Can quitting smoking trigger a psychotic relapse?

Not on its own. Studies show no increase in decompensation in stabilised patients who quit with proper follow-up. The risk mainly comes from unanticipated drug interactions (doses becoming too strong). That is why psychiatric follow-up during the quit matters.

What if I'm hospitalised in psychiatry and want to quit?

Most psychiatric units now have an addiction team or specific protocols. Ask to see a tobacco-trained nurse or addiction physician. Hospitalisation can be an opportunity to quit in a controlled environment, with precise medication adjustment.

Is nicotine alone (substitutes) enough to make up for what the cigarette gave me?

Partially. Substitutes cover physical dependence. For the cognitive or sensory benefits you felt, varenicline (which also acts on the nicotinic receptor) may be more suitable — to discuss with your psychiatrist.

I've heard clozapine becomes dangerous if I quit smoking. Is that true?

Yes: your current dose is calibrated for a smoker. An adjustment is often necessary, but not systematic. Without it, if you quit abruptly, clozapine can reach toxic concentrations in 1-2 weeks. Never quit smoking without telling your psychiatrist if they prescribe clozapine or olanzapine. With follow-up, it's totally manageable.

Cannabis is also very common. Can both be quit at the same time?

It's complicated. Most specialists recommend stabilising one addiction before tackling the next. Cannabis has its own impact on schizophrenia (stronger in adolescence), to treat first in some cases.

Are there specific programmes for people in mental health care?

Yes. CSAPAs offer specialised support. Several psychiatric hospitals now have integrated tobacco-cessation consultations. Ask your care team.

Smoking and schizophrenia: why 70 % of affected people smoke, and how to quit safely

70-90 % of people living with schizophrenia smoke. Quitting improves life expectancy without worsening psychotic symptoms — under close medical follow-up.

June 7, 2026 Aria

The scientific basis on quitting smoking was reviewed on a voluntary basis by Pr. Bertrand Dautzenberg , a tobacco specialist, in order to rule out gross, potentially dangerous errors. It reflects positions commonly shared by health professionals and health agencies, without always corresponding exactly to his thinking or his practice. He is not the author of this text; he has only carried out a vigilance review of it.

Schizophrenia and tobacco maintain a particularly entangled relationship: people living with this disorder smoke 2 to 3 times more than the general population, with heavy consequences on physical health. Yet quitting is possible, beneficial and does not worsen psychotic symptoms when properly supervised. Here's what to know.

Why such a prevalence?

70 to 90 % of people with schizophrenia smoke, vs. an average of 25 to 30 % in the general population.

Royal College of Physicians and Psychiatrists, UK

The health cost

The 'stabilisation by cigarette' myth

Many patients and relatives believe smoking stabilises the illness. Partially true short-term (a few minutes), but very false long-term:

The metabolic trap: a critical point

This is the major specificity of smoking cessation in patients on antipsychotics.

Antipsychotic	Tobacco sensitivity	Action on quitting
Clozapine (Clozaril)	Very high	Dose reduction recommended, close monitoring
Olanzapine (Zyprexa)	High	Dose reduction recommended
Haloperidol	Moderate	Monitoring
Risperidone (Risperdal)	Low	No major adjustment
Aripiprazole (Abilify)	Low	No major adjustment

Safe and effective tools

The right time to quit

Clinical stability of schizophrenia for at least 3 months.
Discussion with the psychiatrist before quitting.
Anticipated adjustment of antipsychotic doses.
Close medical follow-up in the first 4-8 weeks (frequent consultations).
Social support

family, care team, peer-support group.

For relatives and carers

In United Kingdom

Your questions

Can quitting smoking trigger a psychotic relapse?

Not on its own. Studies show no increase in decompensation in stabilised patients who quit with proper follow-up. The risk mainly comes from unanticipated drug interactions (doses becoming too strong). That is why psychiatric follow-up during the quit matters.
What if I'm hospitalised in psychiatry and want to quit?

Most psychiatric units now have an addiction team or specific protocols. Ask to see a tobacco-trained nurse or addiction physician. Hospitalisation can be an opportunity to quit in a controlled environment, with precise medication adjustment.
Is nicotine alone (substitutes) enough to make up for what the cigarette gave me?

Partially. Substitutes cover physical dependence. For the cognitive or sensory benefits you felt, varenicline (which also acts on the nicotinic receptor) may be more suitable — to discuss with your psychiatrist.
I've heard clozapine becomes dangerous if I quit smoking. Is that true?

Yes: your current dose is calibrated for a smoker. An adjustment is often necessary, but not systematic. Without it, if you quit abruptly, clozapine can reach toxic concentrations in 1-2 weeks. Never quit smoking without telling your psychiatrist if they prescribe clozapine or olanzapine. With follow-up, it's totally manageable.
Cannabis is also very common. Can both be quit at the same time?

It's complicated. Most specialists recommend stabilising one addiction before tackling the next. Cannabis has its own impact on schizophrenia (stronger in adolescence), to treat first in some cases.
Are there specific programmes for people in mental health care?

Yes. CSAPAs offer specialised support. Several psychiatric hospitals now have integrated tobacco-cessation consultations. Ask your care team.

sources

Royal College of Physicians and Psychiatrists (UK), Smoking and mental health.
PIC Network, Tobacco and psychotropic drugs, practical fact sheet.
Sciencedirect/Encyclopédie Médico-Chirurgicale, Tobacco and schizophrenia: therapeutic aspects.
Drugs, Health and Society, Smoking and schizophrenia: impacts on disease and treatment.
French Office of Tobaccology, Expert conference: Smoking cessation in psychiatric patients, 2009.
Tidey JW, Miller ME, Smoking cessation and reduction in people with chronic mental illness, BMJ, 2015.