Smoking and recovery used to go together like Sonny and Cher. Those who attended AA meetings 15 or 20 years ago will remember when “the rooms” were almost entirely smoke-filled. Newcomers and old-timers alike chain-smoked on the theory it was a bona fide recovery tool, not an addiction. “I’d rather die of lung cancer than cirrhosis” was their unofficial slogan.
The link between smoking and recovery goes back a long way. Emphysema, caused by years of heavy smoking, was a major factor (along with pneumonia) in the 1971 death of AA cofounder Bill Wilson. But Bill’s death didn’t stop folks from continuing to light up – or from starting to smoke.
Indeed, the recovery world is rife with tales of people who had seldom or never smoked but started puffing with a vengeance after they stopped drinking. “When I first got sober about fifteen years ago, most people in AA smoked,” says Elizabeth R. “I had never been much of a smoker but I started bumming cigarettes and smoking after meetings, mostly to have something to do with my hands so I didn’t feel awkward. Within a couple of years I had developed a two pack a day habit, and continued smoking for about ten years.” (She is currently not smoking.)
These days most of the smoke has cleared up – at least in 12-step meetings in New York State. Smoking in public places has been prohibited – which means smoke-free meetings are the law. Factor in the ever-increasing public cognizance of the health risks associated with smoking – not to mention the dauntingly high cost of cigarettes these days – and you’ll find that tobacco has lost its allure for the recovery community. Abstinence from tobacco has become a logical extension of sobriety.
“When I came into AA, I figured I might as well get rid of two addictions with one program,” says Max H., who has been sober for seven years. “I used the same tools that I did to quit drinking to get off the cancer sticks. It worked beautifully, and still does.”
The Tobacco-Free Initiative
Another sign of the times is that addiction treatment programs have been forced to address tobacco. In 2007, the Office of Alcoholism and Substance Abuse Services (OASAS) announced that New York would be the first state in the nation to make tobacco addiction treatment mandatory in all prevention and treatment programs.
The agency decreed that, effective July 2008, the 1,550 OASAS-certified programs could not allow smoking on their property, and must integrate nicotine replacement therapy into the treatment of other addictions. The Department of Health (DOH) even anted up an $8 million grant to provide smoking cessation training and nicotine replacement patches, lozenges, and gum at no cost to uninsured individuals in treatment.
The edict raised some predictable controversy, with many in the treatment community arguing that asking people in the early phases of recovery to give up tobacco was, if not cruel and unusual punishment, simply too much to ask. It was even thought that OASAS’ so-called “tobacco-free initiative” would discourage addicts and alcoholics from seeking help, forcing programs to close.
More than two years later, though, the initiative seems to be working. Ninety percent of OASAS-certified programs are now said to be in compliance with the regulation. “There’ve been a handful of programs that are blatantly not in compliance,” says Peggy Bonneau, Director of Health Initiatives for OASAS. “But the good news is that, although some programs are still struggling, we have a lot of training available. We’re really pleased with the progress and we credit the leadership and staff at the programs that are [compliant] with working very hard to make this work.”
It is estimated that up to 90 percent of people struggling with alcohol or chemical addiction smoke. Even more sobering is the 50 percent of all addicts and alcoholics whose deaths are linked to tobacco-related diseases.
Higher Recovery Rates?
“Including tobacco dependence while treating other addictions actually leads to higher recovery success rates,” OASAS Commissioner Karen Carpenter-Palumbo has said. “We need to focus on the overall wellness of our patients and not ignore this deadly addiction.”
This writer has worked in the substance abuse field for the past four years and seen the effects of OASAS’ regulation first hand. To be sure, clients still gripe about not being allowed to smoke in or near the facility. Some steadfastly refuse to think about quitting. But surprisingly few have left treatment because of the new rule, and many are embracing the growing number of nicotine-replacement therapy tools (which now include nicotine-inhalers and nicotine nasal spray) available to them.
“Studies tell us that tobacco is a trigger and that there is no harm in addressing this addiction at the same time the other addictions are being addressed,” says Bonneau. “We are hoping that five, maybe ten years from now, this will just be the normal course of business and people will look at this [initiative] and say, ‘Of course we wouldn’t allow an individual being treated for alcoholism to use tobacco.’”
OASAS is currently in the process of preparing a report on the progress of the tobacco-free initiative for release by year’s end. One preliminary finding is impressive: In a nine-month window, 23,000 people who started treatment as smokers left not smoking.
“Can I guarantee that those individuals are smoke-free today?” asks Bonneau. “No, I can’t. I can’t guarantee that they are not drinking today, either. However, they left treatment as non-smokers, so that’s our bar now. And if we can say that 23,000 people in a nine-month period left treatment as non-smokers, that’s something to be pretty happy about.”
Tom Sinclair, a Credentialed Alcoholism and Substance Abuse Counselor employed by the Addiction Institute of New York, smoked Camel Filters for many years. He is currently not smoking.
