The relationship between smoking cessation and binge drinking, depression, and anxiety symptoms among smokers with serious mental illness

Drug Alcohol Depend. 2019 Jan 1;194:128-135. doi: 10.1016/j.drugalcdep.2018.08.043. Epub 2018 Nov 2.


Introduction: Concerns about the adverse effects of smoking cessation on alcohol use and mental health are a barrier to cessation for smokers with serious mental illness (SMI). The purpose of this study is to examine how incident smoking cessation affects binge drinking and symptoms of depression and anxiety among smokers with SMI.

Methods: The present study is a secondary analysis of the OPTIN trial, which demonstrated the effectiveness of proactive outreach for smoking cessation among Minnesota Health Care Programs enrollees. Participants with ICD-9 codes indicating schizophrenia spectrum disorders, psychotic disorders, bipolar disorders, or severe/recurrent major depressive disorder were categorized as having SMI (n = 939); remaining smokers were categorized as non-SMI (n = 1382). Multivariable regressions modeled the association between incident smoking cessation and binge drinking, PHQ-2 depression scores, and PROMIS anxiety scores in the two groups.

Results: Quitting smoking was not associated with binge drinking among those with SMI, but was associated with less binge drinking among those without SMI (p = 0.033). Quitting smoking was not associated with PHQ-2 depression scores among those with or without SMI. However, quitting smoking was associated with lower mean PROMIS anxiety scores for those with SMI (p = 0.031), but not those without SMI.

Conclusion: Quitting smoking was not associated with heightened binge drinking or symptoms of depression and anxiety among smokers with SMI. These findings suggest that quitting smoking is not detrimental for these patients, and provide evidential support for facilitating access to cessation resources for patients with serious mental illness who smoke.

Keywords: Alcohol consumption; Mental health; Serious mental illness; Smoking cessation; Socioeconomic disparities.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / epidemiology
  • Anxiety / psychology*
  • Binge Drinking / epidemiology
  • Binge Drinking / psychology*
  • Depression / epidemiology
  • Depression / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Minnesota / epidemiology
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / psychology
  • Severity of Illness Index
  • Smokers / psychology*
  • Smoking / epidemiology
  • Smoking / psychology*
  • Smoking / therapy
  • Smoking Cessation / psychology*
  • Young Adult