In much the same way that drinking alcohol (a depressant) actually increases feelings of depression, smoking cigarettes may actually increase feelings of anxiety. So, when we drink because we’re sad or smoke because we’re stressed, we may be making our problems worse.
A recent study in the British Journal of Psychiatry found that quitting smoking markedly reduces anxiety for those with psychiatric diagnoses (McDermott, Marteau, Hollands, Hankins & Aveyard, 2013). Against their intuitions, people who are able to quit smoking find that they benefit from an improved mood (Raven, 2014).
Clinicians, particularly those who work in drug and alcohol rehabilitation, have long been protective of a patient’s right to smoke. They see it, in part, as a fairly benign way to cope with the stress and anxiety associated with gaining sobriety. Although the deleterious effects of smoking on one’s physical health are well documented, smoking doesn’t seem to have wider-reaching consequences parallel to those of drinking. It doesn’t tear apart families and marriages; it also doesn’t cause impairments in driving or lead to job loss.
The acceptance of smoking in rehab settings, though, may actually be promoting a culture of smoking in this population. According to one study, more than half of recovering alcoholics smoke, and smoking is the leading cause of death in this population (News Medical, 2008). It’s socially acceptable among this population, and doesn’t seem to be treated as an addiction in the way that alcohol is.
Dr. Paul Aveyard from the University of Oxford argues with the assumption that smoking helps recovering addicts. "’For clinicians like myself, when we see people who smoke who also have mental health difficulties, there's often a feeling that we are depriving them of a way to deal with the stress,’" he says. "’But in fact we are helping these people to get better (Raven, 2014).’"
So why do clinicians so often get the smoking-stress relationship wrong? And why are we, as smokers, drinkers, and anything else, generally so bad at medicating ourselves?
One possible answer is that the habits associated with smoking do provide relaxation. If you work at a company where smoking breaks are still allowed, you know that smokers tend to take more breaks, and also to step outside. Recent research also suggests that smokers engage in inhale-hold-release patterns during smoking that are more similar to those used in meditation than normal breathing. The motions of having a cigarette, and the relaxation involved in deep breathing, may be a major part of the addiction (Wells, 2012). Without the compulsion to smoke, there’s little reason to build revitalizing short breaks and deep breaths into the structure of one’s day. In fact, without an addiction to attend to, you may not even feel entitled to this form of self-care.
Another potential answer is that the belief that we’re doing something relaxing can be pretty powerful. We tend to structure our experience with our expectations, so when we expect an activity to be relaxing, we might experience it that way—even if it subsequently increases our general sense of agitation and overall stress level.
There’s something immediate about smoking and drinking that longer term trends don’t pick up on. The short term value is quantifiable; smoking and drinking activities do produce brain changes. And these brain changes can feel pretty good when our physiological states get intolerable.
But it’s the larger trends that need attention, in part because they give us clues to the short-term puzzle. Why don’t we take 10 minute breaks every few hours? Why don’t we walk around and stretch or step outside for a few deep breaths? Why are we so worried that our self-care be meticulously justified? If smoking makes us more anxious overall, perhaps we need to press harder on the questions it’s trying to answer.
McDermott, M. S., Marteau, T. M, Hollands, G. J., Hankins, M. & Aveyard, P. (2013). Change in anxiety following successful and unsuccessful attempts at smoking cessation: Cohort study. British Journal of Psychiatry, January, 202 (1), 62-67.
New Medical (2008). Coffee and smoking notorious at Alcoholics Anonymous meetings. July 19, Accessed at http://www.news-medical.net/news/2008/07/19/40103.aspx.
Raven, K. (2014). Quitting smoking linked to improved mood. Chicago Tribune, March 12, Accessed at http://articles.chicagotribune.com/2014-03-12/sports/sns-rt-us-quitting-smoking-mood-20140312_1_reuters-health-quitting-smoking-smokers
Wells, S. D. (2012). New research reveals breathing pattern of smokers deepens the addiction. Natural News, Tuesday, May 29. Accessed at http://www.naturalnews.com/036075_smokers_addiction_breathing.html