The Complex Relationship Between Nicotine Consumption and Mental Health

Countless studies have looked into the relationship between the consumption of nicotine and/or tobacco products and mental health. What have these shown?

A recent study titled, “Associations between smoking and vaping prevalence, product use characteristics, and mental health diagnoses in Great Britain: a population survey,” looked into the prevalence of smoking and vaping among people suffering from psychological distress.

Analyzing data from 27,437 adults in Great Britain surveyed between 2020 and 2022, the research team found that compared to never smokers, current smokers were more likely to report a mental health condition (MHC). Similarly, vapers were more likely to report a history of MHCs than non vapers. In fact, smoking, vaping and dual use were all substantially higher among those with a history of MHC, concluded the study.

Meanwhile, a 2022 study published in the Annals of the American Thoracic Society named EVALI lung injuries, as a possible cause of mental health issues in vapers. The study authors, who inaccurately attributed EVALI to vaping, said that beside long-term respiratory problems, the lung injury could cause cognitive impairment and mental health issues.

The Intermountain Healthcare study titled, “Prospectively Assessed Long-Term Outcomes of Patients with E-cigarette or Vaping-associated Lung Injury (EVALI),” said that the long-term impacts of e-cigarette or vaping associated lung injury (EVALI) can persist for a year or more.

At a 12-month follow-up appointment, the research team found that 48% of the patients still had respiratory problems, and one-fourth reported significant shortness of breath. With regards to mental health, a total of 59% had mental issues, namely anxiety, depression, and 62% had experienced post-traumatic stress. Sadly the authors failed to highlight that EVALI is not actually caused by regulated vapes containing nicotine but by illicit cartridges containing unregulated THC oil.

Smoking rates among US mental health patients seem to be declining
Another study recently published in JAMA, reported significant reductions in smoking rates among U.S. adults with major depression and substance use disorder, from 2006 to 2019. Titled, “Trends in Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders, 2006-2019,” the study is reassuring as public health experts have long been concerned about the generally higher smoking rates among people suffering with mental health disorders.

Moreover, individuals suffering from lack of mental wellbeing are more likely to find it harder to quit smoking. To this effect, they benefit greatly from having extra support in relation to smoking cessation and access to safer alternatives, that would at least lessen the chances of them also suffering from smoke-related conditions.

The addiction to smoking is mostly psychological
In fact, a study published in Frontiers in Psychiatry, found Nicotine addiction to be mostly a  psychological factor rather than a physical one, as generally assumed. The research was conducted by following 24 chronic smokers and looking at their brain activity through an MRI machine. Each patient had to visit the research facilities on four occasions, but were only given real cigarettes two times out of the four. When given the real cigarettes, on one occasion they were told the cigarette was real, and on the second occasion they were told it was not. The same process was repeated with the “fake” cigarettes.

The researchers observed that even when smoking the real cigarettes, the study subjects only felt satisfied when they believed that they were smoking real cigarettes. When the participants were told they were not getting nicotine, (even if they were), they did not experience any of the effects of nicotine. While on the other hand non-nicotine containing cigarettes did not have any effect on the study subjects, irrelevant of what they were told.

Targeted smoking cessation approaches required
In line with countless other studies looking into the relationship between mental well-being and consumption of tobacco or nicotine products, the above indicate the need for  targeted smoking cessation approaches for certain populations. Individuals suffering from MHCs are more likely to smoke and have a tougher time quitting, and this needs to be taken into account when designing smoking cessation programmes.