In response to the demonstrated health hazards of tobacco
smoking, health care facilities are increasingly implementing
policies that ban smoking on their premises. Persons with
psychiatric illnesses are about twice as likely to smoke
cigarettes as the general population (1), and the prevalence of
smoking among persons with schizophrenia is reported to be three
or four times higher than in the general population (2,3).
Alcohol and drug abuse are also strongly associated with a high
rate of smoking, with prevalence estimates ranging from 71
percent to 100 percent (4,5,6). Thus persons with psychiatric or
substance use disorders are particularly affected by smoking
bans. A concern has been raised that policies that address the
risks of smoking in the general population may deter smokers who
are mentally ill or substance dependent from obtaining services.
We conducted a critical review of the literature to assess the
strength of the empirical evidence supporting this concern about
smoking bans in psychiatric pop