Smoking and Addiction Recovery

William L. White, a well-respected addictions researcher, has published a good overview of addiction recovery and tobacco use. Here are some statistics from White's work: Between 70-80% of people entering addiction treatment smoke—nearly 4 times the rate for all adults. People treated for alcohol or drug dependence are more likely to subsequently die from smoking-related diseases than from alcohol or drugs other than nicotine. Leading figures within the American history of addiction recovery have died of smoking-related diseases, including Bill Wilson, Dr. Robert Holbrook Smith, Mrs. Marty Mann, Danny C., Jimmy K., Charles Dederich, Dr. Marie Nyswander and Senator Harold Hughes.

It used to be an accepted "truth" in the addictions field, based on anecdotal evidence probably in part supported by the fact that most of the recovering addictions counselors smoked themselves, that an individual in early recovery from alcoholism or other dug addiction should not focus on stopping smoking tobacco products because to do so might cause so much stress or lack of focus on the "primary" problem (alcohol or other drug abstinence) that the individual would be in danger of relapse. I can remember back in the day when, believe it or not, we counselors and patients would smoke cigarettes during group therapy in an addictions treatment program. The thinking then was that addressing smoking could wait until the advent of a stable recovery from alcoholism.

Indeed, the basic text (Big Book) of Alcoholics Anonymous suggests that it may be wrong to make a "burning issue" about smoking by a recovering alcoholic when "his more serious ailments [drinking] were being cured in AA (Alcoholics Anonymous, 4th Ed., page 135)."  I do not criticize this early AA view of smoking. The science showing the serious health effects of smoking was not available then and, of course, the AA program by definition is aimed at alcoholic drinking (though I think stopping smoking can be done using the 12 Steps of AA).

Research, has not confirmed the validity of the old approach of avoidance of addressing nicotine addiction in early recovery; in fact, evidence seems to suggest that continued smoking in recovery can slow healing of the brain damaged by alcoholic drinking and may interfere with recovery. Also, addressing nicotine addiction at the same time as alcoholism (or other drug addiction) does not adversely affect treatment outcomes. I'll provide a summary of some of the research here.

1) Active alcoholism interferes with the flow of blood to the brain, probably in part causing the difficulty drinking alcoholics, and those in recovery, have with memory and thinking. In early recovery from alcoholism, brain imaging studies (2009) have shown that the blood flow to the brain of non-smoking alcoholics returns to normal within five weeks of abstinence, while the same is not true of smoking recovering alcoholics.

2) In a 2004 review of 19 research studies looking at the effect on addiction (non-nicotine) recovery in addiction treatment programs that addressed nicotine addiction as part of treatment of the "primary" addictions, "smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs." In other words, "Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety." According to William L. White in his 2011 review, "Smoking cessation in early recovery does not increase craving for or urges to drink alcohol. Continued smoking following treatment for alcohol and drug dependence is a risk factor for resumption of alcohol and other drug use."

3) According to a federal government supported review of research on alcohol abstinence and recovery, "the short-term effects of alcoholism may appear more dangerous than those of cigarette smoking. However, mortality statistics suggest that more people with alcoholism die from smoking-related diseases than from alcohol-related diseases ***. Comorbid smoking and alcoholism result in synergistic exacerbation of health risks (the two conditions work to worsen health risks)."

4) According to a review of addiction treatment facilities (2010), Direct treatment of nicotine addiction beyond just providing a nicotine replacement drug (e.g., nicotine patch, gum) is rare. "About 71% of publicly funded treatment programs and 65% of therapeutic communities did not offer a counseling-based smoking cessation program or any medications, such as over-the- counter nicotine replacement therapy (NRT) or prescription medications (e.g., varenicline, sustained-release bupropion). Programs that relied on private sources of funding, like insurance and self-paying clients, were more likely to offer services, but the predominant approach offered by 41% of private programs was smoking cessation medications without a formal counseling program."

Those of us in recovery from addiction seem to be attracted to any behavior that feels good, such as eating, sex, gambling, and nicotine use, to name a few, all of which can reach the stage of addiction and become destructive. My experience in the addiction field and in my own recovery, is that the recovering individual needs to be on guard for any replacement addiction that may be rearing its ugly head. Nicotine addiction is probably tougher to treat and recover from than many of the so-called primary addictions (alcohol, opiates, cocaine). Gambling on a regular basis, for example, may not result in a sufficient pattern of negative consequences to seriously interfere with the quality of one's life.  However, the known health effects of smoking, even a few cigarettes a day, are so clear that addressing smoking should come sooner rather than later in one's recovery journey.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 08/27/2013.