You may have heard the old joke that goes, “How do you find your AA meeting? Look for a group of people smoking outside of a church.” The chain-smoking, coffee-drinking stereotype of someone recovering from addiction is old but at least some research suggests there is some truth behind it. A study published in the journal Alcoholism: Clinical & Experimental Research, surveyed AA members in the Nashville area found that nearly 89 percent of respondents drank coffee daily, compared to about 64 percent of Americans, and nearly 57 percent smoked cigarettes, compared to only about 14 percent of Americans. Many studies have shown that moderate coffee consumption is usually ok, but cigarettes are another question. We all know smoking is bad for you, but isn’t it the lesser of two evils if it helps you stay sober? Possibly, but based on what we know, it’s probably a good idea to quit smoking in recovery. Here’s why.
The big question when it comes to smoking is whether it helps you stay sober. Yes, smoking significantly increases your risk for many kinds of health problems that can kill you, but those will likely occur decades from now, whereas a relapse to drugs or alcohol might kill you very soon. So does smoking help you stay sober?
Based on what we know now, it doesn’t. Researchers from Columbia University’s Mailman School of Public Health looked at data from more than 34,000 adults enrolled in the National Epidemiologic Survey on Alcohol and Related Conditions, or NESARC, to identify individuals with substance use disorders. In each case, they looked at data for two periods three years apart to see if there was any relationship between smoking and the risk of relapse to drug or alcohol use. Indeed, there was. After three years, the smokers in the study had relapsed at nearly twice the rate of non-smokers–11 percent and 6.5 percent, respectively. People who smoked when they entered recovery but then quit at some point fared a little better at about 8 percent.
The data set here is large and the correlation is pretty convincing but it remains a correlation. We don’t know whether smokers who didn’t quit, for example, might have had more serious substance use issues and would have had a harder time staying sober regardless of their smoking habits. However, the result is certainly something to keep in mind.
One way smoking might directly affect relapse rates–rather than just correlate with them–is by acting as a trigger. It’s critical to be careful about triggers early in recovery. Triggers are people, places, and things associated with drug or alcohol use. They are essentially little signals the addicted brain looks for that indicate it might get drugs or alcohol soon.
When you think about it, smoking is a perfect trigger. It’s something that many people do while using drugs or alcohol and it has a distinctive smell, taste, and motor pattern associated with it. Smell is an especially strong emotional trigger, since it connects directly to the oldest part of the brain and is involved with primitive instincts like food and sex. It’s a perfect trigger–and a psychoactive substance too–yet treatment programs and mutual aid groups like AA don’t seem too concerned about it.
Of course, we all know that smoking is a massive health risk. Smoking greatly increases your risk of lung cancer, chronic obstructive pulmonary disease, or COPD, coronary heart disease, high blood pressure, and stroke. Smoking increases the risk for many other kinds of cancer as well, including cancer of the colon, esophagus, liver, and stomach. In many cases, smoking compounds the health risks of drugs and alcohol. Excessive drinking, for example, also increases your risk of heart disease, stroke, and various cancers, including those named above. Overall, about 480,000 Americans die each year from smoking-related causes, compared to 88,000 who die from alcohol-related causes and about 70,000 who die from drug overdose.
Another thing to be careful about is using tobacco to self-medicate. The study of AA members in Nashville found that most respondents said they smoked to relieve negative affect, including depression, anxiety, and irritability. These are common withdrawal symptoms but they are also possible symptoms of mental health issues such as major depression, bipolar disorder, and anxiety disorders. Smoking is also more common among people with schizophrenia, which is another major risk factor for addiction. Since this study was conducted among AA members, it’s possible that many respondents have untreated or even unidentified co-occurring mental health issues. If you are smoking to relieve depression, anxiety, or irritability, it’s possible that you need to address a mental health issue for your recovery to last.
Smoking is one of the hardest addictions to break. What’s more, few drug and alcohol treatment programs offer clients help in quitting smoking. They often say it’s too much to tackle all at once, that clients can work on their smoking problem later, once their drug and alcohol issues are under control. However, this ignores the fact that many people seeking help for substance use disorders are already seeking help for addictions to multiple substances or seeking help for a substance addiction and a mental health issue or an eating disorder.
Any way you look at it, a lot of people entering treatment for addiction have a steep hill to climb, so you might as well quit cigarettes too. Keep in mind that it’s your recovery. Even if your treatment program doesn’t encourage you to quit or offer assistance in quitting, you can decide to quit and ask for support. At Hired Power, we help you create a personalized treatment plan for tackling addiction. We help coordinate the different elements of treatment and support you for as long as you need it. To learn more about our services, explore our website or call us at 714-559-3919.
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