What is the prevalence of smoking and vaping among bipolar disorder patients compared to the general population?

Prevalence of Smoking and Vaping in Bipolar Disorder

Smoking prevalence in bipolar disorder is dramatically elevated at 45-70% compared to approximately 17-24% in the general population, representing a 2-3 fold increase in tobacco use among these patients. 1, 2

Smoking Prevalence Data

Bipolar Disorder Population

• Lifetime smoking prevalence ranges from 45-70% in individuals with bipolar disorder, with point prevalence similarly elevated 2
• Among bipolar patients who have smoked ≥100 cigarettes in their lifetime, 87% are current smokers, with 92% of current smokers using tobacco daily 3
• Current smokers with bipolar disorder average 19 cigarettes per day, indicating moderate to heavy use 3
• The U.S. Trans Survey found 23.6% smoking prevalence in the general U.S. population for comparison, though bipolar rates substantially exceed this 4

Severe Mental Disorder (SMD) Context

• In the broader severe mental disorder population (which includes bipolar disorder), daily or almost daily alcohol use was 12.5% compared to 7.4% in the general population 4
• Alcohol use disorders affect 35% of people with bipolar disorder over their lifetime 4
• Among people with severe mental disorders, 82.8% avoid social interactions due to anxiety and 80.1% report loneliness 4

Psychosis and Smoking Relationship

Bipolar patients with a history of psychosis demonstrate significantly higher rates of nicotine dependence than those without psychotic features. 5

• Bipolar disorder patients with psychosis have 1.3 times higher odds of nicotine dependence compared to bipolar patients without psychosis 5
• All bipolar disorder patients (with or without psychosis) have 2.5 times increased risk of nicotine dependence compared to controls 5
• Schizoaffective disorder, bipolar type patients show 1.2 times higher risk of nicotine dependence compared to bipolar disorder patients 5

Vaping Data

Current evidence on vaping prevalence in bipolar disorder is extremely limited, with no specific prevalence data available in the reviewed literature. 4

• Guidelines suggest that harm reduction strategies such as e-cigarettes warrant further research in severe mental disorder populations, but specific prevalence data for bipolar disorder is not yet established 4
• The lack of vaping data represents a significant knowledge gap requiring urgent research attention given the high smoking rates in this population 4

Clinical Characteristics of Smokers with Bipolar Disorder

Age of Onset and Duration

• Bipolar patients begin smoking at a mean age of 17 years, with a median of 7 years of smoking prior to bipolar disorder diagnosis 3
• This temporal pattern suggests smoking often precedes the formal diagnosis of bipolar disorder 3

Mental Health Correlates

• Current smokers demonstrate higher depression, anxiety, and impulsivity levels compared to former smokers and never-smokers with bipolar disorder 6
• There is a gradient of substance use disorder risk from never-smokers to former smokers to current smokers, suggesting shared liability 6
• 48% of current smokers report using tobacco to treat their mental illness, indicating self-medication behavior 3

Metabolic Impact

• Current smokers with bipolar disorder have higher risk of metabolic syndrome compared to never-smokers, particularly in those not using antipsychotics 6
• Prevalence rates in bipolar disorder include: metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%), all contributing to early mortality 1

Cessation Patterns and Barriers

Quit Intentions and Success

• 74% of current smokers with bipolar disorder express desire to quit, though intent is unrelated to current mental health symptoms 3
• Only 13% of the bipolar smoking population are ex-smokers, having abstained for a median of 2.7 years 3
• 48% of successful quitters stopped "cold turkey" without formal cessation programs 3

Treatment Gaps

• Only 33% of bipolar smokers receive advice to quit from their mental health provider, representing a massive treatment gap 3
• 96% of bipolar smokers believe being mentally healthy is important for quitting, yet most (64%) who successfully quit did so while in poor or fair mental health 3

Critical Clinical Implications

Smoking represents a leading cause of the 15-30 year mortality gap in severe mental disorders, making smoking cessation interventions critically important despite being rarely implemented. 4

• Life expectancy is reduced by 12-14 years in people with bipolar disorder, with cardiovascular mortality occurring a mean of 17 years earlier than the general population 1
• Quitting smoking does not cause deterioration in mental health among those with mental disorders and appears to improve psychological well-being 4
• Former smokers with bipolar disorder show return to never-smoker levels of morbidity, strongly supporting cessation efforts 6

Evidence-Based Recommendations

• Smoking interventions are critically needed in mental health care settings given the role of tobacco as both a cause of psychiatric disorders and major source of health inequalities 4
• Combination nicotine replacement therapy plus motivational interviewing and CBT delivered over 9 months shows promise in severe mental disorder populations 4
• Supervised exercise interventions with at least 90 minutes of moderate to vigorous activity per week can reduce psychiatric symptoms and may support cessation efforts 4