For people with a preexisting mental health condition, quitting smoking can seem like climbing two mountains at once.
Managing a mental health condition is a daily — sometimes moment-by-moment — challenge, and smoking is often used as a coping mechanism. Understandably, people with mental health conditions who smoke often fear that taking away that source of comfort could send them into a tailspin.
“That was the way I always seemed to manage my stress: Sit down, light a cigarette, and it would make my brain think, ‘It’s going to be OK.’ But in reality, it’s not,” says Rebecca M.* a Florida resident and participant in the Centers for Disease Control and Prevention (CDC)’s Tips from Former Smokers campaign who lives with depression.
Rebecca smoked her last cigarette in 2010. She quit smoking for good — and found balance in her life — with the support of a professional counselor. In hindsight, smoking only made her depression worse, Rebecca acknowledges.
For many people, mental health and smoking go hand-in-hand — you can’t fix one without addressing the other, she asserts.
“Wanting to be healthy, mentally, while smoking is impossible. After I quit, I was able to look at the world with a completely different mindset,” Rebecca says. “Smoking affects every aspect of your life — family relationships, work life, home life. It’s just a cloud. … When I see people who are struggling with mental health [while smoking], I have deep compassion for them. You want so desperately to get better, but with smoking, it’s like taking two steps forward and two steps back.”
In the family
Rebecca says she was “born into a family of smokers.” Growing up, all of her friends and family smoked, so it seemed natural for her to start smoking as a teenager.
She quit smoking for the first time in 2002. However, she started smoking again seven months later as she was going through a divorce and struggling with intense emotions and stress, she recalls.
Throughout this period, she met with several different counselors to help her manage her depression. She had an “aha!” moment in 2009 when her first grandchild was born; she knew then she wanted to quit smoking for good.
“When my oldest grandson was born, it made me stop and think about life in a different perspective. At that time, I reached out to find another counselor, to learn from past mistakes and learn a new way of life,” says Rebecca.
After smoking for more than three decades, she quit fully in 2010, roughly one year after setting the intention, seeking counseling, and going through “some intense self-reflection,” she says. “I was thinking about how I’m a grandmother now, and where do I want to be [in life]? I had a desperate desire to live a healthy lifestyle, and what can I do to get there?”
“Counseling gave me a sounding board, someone I could trust who could give me trusted answers,” Rebecca says.
Since quitting, she says, she has had to examine some friendships with close friends and even family members who continue to smoke. “If they’re not healthy for you, supportive of your healthy lifestyle, it’s important to make those changes as well,” she says. “It was a perspective shift: It’s the difference between being born into a life that you don’t get to choose and choosing the life that you want to live.”
Professional counselors can help clients meet life’s challenges with an approach based on leveraging the client’s existing strengths. For Rebecca, this included her intention to be a healthy example to her grandson. Practitioners have an arsenal of tools that can help clients make life changes and reach their goals, including smoking cessation.
Rebecca’s counselor helped her establish a self-care routine that includes exercise (she now runs regularly) and meditation. She has come to realize that she needed to exchange one unhealthy behavior, smoking, with a healthy behavior, exercise.
“Nothing will go well unless you take care of yourself first. Counseling taught me how to take care of myself first,” she says.
“[Quitting successfully] is about teaching people about the tools they need. When they are faced with a situation that may make them uncomfortable, or trigger a panic attack or need for a cigarette, they have to have [coping] tools ready and available. For me, it’s been exercise, staying grounded, and focusing on what I can control. I’m [continuing to] educate myself and learn as much as I can so that I can give myself the best self-care I can,” she says.
Most importantly, Rebecca’s counselor helped her accept that her depression, her tobacco dependency, and “all of this was not my fault,” she says.
“I don’t think I could have quit without counseling. I didn’t have the knowledge to do it on my own,” says Rebecca, who turned 63 this summer. “It’s essential to get someone [a mental health professional] who can help you walk this path to healthy living. It’s a path, a journey. It’s one step at a time, one day at a time, sometimes one moment at a time, but it’s empowering. It’s doable, and it feels amazing.”
Ten years after quitting smoking, Rebecca’s mental health is good, but she acknowledges that she has to work at it every day. In addition to exercising regularly, she meditates often and tries to approach each day with an attitude of gratefulness, especially for things like a walk on the beach or video chats with her grandsons.
“I’m grateful for every one of those little moments I get,” she says. “It feels wonderful to climb that mountain. … It’s so empowering to be able to overcome tobacco use. There is a lot of life left [after cigarettes], even if you think there’s not.”
Counselors as allies
Professional counselors are particularly suited to help clients quit smoking because the profession has an array of tools focused on behavior modification. Instead of focusing on the health consequences of smoking — as a medical professional might — counselors can instead help clients focus on why they want to quit and how they can leverage their own strength to achieve that goal.
Practitioners also use a holistic perspective to help clients. For example, if a client turns to smoking in social situations because of anxiety, a counselor would help the client address the root cause, finding ways to cope with social anxiety. Similarly, if a client smokes to escape the negative thoughts that can be a constant companion of anxiety, depression, obsessive-compulsive disorder or other mental health conditions, a counselor can equip the individual with techniques to quiet their inner critic.
Read more about the many ways that professional counselor clinicians can support clients on their journeys in the Counseling Today article “What counselors can do to help clients stop smoking.”
In addition to counseling, Rebecca encourages people to use the plethora of tobacco cessation resources offered by the CDC.
“It’s OK to seek help,” she urges. “[Counselors and other professionals] want to see you succeed. You have it in you to succeed. That success is within you; you just have to learn to be kind to yourself and be loving to yourself. That, more than anything, was what I had to learn: to give myself the love that I give others.”
For support to quit smoking, including free coaching, a free quit plan, educational materials and referrals to local resources, call 1-800-QUIT-NOW (1-800-784-8669).
*Rebecca M.’s last name has been omitted for privacy reasons.
From Counseling Today: “What counselors can do to help clients stop smoking”
Find a professional counselor in your local area through the link here: counseling.org/aca-community/learn-about-counseling/what-is-counseling/find-a-counselor
CDC’s Tips from Former Smokers campaign: cdc.gov/ tips
Rebecca M’s page: cdc.gov/tobacco/campaign/tips/stories/rebecca.html
CDC page on quitting smoking: cdc.gov/quit
Additional CDC resources on addressing tobacco use in individuals with behavioral health conditions:
Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at firstname.lastname@example.org.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
I am proud of my 63 year old daughter for being strong enough to kick the tobacco habit—her older sister could not stop and died too young of COPD. I never smoked but breathed second hand smoke for thirty-seven years. At eighty-three, I feel no ill results now. Congratulations to all who have succeeded to stop smoking.
— Rebecca’s proud Mother