McCreadie & Kelly (Reference McCreadie and Kelly2000) highlight the enormous financial cost of cigarette smoking to patients with schizophrenia and extrapolate from their data that those who smoke return 18-31% of their benefits to the Treasury, thus substantially contributing to the cost of their care. We directly measured the cost of smoking to a group of patients in Waterford and found that those who smoke spend an average of 29% of their income on cigarettes (Reference McDonald and SheppardMcDonald & Sheppard, 1996). They thus contributed 24% of their income back to the Treasury in Ireland through this source alone, a proportion more akin to income tax for most people. This confirms the calculations of McCreadie & Kelly.

Aside from a curiously reduced risk of lung cancer (Reference Gulbinat, Dupont and JablenskyGulbinat et al, 1992), patients with schizophrenia have increased mortality from heart and lung disease (Reference Mortensen and JuelMortenson & Juel, 1993) and it is likely that cigarette smoking contributes largely to this. In addition to such adverse health effects, cigarette smoking clearly represents a huge financial burden on patients with schizophrenia. Money spent on cigarettes is not being spent on clothing, leisure pursuits and personal possessions, which could help to increase the quality of life of these patients. Smoking may be intimately associated with patho-physiological aspects of schizophrenia and further research should be done to clarify the relationship between nicotine consumption and the neurochemistry of schizophrenia. However, health care professionals should be aware of the extent of the financial disadvantage associated with this habit in order to help those patients who might wish to quit through encouragement and support and through prescription of nicotine supplementation where appropriate.