Many addicts who smoke ask, “How many vices do I have to give up at one time? Can’t I just smoke to get through rehab?” Until recently, the prevailing view on this issue was that quitting smoking at the same time as quitting alcohol or other drugs might be too stressful, and could undermine the recovery process. For this reason, letting addicts continue smoking through rehab was deemed acceptable. But as it turns out, quitting cigarettes can actually support the recovery process.
How Smoking Can Hinder Recovery
In my experience, allowing an addict in recovery to continue with a secondary addiction like smoking is not necessarily helpful to their process and, in fact, the opposite is more likely to be true—for a number of reasons:
#1 Treatment is most effective if it addresses all addictions and underlying issues simultaneously. In dual diagnosis programs we can successfully treat multiple addictions at the same time (for example, dual addictions to alcohol and opiates) as well as co-occurring mental health disorders like depression, anxiety and trauma. We teach clients positive coping skills and encourage them to move toward a healthier lifestyle in every way possible.
#2 Smoking can be a relapse trigger. Since alcohol and drug use often goes hand in hand with smoking, cigarettes might hinder recovery if the urge to drink or use is triggered every time a person lights up. One of the goals in an addiction treatment program is to discover the triggers and motivations that drive drug use, learn to avoid or manage those triggers, and find healthier ways to cope with difficult feelings. If a trigger like smoking can be removed and effectively replaced with a healthier coping tool, this is a plus for ongoing sobriety.
#3 Nicotine can pose an even greater health risk than some other substances. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that 60 to 75% of patients in treatment programs for alcoholism are also addicted to tobacco. When alcoholism and smoking co-occur, smoking tends to continue long after the alcohol addiction treatment program has been completed. This is evident at 12-step support group meetings, where you are likely to see many members congregating outside to smoke cigarettes and drink coffee before and after the meeting.
In some cases, an addiction to nicotine can actually represent a greater health risk than drinking, especially over the long term. According to the NIAAA, more people with alcoholism die from smoking-related diseases than from alcohol-related diseases.
From a health standpoint, it makes sense to try and quit smoking at the same time you are in treatment for other addictions. This is a time when you’ll have professional support in a formal treatment setting. It’s a unique opportunity to take an all-encompassing approach to healthier living.
#4 Trading one fix for another is not an effective approach to recovery. Many people who are in drug or alcohol recovery transfer their addictive behaviors to other substances, like nicotine, or to process addictions like sex, food or compulsive gambling.
An individual who has completed treatment for a substance use disorder may have the notion that once they stop drinking or using, everything is “fixed.” This is an unrealistic expectation that needs to be addressed and managed. If an addict in recovery is simply transferring the addictive focus from another substance to cigarettes, without addressing the underlying issues that motivate this behavior, their recovery may be compromised.
If they want to effect lasting change and improve their health, recovering addicts are best served by applying new, healthy coping skills learned during treatment to all other issues as well, including addictive behaviors like smoking.
Getting the Help You Need to Quit Smoking
Ideally, addiction treatment programs should offer smoking cessation options to clients that smoke. Treatments for smoking cessation include behavioral and medication options, often together. Medications approved for smoking cessation include nicotine replacements (over-the-counter lozenges, patches and gum), as well as prescriptions such as bupropion hydrochloride (Zyban) and varenicline tartrate (Chantix). Other prescription-only nicotine replacements include Nicotrol, which is available as a nasal spray and an oral inhaler. It’s beneficial to use these products while under medical care because they can cause side effects that include both physical and behavioral symptoms (depression, anxiety) that should be monitored.
Therapies that help support smoking cessation include cognitive-behavioral therapy, stress management and acupuncture, many of which are available in addiction treatment programs. Another method being explored to help smokers quit is extinction therapy, which may help them “unlearn” or “memory update” the associations that drive them to reach for a cigarette, such as the sight of a lighter or the sound of a beer bottle being opened.
David Sack, MD, is board certified in psychiatry, addiction psychiatry and addiction medicine. As chief medical officer of Elements Behavioral Health, he oversees a network of addiction treatment programs that includes The Right Step rehabs in Texas and Clarity Way drug rehab in Pennsylvania.