Researchers urge smoking cessation as a key part of bipolar treatment

—Smoking tobacco significantly increases the risk of hospital readmissions and emergency room visits in people living with bipolar disorder, according to a study from Hospital Clínic of Barcelona published in the Journal of Affective Disorders.

Researchers followed 279 adults discharged after manic or mixed episodes from a Barcelona hospital between 2015 and 2019. 

Patients’ use of tobacco, cannabis, alcohol, cocaine, and stimulants was tracked over three years. The study closely examined how each substance influenced the odds of returning to the hospital or needing emergency psychiatric care.

Tobacco stood out as the most harmful substance for people with bipolar disorder. More than half the study participants smoked.

Compared to non-smokers, those who used tobacco were nearly twice as likely to be hospitalized again within three years.

Smokers also had more emergency psychiatric visits during the follow-up period. On average, tobacco users had close to one hospitalization, while non-smokers averaged about half that number. Emergency visits were more than twice as common among smokers.

This link between tobacco and relapse held firm even after researchers accounted for other variables like age, sex, and use of other substances. 

“Tobacco seemed to have a clear negative association with the course of the illness,” the authors reported.

Cannabis users in the group tended to develop symptoms at a younger age and were more likely to experience disruptive symptoms such as mania and psychosis. Still, their relapse and hospital readmission rates did not increase.

Researchers emphasized that tobacco appears uniquely harmful for bipolar relapse and could directly undermine recovery and long-term stability. They noted that tobacco smoking was common in this group, making it a priority for intervention. 

While previous studies have found high rates of smoking among people with severe mental illness, this research clarifies just how strongly tobacco is linked to poorer outcomes for those with bipolar disorder.

The findings point to the need for targeted smoking cessation programs within mental health care for people with bipolar disorder. 

Helping patients quit could reduce hospital stays and emergency visits, supporting better recovery. The researchers called for more studies to understand how smoking worsens illness and to develop practical tools for helping this population quit for good.

The study was published in the July 2025 issue of the Journal of Affective Disorders.

Comment from a reader suffering from bipolar disorder: This study confirms what can be seen from fellow sufferers of mania. There are a lot of smokers. And increased smoking seems to correlate with increasing chances of a manic episode. From my own experience, I started smoking and smoking more tobacco when my hypomania turned into mania. It seems like any stimulants, such as nicotine tend to accelerate mania.

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