Psychological Medicine

Original Articles

Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders

P. A. Cavazos-Rehga1 c1, N. Breslaua2, D. Hatsukamia3, M. J. Kraussa1, E. L. Spitznagela4, R. A. Gruczaa1, P. Salyera1, S. M. Hartza1 and L. J. Bieruta1

a1 Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA

a2 Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA

a3 Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA

a4 Department of Mathematics, Washington University in St Louis, St Louis, MO, USA


Background The psychological outcomes that accompany smoking cessation are not yet conclusive but positive outcomes could help to persuade quitting.

Method We used data from the longitudinal National Epidemiological Study of Alcohol and Related Conditions. Logistic regression was used to examine associations between cigarette smoking reduction and Wave 2 status of addiction/mental health disorder among daily smokers at Wave 1, stratified by status of the diagnosis of interest at Wave 1. We adjusted for differences in baseline covariates between smokers with different levels of smoking reduction between Wave 1 and Wave 2 using propensity score regression adjustment.

Results After adjusting for propensity scores and other mental health/addiction co-morbidities at Wave 2, among daily smokers who had current or lifetime history diagnosis of the outcome of interest at Wave 1, quitting by Wave 2 predicted a decreased risk of mood/anxiety disorder [adjusted odds ratio (aOR) 0.6, 95% confidence interval (CI) 0.4–0.9] and alcohol disorder (aOR 0.7, 95% CI 0.5–0.99) at Wave 2. Among daily smokers with no lifetime history diagnosis of the outcome of interest at Wave 1, quitting smoking by Wave 2 predicted a decreased risk of drug use disorder at Wave 2 (aOR 0.3, 95% CI 0.1–0.9).

Conclusions There is no support in our data for the concern that smoking cessation would result in smokers' increased risk of some mental disorders. To the contrary, our data suggest that smoking cessation is associated with risk reduction for mood/anxiety or alcohol use disorder, even among smokers who have had a pre-existing disorder.

(Received June 07 2013)

(Revised November 25 2013)

(Accepted December 07 2013)

(Online publication February 12 2014)

Key words

  • Cessation;
  • longitudinal data;
  • mental health;
  • psychiatry;
  • smoking;
  • substance use disorders


c1 Address for correspondence: P. A. Cavazos-Rehg, Ph.D., Campus Box 8134, Department of Psychiatry, 660 South Euclid, St Louis, MO 63110, USA. (Email: