Nicotine Use and Mental Health

It's widely known that tobacco use can cause physical harm to the body, such as certain cancers and diseases. But the mental health effects that tobacco and nicotine substances pose are not always talked about.  

Many people are not aware that there are distinctions between nicotine and tobacco. Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed. It is found in products such as cigarettes, cigars, and chewing tobacco. Tobacco contains nearly 70 carcinogens that can lead to cancer and an increased risk of certain diseases. It also contains a chemical called nicotine, which is an addictive substance. Nicotine can also be found in non-tobacco products such as e-cigarettes and vaping devices. Not only can nicotine affect our physical health, but also our mental well-being. “The problem of nicotine dependence is broad and encompasses tobacco products such as cigarettes, e-cigarettes and vaping,” explained Clinical Psychologist, Tobacco Treatment Specialist, and KKV Integrative Behavioral Health Coordinator Dr. Lisa Ho.  

According to KKV’s behavioral health providers and tobacco treatment specialists, it’s a two-way street when it comes to nicotine use and mental health. When someone uses nicotine, it can affect their mental health in many ways, including poor impulse control, lack of attention, and an increase in anxiety. “But it’s a ‘which came first, the chicken or the egg’ situation,” says Dr. Ho. Sometimes people are already experiencing mental health concerns like anxiety or depression, so they turn to nicotine products to self-medicate. Other times, the use of nicotine products can lead to mental health concerns. “It can be a constant cycle,” says Tobacco Cessation Coordinator Maria Bautista. Tobacco and nicotine products can offer a temporary feeling of relief, but in the long run, experts say it’s only worsening those mental health conditions. 

There are some differences between generations with nicotine use. In recent years, there has been a massive uptick of e-cigarette or vape use amongst Hawaii’s youth. Most young people reported peer pressure and feeling the need to fit in, as reasons for starting to vape. Being exposed to harmful substances like nicotine can be detrimental to their mental health down the road. “The big problem with the vaping industry is the marketing to appeal to the youth. The companies make it look cool with different flavors, and market it as being ‘healthier’ because vapes don’t contain the toxins found in tobacco,” explained Dr. Ho. However, the reality is that teens can experience symptoms like mood swings, lack of concentration, and impulse control challenges associated with the nicotine in vaping. “Starting nicotine use at an early age can put them at a higher risk of developing a severe nicotine addiction," adds Clinical Social Worker Etsuko Foster. “In some cases, they can also experience other long-term effects related to mental health including substance abuse.”  

Adults who have been using tobacco or nicotine products for a long time have found it challenging to quit. Some adults turn to vaping to try to quit cigarettes, given that vaping is less harmful than smoking cigarettes due to having far fewer toxins. They may then taper off nicotine and tobacco use altogether. However, there are recent studies that show e-cigarettes and vape use can cause a lung injury called EVALI (E-cigarette or Vaping use-Associated Lung Injury).  

Aside from generational differences, we see specific ways in which nicotine products are used in the Kalihi community. In addition to cigarettes and vaping, tobacco treatment specialists at KKV sometimes see patients using chewing tobacco and betel nut. Betel nut is the fruit of the areca palm that is often paired with tobacco and chewed. The stimulant is common in Southeast Asian and some Pacific Island cultures, including certain parts of Micronesia.  These Asian and Pacific Island cultures also struggle with stigma surrounding mental health, making it difficult for people to seek help in quitting. “Tobacco and nicotine products are also used as stress reduction. Most people in our community have so much stress, and other social economic challenges they face,” says Etsuko. KKV continues to work on breaking down those barriers and increasing access to care for the whole person.  

One of the many practices that KKV staff use to help patients quit tobacco and nicotine use is meeting them where they’re at. Etsuko explains that everyone’s reason for quitting smoking is different, so it’s important to help them find their biggest motive. “I had a patient who was struggling to quit smoking. His wife hated that he smoked, but one of the biggest reasons was because it’s so expensive,” she said. After several sessions of counseling, Etsuko offered the idea to put some money aside every time he wanted to buy cigarettes. “He was smoking one pack of cigarettes a day, that’s over $10,” she said. The patient put aside money in a clear jar so that he could see how much he was accumulating by not smoking. He soon stopped smoking altogether because he enjoyed seeing all the money he had saved. “Everyone is different. Finding that reason is so helpful in their quitting journey.” KKV providers highlight that the journey does not always have to end with medications. There are many other ways to cope with these issues, mentally and physically.  

It’s no secret that quitting nicotine can be difficult on many levels. Experts say it can be a mental battle to stay away from something someone has relied on for relief. It’s very common for patients to relapse and struggle throughout the process. But quitting can have so many benefits on mental health in the long run, such as improved mood and less anxiety. Although it can be a challenging journey, KKV has Behavioral Health Providers and Tobacco Treatment Specialists who can provide services to assist you with your quit journey. “Anytime we rely on a substance to feel good or feel better, it is taking away our freedom,” says Dr. Ho. If you’re ready to take back your freedom, please reach out to your primary care provider or our Behavioral Health Department by calling (808)-791-9425.