Schizophrenia and Cigarette Smoking

Family
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My son 38 is just coming out of weeks of psychosis because he went off his meds.
He is taking Invega (first injection 2 weeks ago) Clozapine 250 mg, Depakote and Clonazapam
He’s doing much better but is obsessed with cigarettes now. He is in a psychiatric clinic where they allow limited cigarettes. When they limit the number he can have he gets very irritable and verbally aggressive. He will NOT listen to anything about stopping cigarettes. It’s more than a physical addiction.

Has anyone been through this with their LO? I’m at a loss. When he comes home from the clinic he will hound me day and night for cigarettes and when left to his own discretion will smoke more than 30 a day. Sometimes I wonder if it is worth the fight.
Mary

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So funny you mentioned this. I too am trying to come to terms with why our 35 yo son, who has an unofficial dx of scz, started chain smoking, when the majority of his life he hated smoking and smokers with a passion!!! Poked fun at those who did… now he can’t drag it hard enough and lights one with another. So troubling and confusing! Some material from my NAMI class mentioned this addiction to nicotine. Somehow it soothes their brain disorder.
“ studies show that the ability to screen out background noise improves right after smoking, which explains why ppl with scz have three times the smoking rate of the general population.”

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I wish he would reduce at least, but he gets so pushy and anxious without them I usually give him what he wants. This is bad because cigarettes cut the effectiveness of his main medication, Clozapine.
Has anyone had success in getting LO to stop?

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Hi. My brother was diagnosed decades ago. He’s in his early 60s now and takes medication and is for the most part under control. Spent many years smoking way too many cigarettes. Now he’s done with them. He hasn’t smoked in more than 10 years, and he’s moved on to nicotine gum. Lots of it, one piece after another. Not great, but I’ll take it.

He quit cigarettes, he tells me, because he didn’t want to harm his lungs and shorten his life, and he could feel how they affected him. But in his younger years, I think it was like with your son(s), where not much could stop him.

I briefly smoked in my 20s and while I don’t suffer from serious mental illness, I appreciated how it helped me focus and calm down. It was very hard to stop even my small habit. So, when I think about that, and my brother, and what you write about your sons–Bucky included–I have to conclude nicotine really is massively powerful.

As an aside, and this might be pertinent, my brother lately uses chewing tobacco as an occasional treat. Terrible stuff. He used it once when we were in the car together for an extended period of time, however, and my proximity to him made me very sick. His realization of that blatant fact seems to have helped him ease off that terrible habit, at least around me. I don’t fool myself that he is all that considerate of me as a sister; I think he does realized that I make his life easier, and he didn’t want to harm me if he can help it. Not sure. But anyway, I guess I’m saying it’s hard to tell them “no” and almost impossible when they’re young to appeal to health issues, but as they get older they might be able to conquer the addiction, whether for themselves or for the health of those around them, especially if they are continually pushed to quit.

I’d start a campaign now with a clear message for your son that highlights reasons for him to stop or slow down the smoking, reasons that have deep motivations (because clearly the nicotine feels great.) Maybe tell him you or he cannot afford to keep buying so many packs forever. Tell him you are miserable thinking what he is doing to his lungs. Just be relentless with that message, until he’s able to break away on his own for whatever reason.

Hope this helps. Best of luck.

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Everything hinges on the other person seeing that it is not in their best interest to do something. Whatever it is they’re doing, I’m sure they have their reasons. Everyone outside has limited control. This is the best book for partnering with someone to effect a change: I Am Not Sick, I Don’t Need Help! How to Help Someone Accept Treatment

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Thank you for your insights. The big problem with his continued smoking is it reduces the effectiveness of his antipsychotic (Clozapine) by as much as 50%.
This makes it doubly problematic.
I will continue to talk to him about his health, but so far it has only an occasional effect.

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There are many studies on the interactions of nicotine from smoking and the use of clozapine. I encourage everyone to do their own research from academic/reliable psychiatric sources.

My understanding from my sz sons many psychiatrists over the past 20 years is that if the patient is going to be a smoker and does not have any desire to quit. The number of cigarettes per day should remain as steady as possible. It was explained to me that if the nicotine level rise suddenly then the effectiveness of the clozapine can drop. If the patient suddenly stops of greatly reduces nicotine suddenly then the clozapine strength appears to increase without actually taking any additional mgs on the dosage. My son was a chain smoker when this all started in or about 2006.

Of course, as his mom and a nonsmoker myself I would highly prefer he didn’t smoke at all BUT I learned to choose my battles and err on the side of whatever was going to steady his mind, his thinking, his choices and his nerves as well his overall demeanor while taking medication.

I bet he started out at 3+ packs and I am not even sure how he managed that without a steady income.

Once I got his guardianship and moved him in with me to better manage his health and everything else, we started just reducing the cigarettes and this was before the clozapine.

He went through a slew of meds before we got to clozapine. With the clozapine we were about a pack a day and all these many years later we are down to a steady half a pack a day. it was an extremely slow reduction and there were no noticeable side effects from it.
His doctors have always said reduce slowly. However, every doctor pushes for stopping and for my son he just isn’t on board yet, but he is 39 and I might be too much of an optimist, but I think he is pondering it. I’m posting one link to an article I read it is from the UK but there are many from the United States if you want to google them. Just my two cents, be well. Clozapine and Smoking (nhsggc.org.uk)

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I didn’t immediately think of how nicotine alters the Clozapine’s efforts. Of course. Thank you and now I will have to consider what nicotine gum does to my brother and his meds.

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I just found this information which says it’s not nicotine that lowers Clozapine effects but other things in cigarettes. Nicotine gum may not be a problem.

Clozapine and Smoking (nhsggc.org.uk)

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Oh, that’s interesting. I should add, my brother is not on Clozapine. But like I said, he uses a good bit of nicotine gum. Thanks for sharing and good luck with your son.

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My son is a heavy smoker. he smokes about 3 to 4 packs daily. I tried to convince him numerous times to reduce smoking but he does not want. he said cigarette calms him down.
he gets the Invega shot monthly and takes oral medsL lithum and zyprexa. I notice he smokes more in the first 10 to 12 days right after he takes the Invega Shot.
his Physciatric doctor told me that they smoke because the Invega Shot causes nerve tightness…

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Is there some drug that will combat the nerve tightness, so that he will feel less need to smoke? My son takes Amantadine at night, which is an antidyskinetic medicine, to calm his restless legs caused by the quetiapine and olanzapine he takes.

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not sure, will have to research it. will check with Physciatric doctor again.
are you saying that your son feels discomfort in his legs. does Amantadine helping?
is your son a heavy Smoker?

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@JARCA2016 I believe Amantadine helps him. He doesn’t smoke.

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I read somewhere that 80 percent of people who have Sz are HEAVY smokers. My son is like yours, but we have never tried to control it because it’s just not possible. He has his own money and rolls his own, so at least that part is somewhat better, much cheaper. He has the strangest fixation on smoking. He says it’s good for him. I think what he means, I think I’ve figured he means that it calms him, not that it’s actually good for him. But holy hell how many in a day?? He needs a lot of calming… My poor son.

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@daquilamarguerite1 I’d actually consider buying cigarettes for him providing they were filtered. Many, many years ago I used to roll my own cigarettes and I can remember squeezing them and the tar just oozing out onto my fingers. If he’s going to smoke, anything that lowers the tar content would be helpful IMO.

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I know what you mean My son often smokes forty cigarettes a day. He wants to go for a health check up so we’ll see what effect the information he gets has on him.

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