Smoke: Who's Inhaling?

There are probably four main groups. The first and most obvious are inveterate, long-time smokers with a life-long history of addiction to tobacco. Their habitual use of tobacco goes back to a period of great social upheaval when smoking was accepted, even admired, and when smoking was freely promoted in the media. They are often my age and older. Most have clear and obvious smoking related illnesses. Most want to stop, but having tried and failed, they have largely given up. They are dying breed.

At the other end of the spectrum are the bullet-proof young. It has been suggested that young people are attracted to the tobacco industry 'image' of tough, cool, sophisticated, sexy, attractive. Other suggest it's a form of rebellion.

Although nicotine addiction keeps people smoking, young people usually start smoking because of the social image they want to present to others.

More young women than young men smoke, but though teenagers are the group with the highest uptake rate of cigarette smoking, the proportion of kids who smoke has been falling for the last 10 years at a similar rates to adults. About 20% of 14 to 17 year old now smoke.

The two groups who are now the heaviest smokers have two things in common: high rates of poverty and drug abuse. They are indigenous Australians and the mentally ill. I will deal with indigenous smoking in a separate Intel.

80% of all drug related deaths are due to tobacco, and half of all people who use illicit drugs, like half of all people with an alcohol problem will die from a tobacco related problem, even if they have recovered from their other drug dependence! Sadly, the same statistics apply to people with mental health problems.

Smoking, drug dependence and mental illness are intertwined. The more severe the mental illness, the higher the rate of cigarette use. People with depression and anxiety disorders are twice as likely to smoke as the general population, about 80% of people living with bipolar disorder smoke, and as many as 90% of people with schizophrenia smoke. the only other group that approaches these figures are people with personality disorders, especially borderline ~ guess what they die from!

I have mentioned death several times. death is not the worst consequence of smoking for the mentally ill, Nicotine addiction for people on limited incomes forces a choice between food, shelter and smoking. Too often, smoking wins. And when death comes, it is not a nice quick, clean end. Life expectancy is reduced by about 15 years, and the last 10 are seldom healthy, active ones.

The impact of smoking on medication cannot be underestimated, either. Medications that help control depression and psychosis work for smokers just as with non-smokers: but much higher doses are needed due to the effect of nicotine and hydrocarbons on the liver and other organs.

Higher doses mean more side effects and more negative health consequences. These are the two reasons most people quit taking their medications and subsequently relapse.

Today, about half of all tobacco sold is consumed by people with mental health problems. With diminishing consumption by the general population and few specialised interventions for the mentally ill, it seems that this group represents one of the few remaining cash-cows for tobacco companies in the West. But of course, they would never exploit them, would they!

Incidentally, it is becoming ncreasingly likely that smoking is a direct cause of anxiety and depression. We used to think that people with these problems just smoked more to help them cope... it seems not. Smokers have more anxiety attacks, higher rates of suicide and more depressive illness than non-smokers. When they stop, the rates return to the same levels as the rest of the population...until they begin again.