Cigarette smoking is still the leading cause of preventable disease and death in the United States, accounting for more than 480,000 deaths every year or one of every five deaths.
Smoking is especially prevalent among people with substance use disorders. While cigarette smoking has declined among the general public, a significantly larger percentage of people who are addicted to drugs or alcohol use tobacco as well.
The Centers for Disease Control and Prevention (CDC) report that “current smoking has declined from nearly 21 of every 100 adults (20.9 percent) in 2005 to about 15 of every 100 adults (15.1 percent) in 2015.”
The numbers are quite different for people suffering from alcohol or drug addictions. An estimated 70–80 percent of individuals with substance use disorders are smokers. The consequences are deadly. Drug users who smoke cigarettes are four times more likely to die prematurely than those who do not smoke, according to the CDC. Numerous studies have shown that “alcohol use and smoking, both major public health concerns associated with illness and mortality, are strongly correlated with each other.” Nicotine use tends to stimulate alcohol consumption and drinking alcohol increases nicotine use and its rewarding effects.
A clear correlation also exists between nicotine cessation and successful recovery from addiction. Participation in smoking cessation efforts while engaged in other substance abuse treatment has been associated with a 25 percent greater likelihood of long-term abstinence from alcohol and other drugs (Prochaska et al. 2004).
On the other hand, a study by researchers at Columbia University’s Mailman School of Public Health and the City University of New York found that “adult smokers with a history of problem drinking who continue smoking are at a greater risk of relapsing three years later compared with adults who do not smoke.”
Dr. Wilson Compton of the National Institute on Drug Abuse told NPR that some of the same risk factors leading toward tobacco use can lead to misuse of other substances. “There may even be a biological pathway that starts with nicotine exposure that can prime the brain to be more interested in other drugs,” Compton said.
While treatment for alcohol and drug addiction regularly involves addressing co-occurring behavioral health conditions, encouraging patients to quit smoking is not part of all treatment programs. Some physicians even advise their patients to seek treatment for their alcohol or drug addiction first, fearing that quitting tobacco as well might actually jeopardize their recovery. Patients, too, often feel it is too much to ask when the main challenge is dealing with alcohol or drug addiction but it is definitely worth trying.
At Lakeview Health, the holistic treatment approach includes therapies that address the body, mind, and spirit. Since smoking is dangerously unhealthy and increases the risk of a relapse, Lakeview offers help to patients who would like to quit smoking as part of their recovery.
Therapist Nicola Cimmino runs smoking cessation groups that inform and assist patients who would like to stop using tobacco. “We talk about the dangerous mix of thousands of chemicals contained in tobacco products, about seventy of which can cause cancer. And we explain how the nicotine replacement therapy works and supply nicotine patches and lozenges as needed.”
The Prochaska study found that up to 80 percent of people in addiction treatment are interested in quitting smoking, but cessation can be a real challenge. Among all current US adult cigarette smokers, 68 percent reported in 2015 that they wanted to quit completely. Many people try several times before they succeed. As an addiction, smoking can be as tough to beat as alcoholism or heroin abuse.
“Patients often come to me and say they want to be part of the nicotine cessation group,” says Cimmino. “They are sick of smoking and well aware of the health risks. They usually end up feeling much better and much healthier if they commit to quitting.”
If patients are reluctant at admission, they can always change their mind later and let their primary therapist know that they would like to attend nicotine cessation class. “Patients can choose a date when they would like to quit smoking,” explains Cimmino. “They don’t have to quit as soon as they join the program, and a lot of them actually choose to quit smoking when they are discharged from Lakeview.”
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