“It is important to reiterate that this is a cross-sectional, correlational study, so causation cannot be determined. For example, this study does not show that smoking and substance abuse causes more distress than substance abuse alone,” explains Nicole Siegfried, Ph.D., a licensed clinical psychologist, and chief clinical officer at Lightfully Behavioral Health.

She adds, “It would be an inaccurate and inappropriate conclusion to say that smoking causes distress and therefore eliminating smoking alleviates distress.”

Siegfried notes that psychological distress and cigarette use have a complex relationship and may exist in a self-perpetuating cycle, where each problem contributes to the worsening of another.

“One theory is that individuals who have psychological distress may seek out substances such as cigarettes to provide emotion regulation, soothing, and escape,” she says. “Additionally, withdrawal symptoms often mimic mental health symptoms, further increasing distress. So, over the long term, smoking (as well as other substance use) may actually exacerbate psychological distress, which creates the need for more substances or alternative substances.”

It could also be useful for mental health professionals and physicians to take the link between smoking and psychological well-being into account when screening patients, says Siegfried.

“For instance, based on this study, primary care physicians should screen for mental health symptoms in their clients who abuse substances and who smoke,” she says.

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