Recoveries Up in Smoke Update


Smoking Image Dimitar Marinov

Many people in self-proclaimed addiction recovery experience compromised health and premature death due to a unique form of conceptual blindness--the failure to perceive nicotine dependence on par with the other drug dependencies they have shed from their lives.

On August 23, 2013, I posted a blog noting the following 12 conclusions drawn from available scientific studies of nicotine dependence and its relationship to recovery from other drug addictions.

  1. Tobacco use accounts for more sickness and disease than the combined use of alcohol and other drugs.
  2. Combining nicotine addiction with another drug addiction amplifies the health risks of both addictions.
  3. Between 70-80% of people entering addiction treatment smoke--nearly 4 times the rate for all adults.
  4. Between 44-80% of patients admitted to addiction treatment express a desire to stop smoking.
  5. People treated for alcohol or drug dependence are more likely to subsequently die from smoking-related diseases than from alcohol- or other drug-related causes.
  6. Leading figures within the American history of addiction recovery have died of smoking-related diseases, including Bill Wilson, Dr. Robert Holbrook Smith, Mrs. Marty Mann, Danny C., Jimmy K., Charles Dederich, Dr. Marie Nyswander, and Senator Harold Hughes.
  7. Continued smoking among those seeking to initiate or maintain recovery is a risk factor for resumption of alcohol and other drug use.
  8. Smoking cessation improves recovery rates of other addiction; rates of smoking cessation rise with length of abstinence from alcohol and other drugs.
  9. A growing number of addiction counselors are refusing to model a behavior (smoking) that could take years from their own lives and the lives of those who could be influenced by their example.
  10. Some people in recovery are choosing to change their sobriety/clean dates to reflect the date they stopped all addictive drug use--including nicotine use.
  11. Addiction professionals are broadening their understanding of "recovery" to encompass smoking cessation.
  12. The health benefits of smoking cessation for people in recovery include increased life expectancy, reduced risk of heart disease, heart attacks, strokes, and cancer, as well as a more rapid process of brain recovery from addiction.

Studies published since my first posted summaries (Here and Here) confirm and extend these major findings. The latest study comes from Dr. Andrea H. Weinberger and colleagues who measured the effects of continued smoking or onset of smoking on the recovery outcomes of persons who had previously achieved remission from a substance use disorder. The authors concluded:

Among adults with remitted substance use disorders, those who reported continued smoking 3 years later had increased odds of substance use and relapsing to substance use disorders compared to those who were no longer smoking. (Weinberger et al., 2017, p. e153)

The same risk of increased substance use recurrence was found among nonsmokers who began smoking during the early years of their recovery from other drug dependencies.

The awakening to such realities has progressed in recent years, with many addiction treatment programs now incorporating smoking-related assessment, education, and treatment, as well as encouragement and sustained support for smoking cessation. The National Tobacco Integration Advocacy Committee (NATIAC) is challenging all addiction treatment programs to fully integrate such services through its recently released report A Time to Lead. I encourage all providers of addiction treatment and recovery support services to review and reflect on the NATIAC report. Decisive action on our part can save countless lives and enhance the health and quality of life of people in long-term recovery. Such action could also take us a step closer to correcting the blind spot that has excluded tobacco/nicotine from American drug policies.


Weinberger, A. H., Platt, J., Esan, H., Galea, S., Erlich, D. & Goodwin, R. D. (2017). Cigarette smoking is associated with increased relapse risk of substance use disorder relapse:A National representative, prospective longitudinal investigation. Journal of Clinical Psychiatry, 78:2.