When entering any drug or alcohol treatment program, one of the first questions people are generally asked is What do they consider to be their drug of choice? It is rare; however, that that one responds to this by answering, My drug of choice is nicotine; when in fact, nicotine is just as addictive as other so-called street drugs, such as heroin and cocaine. Nicotine is responsible for more deaths in this country than marijuana, alcohol and most other substances, yet for many recovering addicts, they continue to struggle with nicotine addiction, long after they have conquered their addictions to other drugs and alcohol. If you were to visit any local AA meeting or drive by any drug treatment center, you would encounter scores and scores of people literally puffing their lives away, while attempting to free themselves from the addictions that have controlled them. Whats even more ironic, Bill Wilson, the founder of the AA organization himself, in fact died from complications associated with emphysema, after years and years of smoking and not from alcohol addiction. I am by no means advocating that one drug be regarded safer than the other, I am only suggesting that any drug addiction be viewed as dangerous and the same tenacity and conviction used to help treat people who are addicted to other harmful substances, should also be used to treat nicotine addiction.

In recent years, we have seen a rash of campaigns, movements and programs whose primary focus has been to spread the word about nicotine and its deadly consequences; yet for the recovering addict, smoking is regarded to be the lesser of two evils and thus the push to quit smoking has been ineffective in reaching this population; or perhaps it has been that this population has elected not too hear the push. Whatever, the case may be, I feel as a society we must work harder to encourage recovering addicts to quit smoking. For many alcoholics and drug addicts, nicotine is generally the first drug they ever use and essentially the last one they quit. Historically, the problem has been that patients in drug and alcohol rehab programs were advised to postpone efforts at trying to quit smoking so that the primary focus can be to help the individual abstain from the identified drug of choice. The truth is, recovering addicts tend to receive far less tobacco counseling out of fear that attempts to quit smoking while in recovery will jeopardize efforts at sobriety. In more recent times, this may not necessarily be a spoken rule, but more or less an unspoken rule, as treatment is typically geared toward helping the individual abstain from the drugs that has traditionally been thought of too pose the more immediate risk.

My position is, although I believe addressing the issue of nicotine while in recovery is a delicate one; I believe the risks of not addressing it greatly outweigh the risks of doing nothing and continuing to be passive. In fact, according to research conducted in more recent times, attacking nicotine use while learning the necessary tools and strategies to live a sober and drug free lifestyle may even help to enhance recovery for some. Furthermore, nicotine and other substances share similar brain pathways and may actually reinforce cravings for each other; thus, targeting nicotine use while targeting other substances has shown to have many positive long-term results.

I sometimes wonder if our passivity to confront nicotine addiction in recovering addicts represents a larger societal problem. As a society, it makes us very uncomfortable to air our dirty laundry in public, and the truth is, people who use substances traditionally thought of to be hardcore are seen more of as public nuisances. We are very uncomfortable with the idea of having a family member addicted to alcohol who may be representative of the town drunk or having a family member addicted to crack because of the obvious societal concerns and stigma, yet for the smoker, this same stigma does not exist even through smoking can have a great impact on ones health and quality of life. We tend to view people who use other substances as having little or no self-control and because of this, we are more able to tolerate persons who smoke than we are able to tolerate individual who use hardcore drugs.

In closing, I believe treatment specialists need to do better job of educating recovering addicts about smoking and as the push to increase awareness about smoking continues, I can only hope that we begin to encourage recovering addicts to quit smoking with the same tenacity, passion and enthusiasm that we use to encourage them to stop using other drugs and alcohol.