For most people entering drug addiction treatment, smoking is not a primary concern. In fact, smoking can seem almost innocuous in contrast to the risks associated with addictions to hard drugs like cocaine, opioids, or methamphetamine. And, yet, cigarette smoking is nearly universal amongst drug users, with 84% of those in treatment for drug and alcohol use identifying as smokers compared to only 31% of the general population.
Many of those in residential addiction treatment feel that treatment is the last place they want to quit smoking; after all, you are already dealing with enough stress and taking away one of your primary coping mechanisms for handling that stress may seem like it will threaten your recovery. Unfortunately, this belief has often been perpetuated by addiction treatment programs themselves. As Dr. Nora D. Volkow, director of the National Institute on Drug Abuse (NIDA) says:
Substance abuse treatment programs have historically been hesitant to incorporate concurrent smoking cessation therapies with standard drug addiction treatment because of the concerns that patients would drop out of treatment entirely.
Unfortunately, both clinicians and clients have too often been under the impression that quitting smoking in recovery will be harmful for treatment outcomes, leaving many to continue smoking throughout recovery despite mounting health damage. But recent research is disproving the theory that smoking cessation is incompatible with drug addiction treatment
Quitting Smoking in Recovery Can Prevent Relapse
In 2008, researchers investigated the effects of combined cocaine or meth addiction treatment with smoking cessation measures and found that not only did many of the smokers remain nicotine-free in post-treatment follow-ups, but their recovery from cocaine or meth addiction was not affected. “These findings, coupled with past research, should reassure clinicians that providing smoke-cessation treatment in conjunction with treatment for substance abuse disorders will be beneficial to patients,” says Dr. Theresa Winhusen, lead author on the study.
Other research suggests that quitting smoking isn’t just possible during addiction treatment, it could actually improve treatment outcomes for both substance use disorders and smoking cessation. One meta review of 19 randomized controlled trials found that although immediate substance use treatment outcomes did not appear to be affected by smoking cessation treatment, long-term outcomes were. Smoking cessation intervention was “associated with a 25% greater likelihood of long-term abstinence from alcohol and other drugs.” In other words, rather than being an impediment to recovery, smoking cessation fortifies it; it is smoking, not quitting, that acts as a risk factor for relapse.
Why Smoking Cessation in Addiction Treatment Works
The reasons for these improved outcomes are complex and not yet fully understood. However, the National Institute on Alcohol Abuse and Alcoholism points out that “possible explanatory factors may include greater clinical contact time, reduced exposure to substance use cues, relapse prevention and/or coping skills practice, increased mastery or self-sufficiency, and broader healthy lifestyle choices.” In other words, the clinical and personal support you receive in an addiction treatment is broadly applicable and can be used to create freedom from your entire spectrum of drug addiction, including nicotine addiction.
But there may also be another, additional reason: smoking and drug use often go hand-in-hand. Whether it’s having a cigarette while drinking or chain-smoking through pack after pack while high on stimulants, cigarettes and drugs reinforce each other behaviorally. Simultaneously, Joseph R. Guydish, professor of medicine and health policy at the University of California, San Francisco, points out that nicotine “operates in the same reward pathways of the brain as other addictive drugs,” reinforcing the neural activity that perpetuates addictive behaviors. By disrupting the addictive drive toward one, you may be able to disrupt the addictive drive in general and give your brain the opportunity to learn and integrate new, healthy behaviors.
Nicotine Addiction Treatment Options
There is no one way to quit smoking; each person’s experience is unique and it is vital that you are matched with a method that is right for you. While some are successful going cold turkey, others prefer using nicotine replacement therapies in the form of patches, gum, or inhalers to help you cope with both observable and non-observable withdrawal symptoms and prevent cravings by giving you controlled doses of nicotine without the harmful effects of smoking. You may also consider pharmacological therapies such as Zyban and Chantix, which can both alleviate withdrawal symptoms and reduce your urge to smoke through daily oral medications. Simultaneously, clinical and peer support is often vital to helping you stay nicotine-free both during treatment and beyond. As such, smoking cessation strategies can be a critical part of your aftercare planning to ensure long-term success.
A comprehensive addiction treatment program should assess your nicotine use upon intake and speak to you about your options for integrating smoking cessation into your treatment plan. “Every person who enters substance abuse treatment ought to have their tobacco use evaluated and treated,” says Guydish. “If they don’t want to be treated and quit right away, they should have some education to help them think more about quitting.”
Quitting smoking is hard, but it is possible, and it is one of the most rewarding things you will ever do. With the right therapies and supports, you can create freedom from nicotine and create a healthier, more fulfilling life.
Alta Mira provides comprehensive addiction treatment for people struggling all forms of drug addiction as well as co-occurring mental health disorders and process addictions. Contact us to learn more about our renowned programs and how we can help you or your loved one start the journey toward sustainable recovery.
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