How do you deal with destructive behavior?

If all the people whose doctors have told them not to smoke didn't, tobacco companies would close tomorrow. :-) I'd be more concerned about putting something in his mouth that has been in someone else's mouth and on the ground. I think I'd say something like, "Gosh, Bill, that can't be very sanitary after someone else has used it and thrown it away!" But personally, I would not make a big fuss over it or scold him. A few butts a month are probably the least of this poor guys problems.

Jgo, pick up the book - it's an easy read- "I Am Not Sick I Don't Need Help"

The author will teach you how to address the problem in an effective manner.

Sounds like your client is important to you and that you want to do your best for him.
Are you his only caregiver? Is his family around? Do you live in? Are you part of an agency that can provide some support for you? Do you feel alone in trying to control his smoking? Maybe others have already tried?
Smoking isn't easy to stop to begin with and your client is dealing with dementia and schizophrenia. He may not be at all worried about self destructive behavior. I fear you won't want to hear this and I'm sorry if I offend...Trying to keep such tight control of him could be destructive to you. You are human and need some of your own time. Speaking for myself here: Sometimes when I find myself too deep in trying to fix a client's problem it means that I am avoiding a problem of my own.
I was offended/hurt by an answer I received when I asked my first question on agingcare.com. I stopped participating for a little while to protect myself. I just read what other people were writing to eachother. I noticed different writing styles and oppinions. Mostly I noticed that the people who use this network do care about eachother. The person I felt offended by has truned out to be kind and helpfull. I can take what is usefull to me and leave,(delete), the rest.

Then ask his family and/or doctor for help so you can sleep at night.

It is good that you are so concerned about this gentleman's overall health. How advanced is his dementia? If his short-term memory is pretty well gone, it will not be possible to teach him something new. Isn't there some sort of mechanical cigarette you can buy now that delivers nicotine but no smoke? I think perhaps I've even seen one that is just water vapor for the smoke. Perhaps something such as that could be substituted and allow your client to 'smoke' without further damaging his health.

debparkhurst, you might be on to something! My mother (92) has smoked for 78 years and has no intention of stopping. But she was no longer able to live on her own so my sisters started her on "this new kind of cigarette," in preparation for her living somewhere that smoking would not be allowed in her room. She resisted at first but now she is fine with them. She has mild dementia and she hasn't really learned how to use them on her own. She has moved in with my sister and she periodically asks for a lighter or wants to know what happened to her smoke, but with a little help she is satisfied to use these electronic smokes.

She is going to start spending one weekend a month at my house -- I guess I'm going to have to learn how to use them, so I won't be calling my sister for help!

the quick fix is to pick up the butts as you see them so the client doesnt pick them up. Appears as if he is fine until he sees a butt somewhere. how does he light them? matches and lighters need to be removed for safety if he has dementia or Alzheimer's...he could use either of those even without a cigarette and cause fires etc.

An addict's desperation is difficult to handle on your own, no matter HOW concerned you are. As long as he has "possession of his faculties", options are limited.

If you can pick up those butts first, you might reduce the number he smokes. I would use gloves or something to protect my skin, or crush them with my heel, for what it's worth.

Can you can manage where he goes?

First, where is he finding these cig. butts? Are you his only caregiver? Does he live in a facility or are you caring for him at his home? I would try to find out when and where he is getting hold of these "butts", and eliminate them one way or another. If he is doing this on the sly that seems like one option. That and to keep a monitor on him that tells you if he leaves the premises? Hope you get an answer that helps you. Godbless and Good luck

Dementia and pschophrenia are a serious combination. Likely, it is not the smoking that is the thrill for him but the reaction it may invoke or the feeling of sneaking around as a child and getting away with something. The chances are strong his reality is not current time. Confrontation only worsens matters for any altz patient! The best you can do is be sure he DOES NOT HAVE ACCESS TO CIG BUTTS AND DO NOT LEAVE HIM ALONE!