Tobacco contains over 100 dangerous chemicals which cause serious harm to the body, including nicotine, carbon monoxide, tar, phenols, ammonia and formaldehyde. Using tobacco results in decreased life expectancy and quality of life, and increases the risk of many diseases and health conditions such as:

• Cancer
• Heart disease and stroke
• Respiratory disease
• Diabetes
• Bacterial and viral infections
• Gum disease and dental problems
• Hearing and vision loss
• Fertility problems and harms to the fetus
• Osteoporosis
• Early menopause.

People who use tobacco regularly may also become dependent on nicotine and feel like they need nicotine to function normally in their day-to-day lives. They may also develop tolerance to it and need to take increasing amounts in order to get the same effect.

In Australia, tobacco use is the leading cause of death and accounts for the second-highest burden of disease (after overweight and obesity). In 2024, 12% of preventable deaths in Australia were caused by tobacco use. Recent data indicates that more than 24,000 deaths every year in Australia are attributable to tobacco.

In 2024, tobacco use caused 12.3% of the preventable deaths among Australian men and 10.8% of the preventable deaths among women.

Tobacco smoking is more common among people with mental illness, compared to the general population. People with more severe mental health conditions, such as schizophrenia, have particularly high smoking rates. There are a number of reasons for the higher prevalence of smoking among people with mental illness. These include:

• Perception that smoking is helpful in relieving/managing psychiatric symptoms or side-effects from medication (however evidence suggests that mental health and quality of life may actually improve after quitting smoking)
• Increased difficulty of quitting while also dealing with mental health symptoms
• Quit attempts being discouraged by healthcare providers due to the mistaken belief that quitting will worsen mental health
• Higher rates of psychosocial disadvantage among people with mental illness (e.g., lower income, education, and employment)
• Using smoking as a way to “fit in” and cope with the stigma and exclusion association with mental illness
• Shared genetic predisposition to both smoking and mental illness.

Australians who experience high levels of psychological distress are more than twice as likely to smoke tobacco daily, compared to those with low levels of psychological distress.

In 2022-23, 7% of Australians with low psychological distress smoked daily, compared to 10% with moderate psychological distress and 15% with high or very high psychological distress.

Tobacco smoking is more common among people with mental illness. In 2022-23, 15% of Australians who had been diagnosed with or treated for a mental health condition smoked tobacco daily, compared to 7% who had not been diagnosed/treated.

The reference guide used by clinicians to diagnose mental health disorders is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The most recent version of the manual is the 5th Edition (“DSM-5”).

According to the DSM-5, tobacco use disorder is a problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1.      Loss of control (inability to stop using)

2.      Persistent desire/unsuccessful efforts to stop using

3.      Craving (a strong desire to use the substance)

4.      Failure to fulfill major role obligations due to use

5.      A great deal of time is spent obtaining, using, and recovering from the use of substances

6.      Continued use of substances despite having social or interpersonal problems caused or made worse by the use

7.      Important activities are reduced or given up because of the use

8.      Substance use in situations where it is physically hazardous

9.      Continued use of substances despite having physical or psychological caused or made worse by the use

10.  Tolerance

11.  Withdrawal.