›› Addiction Recovery and Smoking Just Don't Mix

        by Dr. Stephen F. Grinstead

Throughout my professional addiction treatment career I have been an advocate for the cessation of all addictions when clients decide to get into recovery; this includes cigarette smoking and chewing tobacco. Unfortunately, many of my addiction treatment colleagues do not agree - in fact, many of them still use nicotine addictively themselves. On the positive side, more and more addiction programs are now addressing nicotine addiction as part of their treatment curriculum and my hope is that this trend continues.

In an attempt to present some objective reasons why people in recovery from alcohol and other drugs should also be in recovery for their nicotine addiction - and that nicotine recovery is possible and preferable, I offer the following perspective. Part of my motivation is that I am tired of watching the people I care about, personally and professionally, slowing killing themselves with nicotine and not truly seeing what they are doing to their health. Many continue because they simply do not believe they have any other choice. My commitment is to do what I can do as an addiction professional, family member and friend. I say there always is a choice if one is willing and proceeds with an open mind and an open heart.

In my research I found a 2005 report by Alcohol Alert from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) that stated until recently alcoholism treatment professionals have generally not addressed the issue of smoking cessation, largely because of the belief that the added stress of quitting smoking would jeopardize an alcoholic’s recovery. This report goes on to state that current research does not confirm this belief.

Following the lead of other healthcare facilities, many addictions treatment facilities are becoming smoke-free, providing a natural experiment on the effectiveness of dual recovery programs. Initial evaluations suggest that no-smoking policies are feasible in this setting, but that additional research is needed. In addition, this report noted that Canadian scientists have found evidence that the nicotine in cigarettes can induce a craving for alcohol.

The report concludes with a summary by NIAAA Director Enoch Gordis, M.D.; Alcohol and Tobacco: A Commentary. Alcohol and tobacco are frequently used together, may share certain brain pathways underlying dependence, and because of their numerous social and health-related consequences, are a continuing source of national public policy debate.

Many alcoholism treatment professionals have not actively pursued smoking cessation among their patients based on the belief that the stress of quitting smoking while undergoing alcoholism treatment might cause relapse. As a physician who has seen the ravages caused by both alcoholism and smoking, I am pleased that we now have research evidence showing that both can be treated simultaneously without endangering alcoholism recovery. As basic science learns more about how alcohol and nicotine act singly and together within the brain, new treatments for alcohol and nicotine dependence will follow.

Finally, society has attempted to minimize the consequences of using both alcohol and tobacco through public policy actions, including health warning labels, restrictions on advertising, and age restrictions on use . . .

Alcoholics who smoke generally are less successful in achieving and maintaining sobriety than are nonsmoking alcoholics (Hughes; Journal of the American Medical Association 275:1097-1103, 1996). Furthermore, in alcoholics treated for both addictions, relapse to smoking is considered a risk factor for alcohol relapse (Johnson & Jennison; International Journal of the Addictions 27:749-792, 1992.).

Many people who are chemically dependent have also developed either HIV or the Hepatitis C Virus (HCV), usually directly from their addictive and/or self-destructive behaviors. When these people get into a recovery process many continue to use nicotine - which has serious negative health implications for them. The information below is from an article by Jill Cadman in 2002. The study reported in Ms. Cadman’s article (partial text below) appeared in the April 8, 2002 issue of the Archives of Internal Medicine.

About four million people in the U.S. have the hepatitis C virus (HCV). HCV can cause an infection of the liver that is usually spread through blood contact with an infected person. Many HIV-positive people are also infected with HCV. If not treated, hepatitis can cause cirrhosis scarring) of the liver. This can lead to severe sickness or even death. A new study has found that people with HCV should avoid smoking cigarettes and drinking alcohol because both habits can further damage their livers. The study used levels of the liver enzyme ALT to check for liver damage. (Higher ALT levels can be a warning sign of liver damage.)

The researchers found that drinking alcohol and smoking more or less doubled the risk of having high ALT levels. People who smoked a pack or more of cigarettes each day and frequently drank alcohol had a risk of elevated ALT levels that was seven times higher than for those who did not drink or smoke.

The researchers who conducted the study stated that people who have HCV "are strongly advised not to smoke and drink alcohol to reduce the possible risk for aggravating (their) liver dysfunction." A person with HIV and HCV can become very sick. The added strain that HCV puts on the immune system makes it even harder for the body to fight diseases and infections. If you have HIV and HCV, you need to get regular medical attention for both conditions and take care of your body by avoiding habits, such as smoking and drinking.

Other interesting information was published in Counselor Magazine in 1996 in an article written by Terence T. Gorski. I’ve included a brief passage from that article below.

Actively drinking alcoholics have a reduced life expectancy of approximately eleven years. Abstinent alcoholics who continue to smoke cigarettes don’t do much better. Their life expectancy is reduced by nine years. The major causes of death in sober recovering alcoholics are cancer and heart disease related to smoking. Studies conducted by Janet K. Bobo in Seattle and Richard Sandor at the Betty Ford Center show that there is no higher incidence of relapse in people who quit smoking during their treatment for chemical dependency. The research also shows that recovering people who do not smoke have higher recovery rates from all drugs than those who do smoke. In other words, the relapse rates are significantly higher among recovering people who smoke than among recovering people who don’t smoke.

The adverse health effects of nicotine have been widely addressed and that nicotine may also contribute to an addiction relapse, but even this does not motivate people in recovery to stop. So why do people keep smoking or using chewing tobacco even though they know it is dangerous to their health? There are a number of reasons why this is so, but what I believe needs to be addressed first and foremost is the automatic and unconscious defense mechanism called denial.

My personal opinion is that to be totally clean and sober from all addictions will lead to a truly happy, joyous and free life. My professional opinion is that addiction recovery and smoking just don’t mix.

For more information, phone 760.883-1670, email dr.grinstead@yahoo.com or go to www.addiction-free.com.

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