Nicotine’s Impact on Substance Use & Mental Health Disorder Treatment

close up of doctor writing a prescription

Even though millions of people were still smoking or using other tobacco products, cigarette smoking among adults hit an all-time low in 2018.  According to the Centers for Disease Control (CDC), one of the subgroups with the highest use of any tobacco products was adults who reported being under serious psychological distress. Among this subgroup, 37.6% of adults used tobacco. It is not uncommon to see people with psychiatric or substance use disorders smoking or using other tobacco products. However, quitting smoking or using other tobacco products can benefit physical health, mental health and recovery from substance use. It can even make the medications used to treat these disorders safer and more predictable to use.

Is Nicotine Addictive?

Cigarette smoking is the most common nicotine delivery system, but people also use smokeless tobacco. This is because nicotine reaches peak blood levels rapidly and enters the brain faster when smoking cigarettes than through other nicotine delivery methods.

Nicotine is the addictive component in cigarettes and other tobacco products. It causes a temporary increase in endorphins in the brain’s reward centers leading to brief feelings of euphoria. Although the euphoria from nicotine is shorter-lived and not as intense as that provided by other substances, the dopamine released still reinforces the behavior of taking the drug. Although nicotine levels peak rapidly, they also drop quickly along with the feelings of reward. This cycle leads to the desire to continue using and experiencing the reward. In addition, when a person tries to quit using tobacco products, the withdrawal symptoms are unpleasant, making it extremely hard to stop.

How Is Tobacco Use Linked to Psychiatric and Substance Use Disorders?

Smoking is 2-4 times more common in people with substance use disorders than in the general population.  One reason tobacco use may commonly co-occur with other substance use disorders is that nicotine acts as a gateway substance. For example, animal studies have shown that using nicotine primed them to self-administer cocaine. However, this did not work in reverse. People who use other substances may also try to use nicotine to help them manage the unpleasant feelings they experience when they are unable to use their primary substance of choice.

Psychiatric disorders such as depression, anxiety, schizophrenia and bipolar disorder involve neurotransmitters in the brain. Nicotine can briefly relieve some symptoms of psychiatric illnesses, and people may be self-medicating by smoking. Research indicates that another reason so many people with psychiatric illnesses smoke could is because smokers with psychiatric disorders may have more difficulty quitting.

How Nicotine Affects Medications

Many medications are used to treat psychiatric disorders, such as antidepressants, antipsychotics, anxiolytics and mood stabilizers. Can nicotine or other components of tobacco products impact the effects of any of these medications? The pharmacodynamics of psychotropic medications can be affected by nicotine. Nicotine has been shown to increase the metabolism and decrease plasma levels of some psychotropic medications. Nicotine has also been associated with increased clearance of some medications.

These alterations in medication levels in the blood and body can alter the medication’s duration and effectiveness. On the other hand, if a patient is a heavy smoker and quits smoking, this could cause increased serum levels, leading to adverse effects. Therefore, providers should consider smoking as an important factor when prescribing these medications and educate patients regarding the potential effects of smoking.

Nicotine and Medically Assisted Treatment

Buprenorphine, methadone and naltrexone are medications used to treat substance use disorders. These medications and nicotine do interact and affect each other. Research shows that naltrexone can be beneficial in the treatment of nicotine dependence. It helped reduce the number of cigarettes smoked, time to the first cigarette, decreased weight gain and improved quitting rates. However, when the medication was discontinued, the benefit of smoking quit rate was not present upon follow-up.

Opiate users who are smokers and treated with buprenorphine can be at risk for increasing cigarette use. In one study, men who were smokers were given increasing doses of buprenorphine for maintenance. The increase in the number of cigarettes these men smoked was positively correlated to the increase in buprenorphine dose.

As with medications used to treat psychiatric disorders, nicotine use can alter the blood levels of methadone. Smoking can reduce the levels of the medication in the blood. If patients stop smoking, then the blood levels of methadone can increase, leading to adverse reactions or toxicity.

The Importance of Smoking Cessation in Treatment

There has been limited emphasis on smoking cessation due to myths that smoking is less harmful than other substance use or is too difficult to quit using tobacco products while detoxing or in early recovery. However, contrary to myth, many people in treatment are interested in quitting smoking, and smoking cessation may even improve treatment outcomes.

Tobacco use, especially cigarette smoking, sometimes seems to go hand-in-hand with substance use and psychiatric disorders. Many people do not know that cigarette smoking can affect the medications used in the treatment of these disorders. There is no better time to consider smoking cessation than when you are working on recovering from other substances. While you are at Casa Palmera, you will already have the encouragement and support of an expert staff trained to help patients stop using drugs and alcohol. If you are ready to take a healthy recovery one step further, we can help you quit smoking or other tobacco products while you are here. Our Casa Palmera staff can help you apply the skills and knowledge you acquire to maintain abstinence from drugs or alcohol to quitting smoking or other tobacco products. You can stop smoking and improve your health. Call (855) 508-0473 to start your recovery journey while quitting smoking. 


This blog is for informational purposes only and should not be a substitute for medical advice. We understand that everyone’s situation is unique, and this content is to provide an overall understanding of substance use disorders. These disorders are very complex, and this post does not take into account the unique circumstances for every individual. For specific questions about your health needs or that of a loved one, seek the help of a healthcare professional.