Psychosis and Tobacco Use: Tailored Interventions Needed, Study Finds

Psychosis, a condition characterized by a disconnection from reality, affects a significant number of individuals. Those with lifetime psychosis face a higher risk of tobacco use, including poly-tobacco use, quit attempts, and severe nicotine dependence. This presents an urgent need for personalized tobacco-cessation interventions to address their unique challenges.

Tobacco use

Filling Research Gaps

A recent study conducted by the National Institute on Drug Abuse (NIDA) aimed to fill the gaps in understanding tobacco-cessation methods among adults with psychiatric conditions. It also investigated the prevalence of these strategies and the severity of nicotine dependence among people with and without lifetime psychosis. The study was published in JAMA Network Open in March 2023.

Participants and Setting

The research used data from the Wave 5 survey of the Population Assessment of Tobacco and Health (PATH) Study, which was conducted from December 2018 to November 2019. The participants were adults with and without lifetime psychosis, with 2.9% of them (n=1186) meeting the criteria for study inclusion. The study was carried out in the United States.

Tobacco Use Differences

The researchers found differences in tobacco use between those with and without lifetime psychosis. Individuals with psychosis had a higher percentage of using both cigarettes and e-cigarettes and poly-combustible and noncombustible tobacco. However, they had lower exclusive use of cigarettes, e-cigarettes, and smokeless tobacco.

Nicotine Dependence and Quit Attempts

The study revealed that adults with lifetime psychosis and cigarette use in the prior month had higher nicotine dependence scores overall. They were also more likely to make quit attempts and use various tobacco-cessation approaches. They included e-cigarettes, nicotine replacement therapy (NRT), prescription medications, counseling, quitlines, support groups, or web-based programs.

Urgent Need for Targeted Interventions

Dr. Wilson M. Compton, MD, MPE, the corresponding author of the study from NIDA, emphasized the urgent need for evidence-based tobacco-cessation interventions tailored to people with psychosis. Tobacco smoking among people with mental illness has declined in recent years. Still, due to targeted prevention and control interventions, a significant gap remains between those with and without psychosis. To close this gap, pointed efforts are essential to help people with mental disorders reduce or quit smoking successfully.

Future Research Directions

Dr. Compton highlighted the importance of future research in understanding long-term trends in nicotine dependence and the impact of tobacco-cessation interventions for people with psychosis. Additionally, studying tobacco use initiation and prevalence among teens with or without psychiatric disorders, especially with the rising popularity of e-cigarettes among young people, is crucial. Including homeless and institutionalized individuals in research can also help identify effective strategies to mitigate tobacco use risks for populations at higher risk of psychiatric disorders.


The study sheds light on the urgent need for tailored tobacco-cessation interventions for individuals with lifetime psychosis. Integrating these interventions as part of comprehensive medical treatment for psychosis can provide immediate help and improve outcomes. Continued research on effective strategies for tobacco cessation and prevention is crucial to reducing the harmful impact of tobacco use on mental health and overall well-being. With NIDA supporting a broad research portfolio in this area, there is hope for finding better ways to address tobacco use challenges among those with psychiatric conditions.

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