Nicotine Use and Mental Illness

Mental Health Awareness Month

The month of May was Mental Health Awareness month.   What is the connection between mental health/illness and vaping? You’d be surprised to know according to the CDC’s own website “Approximately 1 in 4 (or 25%) of adults in the U.S. have some form of mental illness or substance use disorder, and these adults consume almost 40% of all cigarettes smoked by adults.”  I would venture to say the level of mental illness may actually be higher than 25% in America of the population, but we’ll go with the CDC’s numbers for the sake of this conversation.  It is frightening to think that 1/4 at least of the American population smokes almost half of all the cigarettes smoked!

What does vaping have to do with this?  Vaping is a form of ingesting nicotine through inhaling of aerosolized particles as opposed to lighting a cigarette and inhaling the burning smoke of the leaf mush that is contained within a treated paper. Cigarettes over the years have been treated with all sorts of chemicals, in the recent past a chemical was even added to cigarettes (or their papers) to retard the continuation of burning without puffing on it in an attempt to prevent house fires. Most people don’t realize this has happened and made smoking even more dangerous to those inhaling them.  Cigarettes will kill just about everyone who smokes them through one of many different health problems, from heart disease to lung diseases to cancers. The risk of dying prematurely – because let’s face it we’re all going to die, we just don’t want to die before we naturally would have – from smoking is up in the 90% ish levels.

So, about 80 million adults in America that suffer with mental conditions will likely die prematurely due to smoking that could be replaced with a safer alternative, vaping. The numbers are up in the hundreds of millions world or maybe even more world wide.  And yet the Governments, both at the national level and at state levels, are making laws and regulations to ban, restrict access, and increase price on an activity that allows people who want to consume nicotine an option that is nearly as satisfying as the act of smoking, but carries 95% (at least- possibly 99% less) risk of premature death.  That is what we are talking about folks when people say Vaping is 95% safer than Smoking.  It means you are less at risk of premature death due to diseases caused by chemicals introduced into the body at high doses through smoking. Not that it is 95% safe compared to living in a bubble where you take no risks.

The Mentally Disordered and Addiction

According to that CDC page Alcohol seems to be the most commonly used substance by the 40% of the smokers who have mental health challenges. Nearly half of the smokers also drink alcohol regularly. The levels of Cannabis use are likely not accurately reflected on this page since the many states have legalized recreational and medical cannabis use, and cannabis is more of a medicine for those with anxiety and mood disorders than it is an addictive substance.   But alcohol, while it can be calming, it can be relaxing, it can also have far more adverse effects over something like Cannabis. Alcohol has less value when it comes to your mental health, as it can promote depression and anxiety and out of character behavior once it reduces our inhibitions.

We do have to take the CDC’s numbers with a grain of salt. They do consider alcohol dependence just as much as nicotine dependence to be an addiction and thus a mental illness/disease in and of itself.

Does nicotine use and enjoyment of that use constitute addiction?   Considering that people can use alcohol, cannabis, hallucinogenic substances, and even cocaine at recreational levels without needing to have that substance daily, does daily use of nicotine (not in combustion cigarettes) if it is felt that it is needed to function then yes, according to standard psychology diagnosis it is an addiction.  But how does it differ from other possibly addicting substances? Nicotine itself has only casually been reported to possibly cause stiffness in arteries that might result in heart attacks, but most of those studies were looking at smokers of combustible cigarettes.  Without studying the nicotine on it’s own and it’s consumption on it’s own outside of inhaling smoke, we can not assume that it IS the nicotine that is the cause.

According to a study done on the effectiveness and safety of NRT’s, HERE

Nicotine may play a role in smoking-related cardiovascular disease through hemodynamic effects and possibly through the acceleration of atherosclerosis. However, tobacco smoke contains many chemical constituents that can harm the cardiovascular system, including combustion products such as carbon monoxide and nitrogen oxides. It is not clear what fraction of cardiovascular morbidity is attributable to nicotine intake; however, it is generally believed that the benefits of nicotine pharmacotherapy use in terms of smoking cessation outweigh the risks, even among smokers with stable heart disease…    It has also been shown that smokers tend to titrate their nicotine intake to achieve a relative constant dose, which could lead to a reduced intake of combustion products and a favorable risk–benefit profile. 

They do also go on to say that nicotine shows no real links to being carcinogenic in nature, though there is some uncertainty if using smokeless tobacco or NRT products with nicotine could raise the potential risk of other non smoking related cancers by accelerating cancer cell development, but it is very fuzzy on this research. Also to note this is a study done by Big Pharma, and there are many other studies out there that are like this. But this study concluded that:

Although there is no clear evidence on the role of long-term nicotine intake on disease risk, we have shown that the long-term benefits of increased smoking cessation still far outweigh the risks from long-term NRT use. In addition to premature mortality, smoking is a cause of many nonfatal adverse health conditions that lead to poorer overall health and more days of missed work for smokers than for comparable nonsmokers.

It does lead one to wonder why if there are all these studies out there proving that NRT’s and smokeless tobacco is far safer – cause risk is a spectrum where smoking is a high risk to premature mortality and nicotine itself does not appear to pose the same risk level when used in another form – why is vaping under such attack?  And what does this mean for those who suffer with mental health disorders?

People with mental health disorders appear to be more likely to smoke, smoke on average more cigarettes than neurotypical people, and have a harder time quitting – more likely to relapse to smoking than neurotypical people. This means mentally disordered people are at even higher risk of premature death cause by smoking out of the population.  According to The National Institute of Drug Abuse

Smoking is believed to be more prevalent among people with depression and schizophrenia because nicotine may temporarily lessen the symptoms of these illnesses, such as poor concentration, low mood, and stress.

The disparity in smoking prevalence is costing lives. A recent study found that tobacco-related diseases accounted for approximately 53 percent of deaths among people with schizophrenia, 48 percent among those with bipolar disorder, and 50 percent among those with depression.

Since the 1980s, many providers have believed that people with schizophrenia smoke to obtain relief from symptoms like poor concentration, low mood, and stress. But research is now showing that smoking is associated with worse behavioral and physical health outcomes in people with mental illness, and quitting smoking is showing clear benefits for this population.

Unfortunately for those of us who find we need nicotine just to function in our daily life, who have quit many times and returned back to it at some level, the studies on mental illness and nicotine on it’s own is significantly lacking.  Because so much of the medical community has been focused on smoking as the consumption method for nicotine, they throw nicotine dependence (which can be considered something different to self destructive addiction behaviors) into that self destructive category as something that needs to be treated and stopped.

Of course this all comes from the pharmaceutical companies research where they are perfectly fine with having mentally ill patients dependent upon various drugs they produce for the entirety of their life, but nicotine dependence is bad and must be treated. We have some seriously fucked up attitudes in the medical community that contradict itself constantly, and this is what people deal with when they enter the system for mental health care. Lots of stigma, lots of telling us what we should and shouldn’t do in order to be stable functioning humans on a daily basis, and most of the time their treatments don’t lead to healing, just life long dependence on their drugs.

Nicotine dependence outside of smoking doesn’t appear to constitute a high risk behavior or self destructive addiction.  Use of smokeless alternatives, vaping, or even NRTs can improve the body health of those with mental health conditions, but doesn’t have to be the point of cessation for all people who use them, because nicotine isn’t the bad guy here. Nicotine much like caffeine or even chocolate have a mental effect on the user. They can become dependent upon a substance like caffeine, but as a society we appear to be okay with this socially acceptable “addiction” because it is generally seen as making people more productive and not a high risk, self destructive substance that causes issues for the user (unless one overdoses.) Nicotine dependence is only viewed in this evil light because it is connected to smoking.  It’s not due to nicotine being more risky or harmful than caffeine.  So this is a social issue, not a medical one, and the mental health afflicted community are the ones to suffer the most from this stigma.

My Story

I’m not neurotypical.  I may be able to act like I am on the surface, but underneath it – in my private life outside of my social media presence I am not “normal.” I have a whole host of issues that accompany Autism Spectrum Disorder – sensory disorders, anxiety, social anxiety, overwhelming senses that lead to shut downs and melt downs, lots of quirks and special interests, can’t understand many jokes or sarcasm, and struggle with a lot of day to day activities despite having a high IQ. I would be considered Asperger’s Syndrome if that were still a medical term, though it is now just umbrella’d under ASD in the DSM V.   While having autism these days isn’t connected with as much stigma as it once was, it’s still considered a “boys” disease, because females present the symptoms differently and often use masking (which is another term for award winning acting performances but just in your daily life) to appear normal to the outside world, because we want to fit in.

This is not all that is going on in my mental health. I have other problems too. I don’t talk about my other condition because it carries way more stigma than say bi-polar or BPD or co-dependency, because those disorders have become more common place and people understand what it is when someone says they have that issue. Mental conditions like schizophrenia and dissociative disorders (like I have) carry much more stigma and confusion and general fear in the public. But since it’s been nearly a year since I found out about my condition and since it’s Mental Health Awareness month, I decided it’s time to talk about how these things relate to nicotine dependence.

My mental disorder is called Dissociative Identity Disorder (DID for short.)  For all of you who follow this site or the you tube channel you know me as Jennifer, but in fact the personality who is writing this article is not Jennifer. My name is Jessica and I am a part of a system of identities that were created through our life to deal with stressful and traumatic events.  This disorder has remained hidden for most of our life and the personality of Jennifer was made to not know about it, at least until she was ready to accept it. For years she struggled, trying to figure out why she felt like she lacked an identity sometimes and other times was certain who she was and what she liked and didn’t like, but then in those times of certainty the identity didn’t always fit with who she thought she was.  This is because it was the rest of her mental system.  And while this is still a disorder that is not well known to the public aside from horror movies and often in the medical community is dismissed as flights of fancy or “all in your head” (which ironically yes, yes it is all in our head, cause that is where our brain is located!) it is a disorder that affects 1%- 3% of the population world wide, and is actually more common than schizophrenia.

How does this relate to smoking and vaping?  Well, as a human with multiple mental conditions that make daily living sometimes challenging, nicotine consumption was often the one thing that kept some semblance of normality within the brain. Dissociating is common with autism, and the heightened sensory system leads to high anxiety and more easily traumatized individuals, for which the brain uses dissociation to escape from that pain.  Abuse for a child with autism can be far more traumatic than one might imagine, even when that abuse is mental and emotional. This can lead to disorders on the dissociative spectrum. Much like autism, dissociative disorders are also considered a spectrum and DID is part of that spectrum at the more severe end of it.

Nicotine use helps regulate anxiety and stress levels, but so too does the actual act of smoking a cigarette. The hand to mouth activity is a stimulation act which is something autistic people tend to seek out — this is why fidget spinners are a common tool used for both ASD and ADHD for what is called stimming. Nicotine improves memory, and in someone who dissociates all the time (this is often seen as being spacey or out of it) and in someone who has amnesia barriers in their mind, nicotine can help with memory – to some degree. Nicotine and the act of smoking is often a therapeutic activity for people who are dealing with mental conditions. The act of breathing in the smoke (now as a vaper the aerosolized flavors and nicotine) is also a grounding process. Much like deep breathing and meditating, this act of inhaling a substance into the lungs focuses the mind on the breathing and also acts to calm and center the focus of the person who is in an anxiety/panic attack or who is spacing out and feeling floaty (which is what dissociating feels like.)

Self titration is actually an issue for many people with mental conditions.  I used to find myself chain smoking despite not feeling the “need” for nicotine.  I still vape A LOT, but I have lowered my nicotine to 1 mg because I started to feel myself overdoing the nicotine with vaping than I did with smoking.  The side effects with smoking, the coughing and the general chest irritation covered up the nicotine jitters and racing heart that is now felt very prominently with vaping as the chest irritation is no longer exists.  Over the 6 years since my last cigarette I have moved from 18mg e-liquid down to 1mg. I still vape about 30mg of nicotine a day, but I also use an e-liquid guzzling RDA, so amount of liquid vaped is relative, but it’s about 700 to 1000 puffs per day according to my mod. It’s less about getting a bunch of nicotine and more about the act of vaping and getting the little bit of nicotine that I need to help my mental conditions. Vaping helps me focus my thoughts, gives me a moment to take a few puffs and collect my thoughts, and is something everyone in this DID system enjoys doing. It helps ground us when we’re stressed, or anxious, or confused, and adjusting to being the identity (or blob of neurons) controlling the body.

We will likely never quit vaping. With most of the health risks eliminated by vaping rather than smoking, we see no point in quitting something that helps us with our mental health and is something that most of our system enjoys. While non-smokers might say, “Why not just quit and practice deep breathing meditation.” My answer is that it’s just not the same.  We meditate. We do other things that are calming. It’s not the same as smoking and now vaping. For some of us vaping is not a cessation tool, but a far less risky or self destructive behavior that we want to continue doing and we’re not concerned about a mild nicotine dependence. We use non-nicotine e-liquid often enough, usually at night when we’re trying to settle down before bed or when testing a bunch of single flavor samples, but for the most part we enjoy our 1 mg nicotine just where it is. So is vaping an addiction? It could be, for some people I supposed. But for those who are not neurotypical it may be an activity that they become dependent upon to help with their daily life as a grounding tool, as a centering tool, as a focus tool, as something to help enhance a hindered memory system, and something to calm them in the midst of high anxiety and stress.

These are aspects the anti-smoking and health community have ignored. These are the side of smoking and now vaping that they don’t want to acknowledge.  They want to turn everyone into dirty nicotine addicts who are jonesing for their next fix, like a bunch of crackheads. In trying to stigmatize smoking so that the public will be less likely to do a high risk behavior, they have inadvertently stigmatized nicotine itself and anyone who wishes to use it or is dependent upon it for their mental health. They’ve made addiction itself a disease, rather than another symptom of other mental conditions (which it normally is.) They like to treat the addiction on it’s own like it’s the only disorder present, rather than dealing with the underlying conditions that the person may have that led them to high risk, self destructive behavior. Ignoring the underlying conditions, especially for smokers, leads the general public to look at them as people who just lack self control, who are rebelling against the norm and just want to offend all the normal people.  A lot of the smoking population (and now in turn the vaping population) have mental health conditions, and being stigmatized by the government and health community further stigmatizes an already marginalized part of our population.

So maybe in honor of idea of Mental Health Awareness month – we vapers should take to social media and spread awareness about how we have mental conditions and how vaping helps us with our mental conditions. We should let public health officials know we may not be looking to quit nicotine, we may not be looking to quit vaping, and that we want to continue to have a safer alternative for an activity that we find to help us with our mental conditions.  (While it is now June and not technically mental health awareness month, we think mental health awareness is important and should be discussed year round, not just during one specific month.)


  1. Wonderfully written, deeply honest and generously practical post. Jenn/Jess I guess we can just call you the flavorpro for short 🙂 Something that stands out in your thoughts is that you have taken responsibility for things that you should take responsibility for, and you are not allowing any of life’s friction to slow you down in your artform/life/identity. Keep it up!

  2. This sounds so good and true and yet being labeled myself as someone who has many disorders as well I was diagnosed as borderline multiple personality disorder but also manic OCD PTSD depressed highly anxious and self harming an addict society puts so many labels out and yet still wants to sweep it under a rug so to say thank you for doing this

  3. Thank you for being so open and honest. I too have many mental issues starting with anxiety, panic disorder, depression, personality disorder and I have also experienced dissociative states. I’ve done a lot of therapy, I know what caused all of this, but still I have to live and deal with it on a daily basis. Vaping also helps me. I’ve been thinking about CBD, but still uncertain.
    I just wanted to say thank you, you are amazing!

    Bianka Weber

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