Family and Caregiver Schizophrenia Discussion Forum

Cigarette addiction; How do I help as a caregiver?

I have a friend who had been a street person for 7yrs. I took him in and found out that he was diagnosed with Schizophrenia and had very little family support. He has been making good progress living with me for about four months. I take him to his regular medical appointments and I got him off the cigarettes with the help of Nicotine patches; or so I thought. Now that he is well enough he insists on going home where he has access to cigarettes. His mother isn’t able to help because she is overwhelmed and I feel bad that I cant make him stay and continue getting better. Four days after going home he ended up in hospital from severe dehydration. He has very poor memory and wasn’t taking his meds while he was home and I’m sure he was smoking a lot too. My question is this…How do I help him if he doesn’t have the mental capacity to make the right decision and not smoke. He is an adult and I cant force him to stay with me where I can help. At home he doesn’t have the support and I am afraid his condition will deteriorate and he will end up on the street again or even worse. Not sure where to go from here or if there is anything further I can do to help him. Sadly I explored all resources where I live and there are very little for people with this condition.

Most people with severe mental illnesses smoke.

My son is in the hospital right now. This is a nicer hospital than the one he’s been in the last 3 times, but both he and every other patient who’s been to the not-as-nice hospital like that one better because of one thing - they get to go outside for smoke breaks 3X a day as long as they’re not an escape risk.

I’d worry more about keeping your friend safe & on his meds and forget about the smoking until the very last thing. If it bothers you, make it a rule that he has to smoke outside or something, but he would most likely choose smoking over anything else you could offer him.

For my son, I don’t even think it’s the nicotine - it’s the act of smoking. For them, it’s a very soothing habit.

Wow this response is shocking. This entire situation is very new to me. I knew nothing about the illness before now and I have only been caring for him since Nov 2016. The doctors have stressed that he needs to stop the smoking because it interferes with the ability of the meds to be effective, this is why I put so much focus on getting him to stop. When I initially started to help him I weaned him off the cigarettes by giving him 4 a day for three weeks, then 2 a day for three weeks then finally one a day before starting the patches. Was all this bad advise and am I stressing over nothing when I should be focusing on other things? I however have noticed that when he smokes his speech is more slurred and he seems more disoriented.

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Smoking makes some medications less effective. I know that’s true for Zyprexa, so for males who smoke, they usually increase the dosage by 25 to 50% to compensate for that.

I’ve been reading that with Clozaril, you need to keep the cigarette smoking stable. If you reduce your daily smoking habit by a few cigarettes, you get too much Clozaril in your system. Smoke a few more, you don’t get enough. So, quitting has to be a very, very slow taper because you’re not supposed to make quick changes in your Clozaril dosage.

There are other meds where smoking doesn’t make a difference. It’s all about what receptors the meds are targeting. If they target the same ones that nicotine targets, that’s where you get a problem.

I will be the first one to say that smoking is bad, but I know the reality is that my son will not give it up, so that’s what we live with. Maybe your friend is the same way. If so, I would suggest helping him talk to the doctor about either changing his dosage to compensate for the smoking or trying something different if you can. Med changes always come with a risk of relapse.

My son is in an intensive program and sees a psychiatrist who specializes in schizophrenia & similar illnesses. She knows exactly how much he smokes, and while his treatment team would like him to stop smoking for his health, they don’t say anything about it having an impact on his current meds.

His little bit of drinking, on the other hand, they do not like. They say that will definitely interfere with the effectiveness.

Maybe you should research what med he’s on & see what they say. For example, Zyprexa and Nicotine will bring up that kind of research and you can see that smoking makes the meds clear the body faster so dosages should be increased for smokers - it’s even different by gender.

EDIT: I forgot to say that you’re an amazing person for stepping in to help him like this - not many people would. I wish both you & your friend all the luck in the world. I was mostly just saying you probably picked one of the hardest things to change about him - and a thing that might make him refuse your help in the long run. Don’t let me discourage you if what you’re doing is working.

Thank you slw. I read your ‘EDIT’ and although thankful for the reassurance and vote of confidence, I’m afraid your prediction is exactly what has happened. After being home for the past two weeks I think the cigarettes have taken charge of him again. I picked him up Thursday night after he said he’d spend the weekend but by Friday morning he was insisting on going home again. I’m not sure what to do at this point except read as many of these posts as possible and try to get a better understanding of this illness so I can go forward armed with more knowledge and a better game plan! To be honest I was spending less on giving him 2-4 cigarettes a day than I’m spending on nicotine patches anyway lol. I just feel a little misguided because I was made to think the cigarettes were not an option and maybe that is the case based on his meds. He is on Risperidone and Benztropine; these meds he gets free from the Psychiatric Hospital. I was reading about Risperidone and get the impression it’s not one of the best options. In fact I read that some side affects are constant sleepiness, drowsiness, always feeling cold, and being in a daze, which all accurately describe my friend. At his next doctor’s appointment I will ask more questions about different meds but in the main time I need to work on educating his family so he gets more support from that end also.

They just switched my son to Risperidone & he was already taking Benzotropine - it’s for side effects.

His doctors know how much he smokes & he has a nicotine patch on in the hospital.

I’m still not saying smoking is good for anyone, you just have to pick your battles with MI.
Plus, 2 to 4 cigarettes a day isn’t bad.

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We have a resource here that might help:’s guide to help reduce the health & financial burdens of cigarette addiction