking, for fear that it will see them deeper into a depressive state. You're saying that that doesn't correlate?

What the research actually shows is that the symptoms of your mental illness will get better when you give up smoking. People have a myth, a worry that it will make it worse. So that's why I think 'oh I'm having a terrible time in my life you know, it'd be a bad thing for me to give up smoking' and they continue to smoke. But the problem is that this anxiety reaction that we talked about earlier just continues and so they often mistake those many withdrawals that you get from smoking as part of that mental illness whereas in fact they're a different thing. And there's a couple of things that are really interesting about just tobacco as well. So for people who are going into rehab about giving up other drugs is really good evidence that actually stopping tobacco actually also increases your capacity to stop the other drugs as well. There's something about the triggering effects so that for example people we go into rehab around you know, we've talked about things are quite in front of people's mind like ice and around you know, narcotics but also around alcohol, there is very good evidence for all those things that actually quitting smoking actually gets better results for dealing with those other drugs as well. So that's, that's really important.

Has that surprised you?

Ah no, it doesn't, it makes sense in a way because the issue is that often replacing one addiction with another might be good for you. In fact, actually changing all the habits, it's probably best to do all that at once, you know, it's probably just getting out of all those addictive patterns is probably a really good thing to do. And, and the evidence is really solid that that there are much you know, when people go into rehab programs, stopping smoking actually enhances their chances of succeeding in the other programs as well.

Yeah, and proving to yourself that you can quit something in health and that in the mental struggle, what comes with with with breaking an addiction?

That's right. So you know, there's a whole lot of physical and psychological reasons why people can succeed. It's often these myths that we have in our society, the things that 'I can't do this or no one can do that, or it's really hard, you know. The story of quitting smoking it eases, you have done it many times, you know, the issue is that on average, people take about 10 or 11 attempts to quit and the success rate each time is only really five to 10 per cent but it's about that persistence and about having the right support. And we are much better at supporting people now and understanding that the right and better medications and and better replacement therapies to do it so people can can quit quite successfully.

Dr John Allan, the Executive Director of Mental Health Alcohol and Other Drugs with Queensland Health, talking about smoking and the links with your mental health as well. And some of those stats 10 or 11 attempts on average is what it takes before we can kick the habit. Quitline is a good place to start. If you're a smoker, and you're looking to stop 13 78 48 is the number for the Quitline and it's also something to have a good chat about with your local GP, they may be able to assist.


For more information on 13 QUIT or Quitline, visit Quit HQ. Clinicians looking to support consumers with their smoking habit should use the smoking cessation clinical pathways.

Clinical Excellence Queensland

To keep up to date with news from Clinical Excellence Queensland, subscribe to our mailing list, or follow us on Facebook or Twitter.

Last updated: 18 February 2019