Smoking and Vaping in Bipolar Disorder

Prevalence and Comparison to General Population

The U.S. Trans Survey found a smoking prevalence of 23.6% in the general U.S. population, which is substantially lower than the rates found in bipolar disorder patients 1

Daily or almost daily alcohol use was found to be 12.5% in the severe mental disorder population, compared to 7.4% in the general population 2
Alcohol use disorders affect 35% of people with bipolar disorder over their lifetime 2
Among people with severe mental disorders, 82.8% avoid social interactions due to anxiety and 80.1% report loneliness 3

Guidelines suggest that harm reduction strategies such as e-cigarettes warrant further research in severe mental disorder populations, but specific prevalence data for bipolar disorder is not yet established 4, 5
The lack of vaping data represents a significant knowledge gap requiring urgent research attention given the high smoking rates in this population 4

Quitting smoking does not cause deterioration in mental health among those with mental disorders and appears to improve psychological well-being 4, 5
Smoking interventions are critically needed in mental health care settings given the role of tobacco as both a cause of psychiatric disorders and major source of health inequalities 4, 5
Combination nicotine replacement therapy plus motivational interviewing and CBT delivered over 9 months shows promise in severe mental disorder populations 6
Supervised exercise interventions with at least 90 minutes of moderate to vigorous activity per week can reduce psychiatric symptoms and may support cessation efforts 4, 5

The American College of Physicians notes that smoking prevalence in bipolar disorder is dramatically elevated at 53.9-66% compared to the general U.S. population rate of 17.8-23.6%, representing a 2.36 to 5-fold increased risk, with similar elevations seen across other severe mental illnesses 7
Overall mental illness prevalence is 24.9-27% versus 16.5-19.2% in those without mental illness, according to the American College of Physicians 7

The American Psychological Association suggests that combination nicotine replacement therapy plus motivational interviewing and CBT delivered over 9 months shows promise, with both face-to-face and telephone-delivered interventions achieving 6.2-12% biochemically verified abstinence rates with 16-42% achieving ≥50% reduction in cigarettes 8, 9

The American College of Physicians states that tobacco control policies effective in general populations have demonstrably failed to work as effectively for persons with mental illness, necessitating specialized, intensive interventions integrated into mental health care settings 7