Why So Many People with Schizophrenia Smoke
People with schizophrenia disorders may be drawn to smoking in ways others aren't.
Posted February 11, 2026 | Reviewed by Devon Frye
Almost 70 percent of people with schizophrenia smoke cigarettes, which is two to three times higher than the general population. Why? Is it that people with schizophrenia feel a pull towards nicotine, or does tobacco calm them in ways that other substances can’t?
There might be some truth to both ideas. Past research has suggested that people with schizophrenia may benefit more from certain aspects of nicotine and are more strongly drawn to it than the average person, but the findings were far from comprehensive. Substances can be complicated, often because they have both adverse and positive effects.
A 2025 systematic review was able to narrow down the specific effects that smoking has on people with schizophrenia, and the results reveal a true distinction in the way smoking affects the brains of people with a schizophrenia spectrum disorder (SSD) specifically. Here is what they found.
Smoking and Schizophrenia Spectrum Disorders
For their review, researchers analyzed 22 studies that used various methods to observe the biological traits of those with SSDs. Some of those methods included brain imaging techniques like fMRI, which allows researchers to view brain activity during a task; resting state fMRI, which observes the brain when the participant is lying still and doing nothing; and structural MRI, which allows researchers to view brain region volume—in particular, the loss of gray matter that is common in people with SSDs. Gray matter is responsible for cognitive tasks, and a reduction in volume can worsen symptoms and cognitive skills.
The review found that people with SSDs who smoke tend to have a significant reduction in gray matter. There were noticeable and significant reductions in the prefrontal cortex (which is responsible for higher-order thinking that allows people to conduct cognitive tasks), the amygdala (which is related to emotional regulation ), and the hippocampus (responsible for memory ), to name a few. Smoking and SSDs are both known to be individually associated with gray matter reduction; both combined may worsen the effect.
Surprisingly, however, smoking appears to help the brain and nervous system integrate. One study found that the default mode network (DMN) and the limbic system had more interaction in the participants who smoked, suggesting that smoking might actually improve poor connectivity between neural pathways and brain regions. This was apparent both in people who had SSDs and those who did not.
Some studies revealed unique neural patterns in patients with SSDs who smoke, which suggest that those with SSDs have a susceptibility to smoking and nicotine. There appears to be increased reward sensitivity in those with SSDs, as well as a decrease in pathways that are normally responsible for processing the negative effects of smoking. People with SSDs find short-term rewards fulfilling, while being less sensitive to long-term or cognitive awareness of the negative effects of smoking.
Recovering From Smoking
People with SSDs are generally vulnerable to things the average person isn’t. It seems that nicotine may be particularly neurochemically attractive to those with the disorder, with both positive and negative results. For people with SSDs, smoking can bring comfort and regulation in ways that are difficult to find in other substances—but it does negatively affect the brain, potentially leading to worse outcomes long-term.
Given the negative effects of smoking, which include the higher change of lung cancer, researchers point out that it might be worthwhile to further look into the effects of smoking on people with SSDs to isolate these effects. The results could produce therapies to help engage and satisfy these unique neural pathways, such as heightened reward sensitivity, while minimizing the negative effects by replacing the substance.
Recovery includes regulating cravings that come with both the disorder and medications (which are known to increase appetite that leads to weight gain), but it can be done, and researchers are currently working on ways to increase the hope and livelihood of people with SSDs. Many people are able to live a full life without smoking, using other things like travel, creativity , and hobbies as rewards. What gives you that feeling of reward that isn’t smoking? Maybe look into it!
Koster, M., Mannsdörfer, L., van der Pluijm, M., de Haan, L., Ziermans, T., van Wingen, G., & Vermeulen, J. (2025). The association between chronic tobacco smoking and brain alterations in schizophrenia: a systematic review of magnetic resonance imaging studies. Schizophrenia Bulletin , 51 (3), 608-624.
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Sarah An Myers is a writer with a Master of Arts in psychology and behavioral neuroscience from the University of Missouri-St. Louis. She researches novel computational and therapeutic methods for treating and diagnosing mental disorders.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.