disorders. Attention deficit/hyperactivity
disorder and conduct disorder are the most
common co-occurring mental health disorders in
young patients* being treated for addiction, and
anxiety and depression are the most common co-
occurring mental health disorders in older
patients; trauma-related disorders are common
across age groups.^71
The link between mental illness and smoking is
particularly striking;^72 individuals age 18 and
older with a mental illness involving serious
functional impairment† are nearly twice as likely
as those without such illnesses to have smoked
cigarettes in the past year (49.8 percent vs. 27.4
percent).^73 Up to 60 percent of those with
depression, up to 70 percent of those with
bipolar disorder and up to 88 percent of those
with schizophrenia either are current or former
smokers.‡ 74 Those with clinical anxiety§ are
approximately twice as likely to be current
smokers (39.2 percent vs. 22.2 percent), have
smoked twice as many cigarettes in the past
month (139.5 cigarettes vs. 63.4 cigarettes) and
are more than twice as likely to have addiction
involving nicotine (21.2 percent vs. 8.4 percent)
as smokers without anxiety.** Slightly more
than one-quarter of the population (26.9 percent)
has addiction, a mental health disorder or a
serious mental illness,†† yet this group smokes
72.9 percent of all cigarettes.^75
- Ages 17 and younger.
† National data from 2010. A diagnosable mental,
behavioral or emotional disorder (excluding
developmental disorders and addiction involving
alcohol or drugs other than nicotine) of sufficient
duration to meet diagnostic criteria specified in the
DSM-IV that has resulted in serious functional
impairment, substantially interfering with or limiting
one or more major life activities. Comparable data
are not available for 12- to 17-year olds.
‡ These data are from a review of studies of clinical
and population-based samples.
§ Ages 12 and older.
** Among smokers, those with anxiety smoked an
average of 355.5 cigarettes in the past month
compared to 286.2 cigarettes among smokers without
anxiety.
†† A mental, behavioral or emotional disorder that has
resulted in serious functional impairment which
substantially interferes with or limits one or more
major life activities.
Members of the Military Exposed to Combat..............................................................
Exposure to combat increases the risk of
addiction and co-occurring mental health
problems such as post-traumatic stress disorder
(PTSD), anxiety and depression. Addiction
involving alcohol is one of the most commonly-
reported disorders among Vietnam War
veterans,^76 and co-occurring addiction and
mental health disorders are most prevalentamong veterans of the Vietnam era.^77 Military
personnel and veterans of the more recent
conflicts in Afghanistan and Iraq also are at
increased risk of risky use and addiction as wellas co-occurring mental health disorders.^78
A study of smoking among individuals who
were deployed or not deployed to Iraq and
Afghanistan found that those who were
deployed were more likely than those who were
not deployed to initiate smoking if they never
smoked before (2.3 percent vs. 1.3 percent), to
resume smoking if they had smoked in the past
(39.4 percent vs. 28.7 percent) and to have a
greater increase in their smoking rate if they
were smokers (57 percent vs. 44 percent). The
same study found that those who were deployed
and reported combat exposure were 1.6 times
more likely to initiate smoking (among never-
smokers) and 1.3 times more likely to resume
smoking (among past smokers) compared to
those who were not exposed to combat. The
likelihood of resumption of smoking post-
deployment was associated with length of
deployment.‡‡ 79One study using data from 2005 found that 40
percent of veterans from military operations in
Iraq and Afghanistan who sought Veterans
Administration (VA) health care screened
positive for risky alcohol use and 22 percent
screened positive for addiction involving‡‡ More than nine months and deploying multiple
times.