Smoking: Smoking Cessation

Smoking cessation support combines attention to nicotine dependence, habits and the person’s circumstances. Options can include behavioural support and appropriate cessation medicines, chosen with regard to mental and physical health. A previous unsuccessful attempt does not mean that further support is pointless or that the person cannot benefit.

Smoking is common among people receiving care for schizophrenia, but patterns and reasons vary. Tobacco smoke and nicotine have different pharmacological roles, which matters when discussing medication interactions. Assessment should address dependence, physical health and treatment exposure without assuming that smoking is necessary for cognitive function or that cessation support is unsuitable for people with psychosis.

Planning should include communication with the prescribing team because stopping tobacco smoke can change levels of some antipsychotics. Nicotine replacement may help withdrawal but does not maintain smoke-related enzyme induction. Follow-up can address cravings, sleep, mood and medication effects as well as practical barriers. The person’s goals and preferences matter, and changes should be supported rather than imposed through shame. Integrated care can make cessation safer and more manageable, while ensuring that psychiatric treatment remains effective and that new symptoms are assessed rather than automatically attributed to withdrawal.

A cessation plan can prepare for changes in routine as well as withdrawal. Follow-up should distinguish nicotine symptoms, medication effects and changes in mental health rather than assign every difficulty to one cause. Clear contact arrangements make this easier. Support can be revisited after an unsuccessful attempt, using what was learned to develop a more workable approach next time.

Further reading: NICE clinical guideline; NHS Specialist Pharmacy Service.