Tobacco dependence is common among people with psychotic disorders and is associated with significant morbidity and mortality. Illness, socio-demographic, lifestyle, institutional, and tobacco industry influences are all associated with this high prevalence. While many smokers with psychotic disorders are willing to quit or reduce smoking, they are often provided with limited support within the healthcare system. Numerous randomized controlled trials among smokers with psychotic disorders have demonstrated that smoking cessation interventions can be effective in the short-term, with smoking reduction a common finding. Support for smoking cessation can be offered within primary health settings, and should include adequate and longer-term pharmacotherapies combined with psychosocial counseling. Psychosocial strategies that can readily be incorporated into primary care settings include brief motivational interventions, the encouragement of social support, behavioral strategies such as avoidance of high risk situations and activity scheduling, cognitive strategies to cope with cravings and negative moods and to improve lifestyle, and relapse prevention. As smoking is a chronic and relapsing condition, numerous change attempts should be encouraged and normalized, with flexible combinations of pharmacotherapies and counseling employed.