Treating mental illness with cigarettes

While nationally, only about 20% of Americans smoke, 80% of schizophrenic Americans smoke. That's interesting, but it's not the most interesting part. Apparently, there's some evidence that those people with schizophrenia are using tobacco as a form of self medication.

At the Risk Science Blog, Mark Stewart looks at the weird dilemma people with schizophrenia are faced with when it comes to smoking:

Schizophrenics often have auditory hallucinations, paranoia, delusions, and disorganized thinking. These symptoms are predominantly caused by the inability of the brains of schizophrenics to differentiate, sort, and focus on the multitude of stimuli that go on around us. Think of being in a busy restaurant. Imagine that instead of being able to block out all the noises, conversations, and movements around you, every single piece of sensory information is as important as the interesting things said by the attractive person sitting across from you. The effects of cigarette smoking and nicotine help schizophrenics through increased selective attention.

“They should use other forms of medication,” I hear you say. Great idea, except for the fact that anti-psychotic drugs are very expensive, do not work very well for most people, and have extreme side effects. Tardive dyskinesia is the most common side effect. This makes it very hard for the body to move in normal ways at normal speeds. Also, there are common metabolic side effects that are quite similar to an individual having diabetes. (Just what someone with a severe mental illness needs!) Thus, the cheapness, effectiveness, and availability of cigarettes offer most schizophrenics some succor. Smoking leads to schizophrenics having a 30-60% increased risk of respiratory disorders and heart disease, but is this a risk that is worth taking?

This is really interesting to me. I've heard people talk about cigarettes as self-medication for ADHD, as well, and for much the same reasons. I sure found that smoking made it easier for me to study and write back in college. Although, for my ADHD, behavioral therapy and methylin ended up being a much better option. So I quit. But this poses an interesting question: If my official therapies carried the kind of side-effects that people with schizophrenia have to deal with, would smoking be more attractive?

• [zombiebob]

  Hmm, just from knowing a few people who were schizophrenic, I’d say that a lot of people with that illness both smoke AND take those meds. Those meds are really nasty though, and I think they are over prescribed and not all that effective in many cases. So instead of a raving lunatic, the result is a slightly less mad individual who weighs 300+ lbs. Of course there are also people who become functioning individuals with diabetes. Really, sometimes the cure is worse than the illness, and sometimes it’s equally bad but necessary. Mental illness is a real bitch, and I think there are many people who are just fd from birth in that regard.

• [hassenpfeffer]

  This is hardly “news.” When I worked at the outpatient psych unit of a hospital with an inpatient psych unit in the ’90s, the only patients allowed to smoke were the psych patients. Although I loathe smoking, I’d have to say that given a choice between most neuroleptics and cigarettes, I’d take the cigarettes. (Ever seen anyone with tardive dyskinesia? It’s essentially med-induced Parkinson’s disease.)

  • [Spitty Sumo]

    the fear of td (which doesn’t necessarily ever go away, even if you quit the offending med) is what’s kept me from trying to get any benefit from neuroleptics.  fortunately my symptoms aren’t *so* much that i’m not functional enough to “pass” most of the time, so to say. never felt the urge to smoke (cigarettes), though.

  • [billstewart]

    Nicotine seems to also be a useful drug for Parkinson’s symptoms.    As with many kinds of psychiatric or nervous system problems, there are usually better-tuned drugs out there than alcohol, cigarettes, coffee, and marijuana, but for many people the crude self-medication is where they start, and may be as far as they go.   And at least the medical folks have better drugs than thorazine to offer, though there’s still a long way to go.

• [Ariel Allon]

  I wonder how much of the medicinal effect is due to the nicotine and how much is from everything else. If nicotine accounts for the majority of the positive effect, one could use a nicotine patch, for example, to achieve the desired effect while minimizing the side-effects on their health. (As well as avoiding the social stigma and causing second-hand health risks).

  • [Ashcan]

    The effect is from the nicotine which functions like a neurotransmitter in the brain. I don’t know if patches help but we give them to all our patients who want to smoke. We don’t allow it in our hospital.

  • [donovan acree]

    I’m guessing it’s the MAOI in tobacco smoke and not the nicotine http://biopsychiatry.com/maoi-smoke.htm

• [paul beard]

  If I had a dollar for every time I heard this — “ I think they are over prescribed and not all that effective in many cases.” — I’d be very, very comfortably off. 

  Is there any other medical specialty that gets as much armchair diagnosis as mental health? The organ we know the least about, though many of us use it daily, but everyone is an expert on the care and maintenance of everyone else’s brain. If this was a post on AD[H]D proper, I wonder how many comments would be posted before someone complained about the sedative effects of Ritalin (methylin) et al and how kids are being restrained through drugs. 

  • [zombiebob]

    If I had a dollar for everyone who reacts like you did, I’d be a rich man as well. What is your experience with people who have been diagnosed with mental illness and prescribed anti-psychotic drugs? Do you have any? Because I do, and I’m not just lightly making that statement. You also didn’t seem to comprehend the later part of my post, in which I write that there are people who benefit from those drugs, but that even when that happens, the results come at another cost to their quality of life.

• [solstice2005]

  Interesting to see nicotine (or at least smoking) used as an informal
  medication.  But it has been known for a while that nicotine allows one
  to shift the mood to focus on what one wants to do: concentrate on the
  task at hand for example as MKB mentioned but also to relax (as that last cigarette at night) or to wake up (as that first cigarette upon waking up)

• [Rob]

  Pretty much the worst way in the world to get nicotine is through a pack of cigarettes. Pipes, cigars, electronic cigarettes, snus, etc.. all offer more attractive alternatives. 

  The way that tobacco is processed for cigarettes does a couple of things.. sugar is added (up to 30% by weight… in the form of high fructose corn syrup) to change the pH of the tobacco smoke to allow it to be inhaled without pain. This has the downside of changing the nicotine into larger nicotine salt molecules, which aren’t absorbed through anything but the lung tissue… its why you can puff a cigar or pipe, get your nicotine, and not have to inhale. You have to inhale cigarettes to get the nicotine. 

  Fresh tobacco doesn’t contain the Tobacco Specific Nitrosamines that fermented tobacco does. Those TSNAs are largely responsible for the cancerous effect of cigarettes. Pasturized tobacco like one finds in snus contain a fraction of a fraction of that found in cigarettes.

  Finally cigarettes hit you with such a huge amount of nicotine all at once, that it tends to increase the addictiveness of its use…. analogous to shooting up.

  My point here? Schitzophrenics and the rest of the worlds tobacco users have a myriad of much better options for getting the nicotine they want or need, or whatever. There are plenty of effective ways to mitigate the risks of tobacco use.

  • [Guest]

    That is all true of cigarettes with additives which are designed for those effects But, not all brands are prepared that way. Not all tobacco is the same. Caveat Emptor.

    Any of it can cause lung cancer and heart disease.

• [Guest]

  Seriously, how many different receptors has nicotine been found to bind to? There’s no question nicotine is a psychoactive drug.

  • [theCanuck]

    There’s at least 10 different isoforms that have been described to date in nature, not all of which occur in humans.  All bind nicotine, or naturally, the neurotransmitter acetylcholine.  Most importantly, a nicotine receptor controls muscle movement throughout the human body, as well as other organisms.  There are also two distinct isoforms found at higher levels in the human brain than anywhere else in the body.  Of the two isoforms in the brain, polymorphisms in one particular isoform (the alpha 7 receptor) are very suspect in Schizophrenia.  Overall, these nicotinic receptors and their underlying neural network function to regulate brain activity, particularly learning, memory and attention.  One of the activities regulated by the alpha 7 receptor is thought to be auditory gating, it’s possible that a deficiency caused by polymorphisms in the alpha 7 receptor could disrupt one’s ability to differentiate between incoming sounds.  (This could perhaps lead to auditory hallucinations.)  The current hypothesis suggests that individuals suffering from Schizophrenia are smoking, HEAVILY, as a means to make up for the reduced function of their brain’s nicotine receptors.  However, I imagine that there has to be a safer alternative to nicotine out there, although as this is all relatively new science, I think that current approved therapeutics don’t even consider the underlying physiological factors that have a role in the disorder.

• [morgan]

  Tobacco doesn’t need to be considered as harmful as *cigarettes*. 
  Something like 30% the dry weight of a cigarette is made up of chemicals. Tobacco leaves, however, have been used for millennia for many purposes, including for health purposes. There is discussion out there regarding Tobacco, Shamanism and Schizophrenia – because shamans are sometimes described as being “schizophrenic”, or display some of the same characteristics, and shamans in most cultures use tobacco to mediate between worlds. Or to “keep the spirits happy”. So, schizophrenics may be using tobacco/cigarettes in the same way, to mediate between the worlds/emotions/thoughts/etc they’re experiencing.

  Also, this is somewhat related:
  “…fresh tobacco leaves may possess certain useful anticancer compounds, according to Dr. Khalid El Sayed, an Associate Professor of Medicinal Chemistry at the ULM College of Pharmacy.

  For inspiration, El Sayed looked at several marine soft-bodied corals, which also protect themselves against natural predators through their ability to produce large amounts of cembranoids.

  “These marine cembranoids are known for their anticancer activity,” he said. “Since the leaf and flower cuticular wax of tobacco are rich in cembranoids, and also act as a chemical defense to protect the plant against insects and harmful microbial infections, we believed that natural, fresh tobacco ingredients would offer the greatest potential as an anticancer agent.”

  http://www.ulm.edu/universityrelations/news/july11/anticancer.html

• [Lexicat]

  Maggie, you might want to check with research by J Prochaska who studies the effects of smoking and quitting smoking on those with mental illness, particularly within inpatient populations. I used to see her around at work at UCSF, and in discussions she and other clinical tobacco researchers are faced with clinical culture among nurses, nurse practitioners and doctors of “common knowledge” about inpatient schizophrenics, depressives and the elderly who are often argued to have limited quality of life, so they may as well obtain enjoyment from smoking.

  The consistent result from those who actually do the research to test this common knowledge is that both mental health symptom severity and quality of life indicators improve with quitting smoking.

  See, for example:
  Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?

  and also

  Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction?

  Cheers

  • [Morrigan]

    Hey do you have a paper for how tobacco and caffeine have been used by schizophrenics to self-medicate?  A pot of coffee and a pack of cigarettes was essential for a relative of mine.

• [Peter Q]

  Going down this line of reasoning, I would say a less harmful option than cigarettes would be Swedish Snus.  For those not familiar, it’s a small packet of tobacco, about the size of a piece of chewing gum that a person sticks between their lip and gums.  Because the nicotine is absorbed through the gums, it avoids the respiratory risks of smoking, but nicotine is still toxic.  Safer does not equal safe.

  Has there been any investigation into whether tobacco companies attempt to target schizophrenics in their marketing?  I’m just speculating of course, but it wouldn’t surprise me if they saw this as a condition worth taking advantage of.

• [Guest]

  Re: tobacco companies marketed to schizophrenics – do you remember Joe Camel? Guy was a walking talking hallucination.

  • [Lexicat]

    Funny you should mention that. . .
    Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill, by D Appolonio in Tobacco Control 14(6):409–415.

    The legacy tobacco documents archive (i.e. the searchable and well indexed database of all of the tobacco industry’s internal documents which are required to be made public as part of the Master Settlement Agreement) provide ample opportunity to examine precisely how the tobacco industry markets its products, including by targeting the mentally ill. http://legacy.library.ucsf.edu/

• [berkeley]

  I think that this area is worth additional research. Particularly to find a way to enhance selective attentional without the LETHAL effects of smoking.  

  This post seems to dangerously suggest that we should not only not encourage people with schizophrenia who smoke to quit, but that we should suggest they stop taking their other medications, and we should encourage the remaining 20% who don’t smoke to start.  As others have pointed out, this is not new thinking – there is evidence that tobacco companies have been targeting the mentally ill since the 1950s.

  Also, this article makes no mention of non-medication therapies (e.g. Cognitive Behavior Therapy) for schizophrenia/psychosis, for which there is also an evidence base.

• [berkeley]

  excellent point Lexicat! “The consistent result from those who actually do the research to test this common knowledge is that both mental health symptom severity and quality of life indicators improve with quitting smoking.”

• [urbanspaceman]

  Nicotine has been proven effective against Tourette Syndrome, so it’s not surprising that it may be effective against other neurological disorders. As stated above, the chief drawbacks are lung disease, heart disease and cancer.

  Is there any other medical specialty that gets as much armchair diagnosis as mental health?

  And is there any other category of illness that generates so much hate against its sufferers as psychiatric disorders? No one harasses, bullies, attacks or makes crude jokes about cancer patients. The public mental health system is out of control, less so than in previous years but out of control just the same. If I had a dollar for every healthy person or person with fairly minor problems who was slammed into a psych ward against their will, forced by a judge to take inappropriate medications, or prescribed powerful neuroleptics by marginally-competent doctors in public mental-health clinics, I could probably buy every health insurance industry lobbying firm in America.

  There is no excuse for prevailing medieval attitudes toward psychiatric illnesses just as there is no reason for neuroleptics to be as marginally effective and as dangerous as they are. If we can send men to the moon, if we can build a space station, then we can certainly invent medications which don’t turn chronic psych patients into chronic diabetics, make them morbidly obese or destroy their ability to function in other ways.

  I think the hate which has turned schizophrenics into pariahs or objects of scorn is also holding up serious research on effective treatments for their condition.

  • [Andrew Janssen]

    You say, “there is no reason for neuroleptics to be as marginally effective and as dangerous as they are.” In fact, there are several good reasons why neuroleptics are marginally effective and dangerous. First, we don’t completely understand what’s going wrong in the brains of schizophrenics, so we can’t make drugs which precisely target the problem. Second, drug development, especially of brain drugs, is non-trivially hard. Derek Lowe’s blog, In the Pipeline (http://pipeline.corante.com/) is a good place to start looking for more information. Comparing the difficulty of going to the moon to the difficulty of making a neuroleptic that doesn’t cause TD or diabetes is like comparing apples to orangutans.

    • [urbanspaceman]

      What the Apollo program proved is that when American society *wants* to do something, it will. Think of the engineers who stretched 1960s technology until it screamed. Think of the literally billions of 1960s dollars spent. We did it for the sake of national prestige and strategic advantage among other things, in the midst of the Cold War. (Many inventions from the space program ended up being used by the military.)

      The image of schizophrenics aimlessly roaming our streets, often homeless and untreated is certainly damaging to our national prestige to say nothing of what these people are going through. We need an Apollo program for the development of new, more effective and less damaging  treatments for schizophrenia; most of the current treatment regimes have changed very little in over 50 years.

      (The blog which you referenced appears to be down as of this writing).

      • [Andrew Janssen]

        I don’t disagree that we need to increase our investment in researching new treatments for schizophrenia; my point is that the difficulty of developing drugs makes going to the moon look easy.

        In the Pipeline, Lowe’s blog was up as of 1:52 a.m. CDT on 9/1/11. Beyond the entries on drug discovery, I recommend the entries tagged ‘Things I Won’t Work With’.

• [The Mayor of Awesometown]

  You know those commercials for meds that have a rediculously long list of side effects?

  This ones could just say “side effects include smelling like an ash tray, and CANCER.”

  • [GyroMagician]

    …”side effects include smelling like an ash tray, and CANCER.”

    The thing is, for pysch drugs, those side effects don’t look particularly frightening.

  • [Lexicat]

    And the big one: heart disease.

• [Kelly Crandall]

  Think about the typical patient, here. He is probably isolated and alone. Probably not very well off, as symptoms of schizophrenia kind of work against long-term job security. Maybe he has one or two inexperienced family members who are as baffled as he is about his behavior, who cannot get into his mind, who don’t know what to do.

  The patient tries cigarettes because they are commonly available. He feels some relief. So, he keeps smoking.

  All this medical knowledge you guys are throwing around doesn’t really help the typical patient, who may or may not even be diagnosed yet when he begins smoking. So, yes, there are better alternatives, but most of them will not just happen to be stumbled upon by the typical patient.

• [awjt]

  We should be thinking up a way to conduct a CONTROLLED experiment rather than basing policy or health recommendations on hearsay.

• [Linda Sewell]

  My dear brother-in-law was diagnosed with Paranoid/schizophrenia when he was 18…he’s now 55, has diabetes, copd, multiple sclerosis, and several other nasty side-effects from the meds he’s been taking (albeit off and on) for the last 30+ years. He’s been a heavy smoker all of these years, and I believe that he actually did better (psych-wise) when he was smoking. Now, however, he’s hospitalized with tumors in his lungs, severe pneumonia, and asthma…but he still wants his cigarettes and says that they are the only reason he keeps on going. As a matter of fact, he called me this morning to beg me to bring him a carton of cigarettes to the nursing home! It’s a sad situation, and I hope that more research is done in this area so that those who are diagnosed as young men and women now might not have to go through the same hell he has. Good luck to those who have loved ones with mental illness (and especially those of you who suffer with it yourselves).

• [lknope]

  Cigarette smoking is often encouraged for alcoholics and other drug addicts as well.  Do we consider addiction to be a mental illness?

  • [C W]

    “Do we consider addiction to be a mental illness?”

    Depends on how you look at it. The disease model is used for treatment, yes.

• [jeb]

  My extended family kept our schizophrenics in-house.  Smoking was preferable and less restricted than coffee drinking.  

  You always knew when somebody had experienced an episode; the meds would make them scratch and rub their palms.

• [Ashcan]

  On average, people with schizophrenia lose 20 years off their life span due to smoking.

• [CastanhasDoPara]

  Interesting debate about the effectiveness of nicotine (or other chemicals in tobacco). I did just want to see what people think of the actual act of smoking, as in the repetition, routine and the calming effects that the physical activity can provide for some smokers. It seems likely that such a structured activity would help people focus on something and therefore help them block out other environmental noise. Indeed controlled studies should be done. Though, I’m willing to bet that smoking is still pretty bad for your health, mental or otherwise.

• [r]

  Can’t talk about tobacco smoking in any sort of positive context without the anti-smoking nazis coming out in force…and I’m a former heavy smoker. As far as treating schizophrenics, I think it interesting and maybe or maybe not related, but when I was a heavy pot smoker and tobacco smoker, I didn’t like to smoke a cigarette after getting high (unlike most of my peers at that time) because the tobacco killed the marijuana high for me.

• [r]

  Forgot to mention, I’ve been tobacco free for over 10 years now.

• [DavidP]

  Makes me hate Nurse Ratched even more. 

• [Bionicgeek]

  I wonder if the new e-cigarettes would be a viable choice in this kind of treatment.

• [philarete]

  It seems to me that the e-cigarette has a lot of potential as a safe means of nicotine delivery for treating various conditions. In addition to schizophrenia, it might be helpful during the early stages of Alzheimer’s.

  I’ve been somewhat tempted to take them up myself, even though I don’t smoke. During my brief stint as a social smoker, I enjoyed the nicotine, but I hated the taste, smell, expense, and potential health risks. E-cigarettes solve all four problems. (Pending further research on health risks, of course.)

  My main concern is that I’d become addicted to nicotine, only to have the things banned by law, leaving me left with actually smoking. Yuck!

• [MossWatson]

  Oregon is in the process of banning tobacco use from all facilities which receive state health service funding.  This would include all mental health group homes, and will more or less force thousands of schizophrenics to quit using tobacco.  

• [snusles]

  I’ve had a few manic episodes, which are a temporary version of schizophrenia as far as I can gather.  Whenever I’m manic, cigarettes taste absolutely delicious – completely different to when I’m lucid.  There is almost a medicinal taste to them, and I can see why they are used as part of a shamanic ritual.  To me it doesn’t so much focus the mind as provide a mellower, perfumed experience, temporarily.  Which is nice when your brain is going at 1000 miles an hour and you’re feeling overly on top of the world.  

  I can’t speak for anybody but myself here, but I wouldn’t say that tobacco comes anywhere close to snapping one out of a deeply hallucinatory experience, which is my best description for mania.  But then again, neither do antipsychotics.  What works for me is to have a hot bath and reminding myself that what my brain is telling me about the world is not necessarily true.  And steering very well clear of psychiatrists.  It also really helps to have a non-judgemental person to ask reality-check questions of.  ”Am I actually dead and this is the afterlife?” “No” “Are you a god?” “No”, etc.

• [snusles]

  Oh dear, hope that comment didn’t kill the thread.  Just thought a subjective experience with mental illness/tobacco smoking might be of interest.  Or perhaps it was as unwelcome as a fart in a spacesuit…

  • [ShawShaw]

    You hadn’t killed the thread at all! I think the most valuable comments here are those recounting first-hand experiences like yours.
     
    And I must say, I really love the term, “unwelcome as a fart in a spacesuit.” Definitely filing that one away for later use.

• [Daren_Gray]

  Cheap?!

  In some places, $10 for a pack of cigarettes. That’s $300/month for pack a day habit. $600/month for two pack addiction.

  • [Sterno Dare]

    My current set of narcolepsy medications run about $700/month. When I smoke, it is two or three packs/week.

• [Sterno Dare]

  I definitely find tobacco, whether in a patch, lozenge, or cigarette, helpful for the effects of narcolepsy. And the side effects are much less horrible than the available medications. I have quit smoking more times than I can count, because I am aware that it is bad for you, but I don’t feel great about chronic amphetamine use either. Modafanil is not very effective and I find it extremely unpleasant. I would love to see more research into the possible beneficial uses of nicotine for neurological disorders.

• [Annika Raaen]

  My dearest friend had been a schizophrenic, and would often lament to me how she wished she could quit smoking but it kept her more sane and together than when she wasn’t smoking. Her grandmother died of an illness related to tobacco use, so she knew full well what could happen. She didn’t like it, but it helped her for the time she was alive. I couldn’t imagine being in her place…with the hallucinations, the TD, the weight gain, and the depression that comes with all that. So, if smoking gave her something positive, than so be it.

• [stevepalmateer]

  Jack Black plays a schizophrenic, self-medicating with nicotine in Bob Odenkirk’s 2003, “Melvin Goes to Dinner”.

  Michael Blieden: “Do you have any brain injuries?’
  Jack Black: “Yeah.”
  Michael Blieden: “What happened?”
  Jack Black: “I fell off my pteradactyl.”

• [MrEricSir]

  Here in the Mission District of San Francisco, there’s a schizophrenic guy who most of the day  feeding pigeons — but when he’s not doing that, he’s always smoking.

• [Maryn McKenna]

  One of those random observations that cops make and pass on to reporters: Given the decline in smoking in the general population, If you see a large group of people smoking outside a building — especially a non-business building, e.g. a church — it is almost certainly an AA meeting.

• [Marshall Astor]

  One of my dearest friends and co-workers was a heavy smoker with a serious history of mental illness who was on SSI.  She smoked heavily (and drank coffee around the clock) until she died of throat and lung cancer a few years back.

  I’m not sure whatever other meds she was on, but those cigarettes are the only reason she didn’t spend the last 25 years of her live in a totally institutionalized, catatonic state.  Even though I knew they were killing her, they were also the only thing that gave her anything close to a normal life.  When she was dying, there was never a moment when I wished she hadn’t smoked the cigarettes that gave her cancer.

• [Amelia_G]

  When my brilliant kindergarten friend developed schizophrenia 20 years ago, the doctors said on the official meds available his liver and/or kidneys would fail in 20 years. He’s done an amazing balancing act since then. In the local documentary (http://vimeo.com/10511236) he’s smoking obsessively. He’s had ups and downs but managed to edit together some truths in the 20 years big pharma gave him.

• [funchy crunchy]

  Schizophrenic people are far more likely to also drink and use recreational drugs.   Some people call it “self medicating”, as if being drunk or stoned is a “medication”.   Some schizophrenics use the drugs alone; some mix it with the prescription anti-psychotics or other psych meds.     

  I did a clinical rotation in a psych ward.   Before we make sweeping generalizations on the merits of what many schizophrenics do, understand that not all schizophrenics are the same.  Some do fight hallucinations (visual and/or auditory).    Others are delusional to the point of not being functional in society.   Some struggle to filter out environmental stimuli, especially from other people, to the point where it makes them agitated.     It’s not unusual for a patient with a schizophrenic diagnosis to have other psych conditions (severe anxiety disorder, depression, etc).      Many schizophrenics live in the community and can have a reasonably normal life with psych support & medication.   Only a small % end up as bad as the schizophrenic portrayed on TV or movies: completely broken with reality, totally delusional — the crazy homeless guy who goes on a murder spree because voices told him to.

  Science really doesn’t understand yet what is wrong in the brains of schizophrenics.   All we know is they share similar traits and some psych drugs can control the symptoms (though we don’t even know how).    To suggest they need to add another addiction to their list — an addiction with a high risk for cancer, COPD/emphysema, and stroke — seems counter productive 

• [berkeley]

  I’m confused about when “big pharma” became more of a threat than big tobacco.

• [bagelboy]

  I worked for a few years transporting patients to a daily outpatient mental facility, and I had a few patients who, in addition to their battery of daily meds, were encouraged to smoke. I was nearly outraged when I was told this, but it was then explained that, instead of mega-doses of meds, the nicotine served to aid in curbing nervousness, anxiety, and trepidation in some patients. So I can see the good in helping to not over-medicate. However there is still that little problem concerning cancer, emphysema, and the multitude of other possible ailments associated with smoking. But I guess you take the good with the bad here.

• [Tom Sheft]

  Nicotine patches?

• [jonw]

  cigarettes may be bad, but cigarettes ≠ tobacco
  smoke a pipe, get the best of both worlds

• [Matthew Gilmore]

  On an interesting tangent, in Peru Ayahuasqueros (shamans) may smoke a jungle grown tobacco when treating patients because, “the bad spirits can’t stand the smell,” which was told on a trip down there a few years ago.

• [brian12]

  What ever it was that effected me many years ago, diagnosed at some point as schizoid, was more effectively treated with nicotine than the meds I was prescribed. There’s another self-med that I have never seen discussed, which is the similarity in effect of alcohol induced hangover to electro-convulsive therapy in alleviating anxious depression.  

  • [querent]

    Interesting point.

    I was diagnosed as having “mild psychotic tendencies, with leanings towards paranoia,” and I lied through my fucking teeth to that shrink.  I just wanted to try paxil, but he put me on risperdol (sp?), too.  Had I told the full truth, god knows what he would have done.

    What most would consider auditory hallucinations are near constant for me.  And the inability to exercise selective attention.  Everything characteristic of schizophrenia, except the “disorganized thinking,” or however it’s described.  I’m actually a math grad student, and am quite good at it (with all due modesty).  The math is easy.  The hard part is showing up every day and existing in a crowd.  LOTS of anxiety (and insecurity) and a tendency to depression, too.

    I’m off all the psych drugs now, but I did have a fairly serious problem self medicating with alcohol, and would almost relish the hangovers sometimes.  Somehow the rawness of them, the overt, tangible pain, was preferable to the voices (usually hyper-critical female voices…my mom was a junkie and cut out when I was 6 months old).

    I have a loving partner (and she’s HAWT!) and I’ve been holding down this grad school gig for 2 years now (never held down a job that long before, and I’m 30).  I’m not as bad as some, but I can see it from here.

    Tobacco has always been an on and off affair for me.  I pick it up and put it down again once every two months or so.  To quote Dale Pendell, “Nicotiana is the Hammer.”  To paraphrase him, it pushes it all back a bit, gives you some breathing room and time to regroup.  But I try to stay in good physical shape too, and that is incompatible with tobacco use (or cigarette smoking, I guess).

    I don’t really have anything terribly productive to say here, but felt like airing this a bit.

    I am deadly serious when I say that you cannot judge another’s pain, or chastise them for the way in which they deal.  If you’ve never been sick, you cannot be a healer.

    peace.

    • [querent]

      http://www.amazon.com/Pharmako-Poeia-Revised-Updated-Herbcraft/dp/1556438052/ref=sr_1_1?ie=UTF8&qid=1314806733&sr=8-1

      required reading for any would-be practitioner of the shamanic arts. he dwells with equal ease in the mytho-poetic realm and the scientific-empirical realm. and he’s my favorite living poet.

    • [Guest]

      “If you’ve never been sick, you cannot be a healer.”

      WORD

• [bwcbwc]

  Seems like lung disease and cancer are pretty big side-effects to be taken into consideration, too. But the temporal factor always skews human perception of risk: why deal with a side effect now, when I can deal with a different side-effect later, or maybe get lucky?

• [Maurice Reeves]

  Nicotine has wide-ranging effects across the entire brain.  I don’t routinely smoke or use tobacco in any form but when I was diagnosed with epilepsy I researched different natural or homeopathic ways to regulate the seizures and I came across a double-blind study which showed epileptics had less seizures when on a nicotine patch then when not: http://www.cnsforum.com/commenteditem/3c5dccdc-27fb-4b80-9516-ab81e3e4ea6c/default.aspx

• [brian12]

  querent
  Thanks for your input. I quit being a patient almost 40 years ago, quit smoking 27 years ago, and haven’t had a real hangover in 20 years. The thing I sought in tobacco and alcohol was to reduce, temporarily, the avenues that thinking could go down. Painters say they are overawed by a white canvas and writers say they hate an open brief, I suppose this is similar.
  I started to thrive in this world once I had atained sufficient value to my employers, and my friends, that I had fuck-off privileges; I could establish reasonable boundaries in time and space about what I would or wouldn’t do. High level maths sounds like as good a ticket as any.
  and peace be with you

  • [querent]

    thanks man.  good to hear you’re doing well.  fuck off time is invaluable.

• [SCAQTony]

  It’s a dandy and worthwhile observation. Obviously there may be a benign drug within the cigarette that is useful and perhaps that benign drug is the same anti-anti-inflammatory that protects a smokers’ joints from getting arthritis. Hence, locating and/or “amping-up” that specific chemical would be the best alternative but till theninflammatory

• [social_maladroit]

  God, just reading this made me want a cigarette.

  I’m not schizophrenic, but I will cop to having SAD and OCD. I loved everything about smoking, except the cost and the knowledge that it stood a very good chance of giving me cancer, like my grandmother had. (That was an ugly death. Near the end, the act of simply moving her from a gurney to a hospital bed broke both her legs.) So I quit 2-1/2 years ago.

  But, as @boingboing-0ae444bcc39cbfb377925f6dfa5826af:disqus wrote above, cigarettes were useful for waking up in the morning and relaxing before going to sleep. In between, they allowed me to temporarily get away from the cacophony of life, and helped me concentrate, among other things. The idea that they’re used for self-medication is no surprise. I once knew a schizophrenic guy who smoked like a chimney.
   
  One of my pet peeves is the way society likes to pile taxes on cigarettes. Does my state need more money in its coffers? Ramp up the cigarette tax. Does the nation want to offer expanded health benefits to needy children? Ramp up the cigarette tax. Hey, it cuts down on cigarette use, and that’s a good thing, right? Well, dumping a higher tax burden on a small group of people you feel morally superior to is taking the easy way out. If you want higher tax revenue, everyone should pay for it, not just those evil smokers.

• [Daniel Bessonov]

  Say “people with schizophrenia”, not “schizophrenics”. The person is not characterized by his/her mental illness. Saying “schizophrenics” is as offensive as racism.

• [KateZeGreat]

  Isolate the active compounds that help with mental illness and put those active compounds in a pill/patch/water-inhaler…

• [Barbara Wagner]

  This post ignores the fact that the massive social stigma faced by people with schizophrenia is a huge factor as well – many people/their parents/spouses/friends don’t want to, or can’t face the possibility that they might have the kind of illness most commonly known from crime shows (where of course the person with schizophrenia is the serial killer everyone’s trying to catch) and so they won’t (or aren’t allowed to, or are discouraged from seeking professional help.)

  It’s the same with biopolar disorder – a lot of people, if they know you have it, either think that it means that you’re going to kill them in their sleep, or that you’re irredeemably crazy and so they can do whatever they like to you and use your illness as an excuse.

  Small wonder people self-medicate.

• [John Hubanks]

  Well, at the risk of over-exposing myself, I can tell you that those of us who struggle with Bipolar 1 can experience dissociative incidents resembling those of schizophrenics and, as a result, end up taking many of the same medications. My experiences at both mood extremes are disparate for obvious reasons, but on the highest end of mania the overwhelming sensory perceptions are, quite literally, maddening. Fortunately, I haven’t faced that situation for some time, but when I have in the past I found myself smoking each and every time and, often, without remembering when I picked it up again. I can’t speak to what drives me to the habit, but there’s clearly something about it that benefits me at those times. The side effects are worrisome, however, as are those of the accepted treatments. I’ve also taken pretty much every atypical antipsychotic at some point or another but most recently Geodon and, subsequently, Abilify at their maximum doses for over two years altogether. As it turns out, I shouldn’t have been taking those medications because the issue they were meant to address was not, in the end, what it appeared to be at first. Still, here I sit a little less than a year after having been weaned off the last one, and I weigh 60 pounds more than I did at the start (one of those notorious diabetes-like side effects). As a result of the sedative effects of those medications, I was not particularly motivated to do anything, as you might expect what with the sedation and all. I not only gained weight but atrophied over that period which lead to an injury when I began to try to get back into shape last fall (honestly, due to my own failure to grasp my condition as much as anything else). I’m only now beginning to get active once again. My injury has not entirely healed, but I have to start sometime. Hopefully, I’ve learned to be more careful in the interim.

  I offer that litany of complaints only to point out that I’m unsure whether or not I would be worse off had I smoked during that period rather than submit to the medication regimin offered. Certainly, my wife would not have appreciated the many issues that accompany living with a smoker so that must be taken into account, and I would have faced side effects from the tobacco as surely as I now do. But I honestly cannot say that an increased risk of respiratory disorders and heart disease (as serious as those ailments are) would have been worse than the all-but-guaranteed weight gain and metabolic issues since both affect the heart and, in the case of metabolic issues, also the pancreas. To employ a cliche, it truly is a Sophie’s choice.