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Individuals with schizophrenia are more likely to smoke than those with other Axis I disorders1 and are 10 times more likely to have ever smoked daily than individuals in the general population.2 In addition to more frequent medical consequences of smoking3 as compared to smokers in the general population, smokers with schizophrenia experience negative consequences unique to their mental illness. One often overlooked example includes the substantial financial implications from tobacco use among smokers with schizophrenia—many of whom are dependent on a limited, fixed income.4,5 Quality of life issues relating to the ability to pay for occasional entertainment desires, or more seriously, adequate housing and nutrition, are already compromised for many with a serious mental illness. This is only worsened by their addiction to cigarettes, the financial cost of which comprises a substantial percentage of their monthly budget.
As part of a larger study on motivational interviewing in smokers with schizophrenia or schizoaffective disorder,6 participants (n = 78) provided information on public financial assistance in addition to information on tobacco use. All participants were smoking at least 10 cigarettes per day, were psychiatrically stable, and attending outpatient treatment for their psychiatric disorders. They were not currently seeking tobacco dependence treatment (table 1).
Participants spent a median of $142.50 (range $57.15–$319.13) per month on cigarettes. The majority (87.2%) were receiving public assistance at a median benefit of $596 (range $60–$1500) per month. It was therefore calculated that the median percentage of income spent on cigarettes each month was 27.36% (range 6.3–331.3%). In contrast to the general population, where only 10% smoke generic brand cigarettes,7 30.8% of participants in the current sample were smoking generic brand cigarettes. Participants reported smoking generic brand cigarettes because of their lower cost, thus recognising to some degree the high financial burden caused by their tobacco dependence. Some reported purchasing cartons through discount mail order programmes or rolling cigarettes themselves from loose tobacco to save money. This illustrates the great lengths these smokers will go to in obtaining cigarettes while struggling with motivation to perform many other daily activities.
It should be acknowledged that the sample was heterogeneous with respect to independence from their family of origin. Participants ranged from having their basic financial needs taken care of by their parents, to those who lived in rooming homes where they were financially independent. These differences may moderate the financial implications of tobacco dependence in this group.
This letter presents yet one more reason clinicians and the tobacco control community should address tobacco use in smokers with serious mental illness: the financial implications of tobacco use in this group are considerable. By spending almost 30% of their public assistance income on cigarettes, the already limited financial resources of smokers with schizophrenia are substantially reduced. The financial burden of smoking for individuals with schizophrenia is serious and often overlooked.
This research was supported in part by grants from the Center for Substance Abuse Treatment (DK1-TI12549-01 to DMZ), National Institute on Drug Abuse (R01-DA15978-01 to DMZ and K-DA14009-01 to JMW). DMZ and JMW are also supported in part by the New Jersey Department of Health and Senior Services through the Comprehensive Tobacco Control Program and the Robert Wood Johnson Foundation.