Smokers’ careers and mental health: overlapping perspectives on cannabis and tobacco use

Background 

Since 2014, the French Monitoring Centre for Drugs and Drug Addiction took part in several surveys allowing data collection on tobacco and cannabis use amongst youths and adults, including qualitative studies. Tabatraj (2022-2024) is a sociological survey which explored tobacco use and cessation through the lens of social health inequalities. It aimed to better identify the diversity of patterns around withdrawal practices. Novurc (2023-2025) is an ongoing sociological study focusing on the life trajectories and consumption patterns of socially integrated cannabis users (>30 yo). Both studies revealed complementary findings on mental health and its entanglement with substance use trajectories.

Methods

The theoretical framework of these two studies relies on the interactionist concept of “career” (Becker, 1963) which allows a comprehensive and sequential analysis of the consumption and cessation process. Tabatraj results are based on 75 semi-structured interviews (≈1 to 2h) conducted with adults (>18 yo) that had decided to reduce or quit smoking within 24 months prior to the study. For Novurc, 38 semi-structured interviews (≈2h) were conducted so far. 20 more will be carried out by October 2024. In both studies, interviewees were asked about their life stories including questions on their relation to health, smoking experiences and habits, and reduction and/or cessation attempts.

Results

25 of our interviewees (12 in Tabatraj, 13 in Novurc) stressed out sporadic or chronic mental health issues – in most cases diagnosed, sometimes with medical follow-up : anxiety, depressive, bipolar and eating disorders, ADHD, hypersexuality, self-mutilation and/or violent behavior. A few had made 1 or more suicide attempts.

Smoking tobacco and/or cannabis to find relief from their psychological conditions was often presented by our interviewees as a reason to maintain daily use. The ones who had been prescribed psychotropic drugs had negative experiences with it due to its sedative effects. Some alternated between taking medication and smoking, with occasional use of other substances. Other managed to spontaneously stop these treatments perceived as “harmful” through a controlled use of cannabis. Detachment from health professionals’ advices and emphasis on self-management of their healthcare were then expressed. However, when withdrawal from substances was either necessary or deeply desired, medical support was reconsidered and mobilized in adjusted ways. In this regard, interviewees with higher socioeconomical status had more resources to diversify and navigate both their consumption habits and their chosen care pathways.

Conclusions

Our surveys document the relationship between health professionals and smokers, and how they readjust their substance use around medical injunctions. Those practices run counter to health organizations’ recommendations and raise numerous questions regarding the management of mental health issues and addictive behaviors.