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up in smoke (Featured in Schizophrenia Digest)

As many as 90 percent of schizophrenics smoke.
Is anything being done to address this issue?

by Christina Friedrichsen

Smoke pours from Paul Stanutz’s mouth, as his nicotine-stained hands reach for a second cup of Coca Cola.
Stanutz, 44, who suffers from schizophrenia, has been smoking for more than 20 years. Although there aren’t too many public places left for him to light up, a Burger King in the small town of Amherstburg, Ontario allows him to satisfy his nicotine cravings.
One after another, cigarette butts smoked clean to the filter pile up in the tin ashtray in front of him. Players Light is his brand of choice.
“I started smoking when I went into the hospital at 23 years old,” he says, adding that he is now a pack-a-day smoker.
Stanutz says smoking gives him a “relaxing feeling.” But, he admits, it also makes him feel tired.
“I don’t have as much energy as I used to,” he says. It also aggravates his respiratory condition.
“My asthma comes back on me when I smoke too much,” he says.
With only $112 spending money each month, cigarettes also devour most of his monthly budget, leaving him with only $12 left over each month.
He’s tried quitting. Back in the early 90’s he gave up cigarettes for an entire month – and he did it cold turkey.
But the addiction dragged him back. He thinks about quitting again.
According to researchers, people with schizophrenia have more than triple the smoking rate of the general population.
While the Journal of the American Medical Association states that people with mental illness smoke half of all cigarettes purchased in the U.S., other reports suggest that the smoking rate among schizophrenics is as high as 90 percent.
Why is the smoking rate so high among those with schizophrenia?
Some researchers have reported that people with schizophrenia have a deficiency of nicotinic receptors in the hippocampus, an area of the brain that is involved in cognitive processes such as memory, attention and sensory gating (the ability to filter out extraneous sensory input).
Researchers state that nicotine can stimulate these brain receptors, and improve sensory gating in schizophrenics, thereby helping them to filter out stimuli – such as background noise, and other distractions which can otherwise cause a schizophrenic to suffer information overload.
A study in the Journal of Orthomolecular Medicine offers a different theory. A recent article in the journal proposes that schizophrenics use smoking as a form of self-medication to “temporarily relieve the adverse symptoms associated with adrenaline deficiency.” The study states that schizophrenics are adrenalin deficient because their bodies convert the compound adrenalin abnormally rapidly to adrenochrome, a hallucinogen that promotes psychosis. Interestingly, the study states that adrenochrome is “a double edged sword” because it is also believed to protect against lung cancer.
The article cites several studies that reveal that there is low lung cancer incidence among schizophrenics.

Smoking cessation

Little has been done to address the issue of smoking and schizophrenia.
Five years ago, the Addiction Centre at Foothills Hospital in Calgary, Alberta operated a smoking cessation program that was modified to meet the specific needs of schizophrenics. This program is no longer in existence.
Rick Kennedy, director of marketing and development at the CMHA (Canadian Mental Health Association) national office says he is not aware of any programs on a national level that deal with this issue, and that during his three years as director of marketing and development, CMHA has not been approached with requests for this type of program.
Frank Sheehan, president of the Schizophrenia Society of Ontario, Windsor-Essex Chapter, says he would like to see smoking cessation programs that are run by the medical profession and specifically tailored to those with schizophrenia.
“(That) would be excellent,” he says.
Sheehan says traditional smoking cessation methods would not be effective for people with schizophrenia. He points out that medications that include nicotine could be beneficial.
“The ingestion of nicotine helps (those with schizophrenia),” he says.
A recent study conducted at Yale University reveals that schizophrenics who took the newer anti-psychotic drugs, such as Risperidone (Risperdal) and olanzapine (Zyprexa) along with the nicotine patch were nearly three times more successful in quitting smoking than schizophrenics taking more traditional anti-psychotic medications and the nicotine patch.
Another study revealed that schizophrenics smoke fewer cigarettes when they are on the drug clozapine.

Cold turkey

Ed Adams, is one of the few schizophrenics who has successfully quit using the cold turkey method.
Adams, who was once a three-pack-a-day smoker, hasn’t had a cigarette in 10 years.
Health problems, and a physician’s verbal warning motivated the 52-year old to quit.
“I started getting pains in my chest,” he says.
After telling his physician about his smoking habits, he was warned to give up cigarettes.
“The doctor said ‘You’re just working your way to the grave’,” he explains. “I thought ‘I’m way too young to die. There must be something else I can do besides smoke’.”
Adams says he’s gone from 180 lbs to 320 lbs since he gave up his Export A’s. And even after a decade of not smoking, Adams still gets cravings.
“I think about it all the time,” he says.
But so far, his willpower and desire to stay healthy has won over.
“I think any amount you smoke is terrible.”