Smoking and substance use are common in people with schizophrenia. It’s important to consider these issues when planning overall treatment for schizophrenia.

Studies estimate that between 64 and 79 percent of people with schizophrenia smoke regularly. Most people also want to quit.

While smoking may be a way people with schizophrenia manage symptoms, there may also be a genetic component that increases nicotine dependence.

In this article, we look at why people with schizophrenia may be more susceptible to nicotine use, how this might interfere with treatment, and what you can do if you want to quit smoking.

The link between schizophrenia and smoking is a complex issue. Researchers previously thought that smoking was primarily linked to self-medication in schizophrenia. But evolving research suggests smoking could increase the risk of psychosis in some people.

According to a 2019 review of research on the topic, a genetic component could account for a predisposition to both schizophrenia and nicotine dependence.

Certain variants of the CHRNA5 gene were linked with an increased risk of developing schizophrenia as well as nicotine dependence.

People with certain mental health disorders may also be more likely to smoke heavily, and have a more difficult time quitting than other smokers.

More research is needed to understand the genetics of schizophrenia and nicotine dependence.

Nicotine products are not treatment methods for schizophrenia. But the effects of smoking could explain why some people with the condition may use it to self-medicate, or why they may develop more of a dependence on nicotine.

Scientists think nicotine use activates nicotinic acetylcholine receptors in the central nervous system. It may also affect dopamine levels.

According to a 2018 review, people with schizophrenia who smoked heavily experienced stronger effects on their brains due to increased dopamine activity.

These effects on the brain may drive someone to continue to smoke.

Researchers also believe that smoking may affect “negative” symptoms in schizophrenia, which could also increase the rate of dependence. Negative symptoms in schizophrenia may include a lack of emotional responses or facial expressions.

A 2019 review of 29 studies suggests that smoking may also provide relief from some side effects of antipsychotic medications.

Interestingly, while heavy smoking is often associated with reduced cognition, or the ability to think, the opposite may be the case in people with schizophrenia. Such effects could further reinforce nicotine dependence.

Still, it’s important to remember that while research shows a link between smoking and schizophrenia, not everyone with this mental health condition attempts to self-medicate with smoking.

Anyone who smokes should try to quit. Quitting can reduce your risk of associated health effects, regardless of whether you have schizophrenia.

According to the Centers for Disease Control and Prevention (CDC), at least 16 million people in the United States alone may have a smoking-related illness.

These may include:

Your friends and loved ones could also be at risk of these conditions from exposure to secondhand smoke. It contributes to about 41,000 related deaths in nonsmokers each year.

Quitting smoking will not only reduce the direct negative effects on your health and others. It may even help medications prescribed for schizophrenia work more effectively, too.

In addition to nicotine replacement therapy (NRT), such as a transdermal patch, a doctor may recommend a combination of the following treatments and therapies to help you quit:

  • varenicline (Chantix), a prescription smoking cessation medication
  • bupropion (Wellbutrin), a prescription antidepressant that doctors also use as a smoking cessation aid
  • behavioral therapy

If you or a loved one with schizophrenia smokes to self-medicate, it’s important to understand the biology behind this connection.

It’s also important to seek help for quitting to avoid smoking’s negative health effects.

Talk with a doctor about how you can get started with quitting smoking. They will likely recommend a combination of treatments, such as prescription medications, NRTs, and behavioral therapy.

It may take some trial and error to get there, but quitting smoking is possible with the right treatment.