People with serious mental illnesses are far more likely to be current smokers as the general population, however smoking cessation rates are much lower. Smoking is the single most important risk factor for many of the most common causes of death in these individuals, including cardiovascular disease, COPD, and lung cancer. Buproprion, varenicline, and nicotine replacement can all be helpful in achieving abstinence in tobacco dependence in people with serious mental illnesses, and do not worsen underlying psychiatric symptoms. Behavioral treatment alone for tobacco smoking cessation has not been demonstrated to be sufficient for achieving abstinence from smoking in patients with SMI. However, they may be useful in conjunction with pharmacotherapy.