When it comes to coping strategies to help with substance abuse rehabilitation, there is a spectrum of behaviors. On one end of the spectrum are the good ideas, like exercise, mental and spiritual exercises, and family time. But there is a bad side to the spectrum, one that offers short-term relief and long-term dangers. Nicotine use during addiction recovery is a problem for a number of people who turn to other substances to manage their cravings. Such behavior scratches an itch, but it primes the brain for a relapse.
Smoking in Recovery
There are almost 60,000 smokers among the 1 million people who are members of Alcoholics Anonymous, says Healthday News, quoting researchers at Vanderbilt University. At face value, it makes sense: Smoking has long been prized for the way it reduces depression, anxiety, and irritability. Such benefits might be seen as exceptionally valuable for people who are trying to quit a drinking problem; cravings for drugs post treatment can be one of the most challenging parts of recovery, and the comfort that comes with a dose of nicotine can present itself as an easy solution.1
The Vanderbilt researchers conducted a study in 2008, the results of which were published in the journal of Alcoholism: Clinical and Experimental Research. In the study, 289 Alcoholics Anonymous members were asked about their consumption of coffee, cigarettes, and alcohol. While nearly all of them upped their coffee intake following quitting alcohol, 56.9 percent of them smoked; and among that 56.9 percent, 78.7 percent smoked at least a half-pack of cigarettes every day. More than 60 percent of AA members said they were “highly dependent” on their cigarettes.
Even on a general scale, the numbers bear out. The Huffington Post writes that people who meet the criteria for a substance abuse problem have “disproportionately higher rates” of cigarette use than the general population. Seventy-five percent of people from the age of 12 and up, who checked into a treatment facility for an addiction problem, reported smoking cigarettes in the month prior to their treatment beginning. The Substance Abuse and Mental Health administration reports that only 24 percent of the general population smoked in a comparable time period.2
Similarly, the National Survey on Drug Use and Health discovered that while adults diagnosed with mental illnesses or substance abuse problems made up 25 percent of the national population, they accounted for 40 percent of all cigarettes smoked in the United States. Among the general population, smoking is the number one cause of preventable death, but for people who have mental health and addiction disorders, the rates of morbidity and mortality are even higher.
10 Seconds after a Puff
Newly sober people face a lot of challenges in their abstinent life. An in-depth report on alcoholism from The New York Times explains that a person who is relearning life without alcohol has to deal with the brain trying to return to the false sense of comfort it was forced into as a result of the problem drinking. This has the effect of the person feeling depressed, anxious, and tense due to the chemical imbalances in the brain constantly shifting. The negative moods present a troubling source of temptation to former alcoholics, one that needs to be constantly guarded against.3
Most recovering alcoholics fight back by channeling their negative feelings into something positive. Mindfulness therapy helps people counter depression and avoid relapse, and exercise has been shown to improve brain functioning, to the point that exercise groups are now a widespread sober activity.4, 5
But some try smoking. A single inhalation from a cigarette results in nicotine hitting the brain within just 10 seconds, and stimulating the same areas of the brain that are also tickled by the consumption of alcohol. Nicotine increases the production of the dopamine neurotransmitter, inducing sensations of pleasure and satisfaction (which, for a person struggling with the stress of alcohol cravings, can be exceptionally blissful).
Unlike alcohol, however, the effects of nicotine wear off very quickly, after only a few minutes; and with as many as 25 cigarettes in a pack (and boxes sold conveniently), a smoker has a ready supply to keep nicotine intake going throughout the day.6
Psychology Today writes that in five minutes, a typical smoker will take 10 puffs from a lit cigarette. If that same smoker were to go through 30 cigarettes (1.5 packs) every day, the smoker’s brain would be on the receiving end of 300 daily hits of nicotine. That means the brain would be induced into producing dopamine 300 times every day, warping its functioning and contributing to the development of an addiction.7
Therefore, it does not come as much of a surprise that the researchers at Vanderbilt University pointed to there being a “biological basis” in how much a large number of recovering alcoholics rely on cigarettes. The researchers add that this may actually contribute to the chances of a relapse, because of the way that alcohol and nicotine have a similar effect on the brain’s mesolimbic (reward) pathways.8
Similarly, even as fewer people smoke (probably due to graphic and widespread anti-smoking campaigns and laws), the number of people who smoke socially – and usually after having alcohol – is rising, especially among young women, notes Medical Daily.9, 10 The results of a study published in the October 2015 edition of the Journal of Neurochemistry found that many people who drink do so because while nicotine and alcohol work in similar ways, they have markedly different effects. Tests on rats showed that nicotine affects the areas of the brain responsible for controlling reflexes and attention. Alcohol, on the other hand, is a depressant, so it slows the central nervous system. Put the two together, and many drinkers will reach for a cigarette because the act of smoking helps them counter the drowsiness they feel after drinking too much.11
To that point, the National Institutes of Health wrote as far back as 1998 that 90 percent of alcoholics also smoke cigarettes. Even people who do not have a physical or psychological dependence on alcohol will indulge in a cigarette when they are drinking (so-called “social smoking”).
Other research confirms theories that nicotine boosts the pleasurable effects of alcohol, both increasing the high of someone who is already drunk and furthering the desire to drink more.12
Smoking, Alcoholism Recovery, and Neurocognitive Functions
Such is the extent of the problem, that in writing how “smoking may make it harder for brains to recover from alcohol abuse,” Medical Daily notes that clients reminding family members to bring cigarettes on rehab visits happens all too often. For a long time, this vice was indulged; the prevailing belief was that cigarettes helped the abstinence process, giving clients a less harmful substance to moderate cravings for the drugs or alcohol that led them to rehab to begin with.13
However, this practice has been shown to be even more harmful than suspected. In addition to the plethora of negative health effects caused by smoking (damaging arteries, impotence, tissue damage and blocking blood flow, among many others), the way smoking alters the brain’s chemistry is strikingly similar to what long-term alcohol abuse does.14
Another study published in Alcoholism: Clinical and Experimental Research discovered a connection between different levels of nicotine use and how well clients recovered the use of their neurocognitive abilities (such as maintaining attention and concentration, solving problems, and retaining new information and old memories) in the first eight months of their rehabilitation. Among
heavy smokers, there were “wide discrepancies” in how well study participants were able to get back their advanced brain functions. Over eight months of clients not using alcohol, wrote the researchers, those who were active smokers had poorer results in learning and processing information than those who never smoked.15
At the end of the eight-month period, clients who had never smoked “reached full recovery of neurocognitive functions.” Those who still smoked “continued to be slower with mental tasks.”
The Three-Year Threat
Why such a debilitating effect? There are a number of toxins in cigarette smoke, which can directly hit brain cells in a number of seconds. As the pleasurable effects of smoking wear off fairly quickly, a smoker is compelled to smoke again and again, exposing the brain to a list of chemicals that, according to the American Lung Association, include:
- Arsenic (found in rat poison)
- Acetone (found in nail polish remover)
- Cadmium (the active chemical component in battery acid)
- Toluene (an ingredient in the manufacturing of paint)16
- Lead (found in batteries)
The writers of the study in the Alcoholism: Clinical and Experimental Research suggest that instead of merely telling smokers in alcohol recovery programs to give up their cigarettes (for fear that it would be asking too much), the treatment community should “offer a comprehensive smoking-cessation program,” effectively combining therapy for nicotine abuse with the pre-existing treatment model in place for alcohol addiction.
Yet another study on the topic published in the same journal suggests that the threat of relapse induced by smoking can last for as long as three years.17 Part of the problem is that current treatment models do not take into account the reality that many clients who are in therapy for alcohol problems smoke cigarettes as a way to deal with the vestiges of their addiction. The lead author in this study told Science Daily that there was even the prevailing opinion that “continued nicotine dependence would make no difference in the long run.”18
The reality, of course, is that smoking is incredibly bad for anyone’s health (whether substance abuse disorders are present or not), especially so for people whose habit of drug or alcohol abuse has primed their brains to constantly seek out the same kind of sources – if not in drugs or alcohol, then in nicotine. Giving up cigarettes, said the authors of the Alcoholism study, could be the key to help adults in recovery stay sober.
The alternative is relapse. People who smoke every day, and even people who do not smoke on a daily basis, are two times more likely to relapse back into their alcohol dependence, compared to people who don’t smoke at all.
Addressing Two Drugs
The American Family Physician journal warns that smokers who are in recovery for alcohol treatment could be at risk for being more addicted to their nicotine than smokers who do not have a substance abuse problem. In order to secure a better chance for staying sober, a therapist should work with a client on quitting smoking at the same time the alcohol addiction is being treated or as soon as the alcohol treatment has concluded.19
In dispelling a series of myths about the addictiveness of nicotine, the journal counters the notion that some people in recovery have; that smoking in the aftermath of an alcohol addiction is a relatively harmless vice and not as destructive as alcoholism. In line with other evidence- and research-based findings, the journal reiterates that a smoking addiction can be as deadly, if not even more deadly, than any other form of substance abuse. Recovering alcoholics who smoke have a greater chance of developing heart and/or lung disease, as well as various forms of cancer, and are more likely to die sooner than the public.
As with the case of most kinds of addiction, the negative effects of pulling away from the substance of choice play a large role in compelling clients to persist with their habits. Much like alcohol, patients who give up on their cigarettes will feel withdrawal symptoms on the lines of agitation, tension, and difficulty concentrating, as well as physical effects like constipation, nausea, and insomnia. Perhaps most distressing, clients will experience the same kind of craving for nicotine, as they do for alcohol – indeed, the same kind of craving that they tried to smooth over with cigarettes in the first place.20
However, says the American Family Physician journal, in the same way that there are many options for treating an alcohol problem, there exists a similar abundance for treating nicotine dependence. Since alcohol and nicotine derive their addictive potential in very comparable ways, the therapeutic approaches can easily and naturally overlap.
Cognitive Behavioral Therapy for Nicotine Use during Addiction Recovery
Everyday Health explains that Cognitive Behavioral Therapy (CBT), one of the most popular methods of counseling to help clients overcome the psychological damage wrought by drinking and drug abuse, can also help clients quit smoking.21
CBT works by pinpointing the negative thought processes that lead to a client wanting to smoke, and then forming new ways of dealing with those urges. A therapist will encourage a client to think out loud, to get the patterns of thought and behavior out into the open, and then work on changing them. Wherever the therapist sees illogical or faulty ideas, the client will be encouraged to develop healthier and better alternatives: when the familiar itching for a cigarette begins, to go outside and take a walk instead, for example; when anxiety and depression compel the craving for a cigarette, to perform a quick breathing or meditative exercise instead.
To help the client reach this point, the counselor will assign small exercises and practice tasks, to introduce the concept (and then the practice) of intercepting harmful thought patterns before they have a chance to materialize. This is usually done in form of “homework” assignments (such as journaling, taking short walks, finding new hobbies, etc.), gradually getting the client used to the idea of thinking in new and different ways that don’t involve reaching for a cigarette to deny an alcohol craving.
The end goal is to help the client be more confident about the ability to quit smoking, creating a sense of empowerment and self-control that did not exist in the face how overwhelming post-recovery abstinence seemed. Stressful life situations will inevitably occur, but CBT will give the client a new arsenal of tools to stave off the negative thoughts that would usually characterize the urge to reach for a cigarette when sobriety felt too difficult.
In 2016, the journal of Substance Abuse: Research and Treatment looked at 92 published studies on the topic of different strategies to try and help people overcome their nicotine habits. Researchers found that CBT was “consistently effective in helping people quit smoking,” further adding that there are no side effects as one might expect with medication-based forms of treatment.22> Such a point may be especially pertinent for clients who are already in the process of overcoming a substance abuse problem, if a doctor feels that a course of medication carries too high a risk for triggering a relapse.
Alcohol and tobacco are two of the deadliest drugs in the United States, writes Medical Daily, and their individual and collective consumption is widespread, promoted, and encouraged. They are responsible for a death toll that ranges from under a half-million to approximately 2.5 million, and whether at a bar or in recovery, they provide a false sense of security and comfort.23, 24 But by the same measure that nicotine and alcohol poison thoughts and lives, treatment and therapy can help clients get their recovery back on track, and focus on methods and strategies that actually work.
- “Many Recovering Alcoholics Depend on Coffee, Cigarettes.” (July 2008). Healthday News. Accessed July 11, 2016.
- “Building a Smoke-Free Life in Recovery.” (March 2014). The Huffington Post. Accessed July 11, 2016.
- “Alcoholism In-Depth Report.” (n.d.) The New York Times. Accessed July 11, 2016.
- “Mindfulness Therapies Can Help People Suffering From Depression Avoid Relapse, Study Finds.” (April 2016). National Post. Accessed July 11, 2016.
- “How Exercise Keeps You Sober.” (January 2012). The Fix. Accessed July 11, 2016.
- “What a Pack of Cigarettes Costs, in Every State.” (August 2015). The Awl. Accessed July 11, 2016.
- “Nicotine.” (December 2015). Psychology Today. Accessed July 11, 2016.
- “Brain Reward Pathways.” (n.d.) Icahn School of Medicine. Accessed July 11, 2016.
- “America’s Quitting Smoking: CDC Report Shows Cigarette Smoking Rates Are Dropping.” (September 2015). Medical Daily. Accessed July 12, 2016.
- “Cigarettes And Alcohol: Science Finally Figures Out Why We Like To Smoke When We Drink.” (October 2015). Medical Daily. Accessed July 12, 2016.
- “Nicotine Administration In The Wake-Promoting Basal Forebrain Attenuates Sleep-Promoting Effects Of Alcohol.” (October 2015). Journal of Neurochemistry. Accessed July 12, 2016.
- “Effects Of State Cigarette Excise Taxes And Smoke-Free Air Policies On State Per Capita Alcohol Consumption In The U.S., 1980–2009.” (October 2014). Alcoholism: Clinical and Experimental Research. Accessed July 12, 2015.
- “Case Against Cigarettes In Rehab: Smoking May Make It Harder For Brains To Recover From Alcohol Abuse.”(October 2014). Medical Daily. Accessed July 11, 2016.
- “It’s Not The Smoke, It’s The Nicotine: E-Cigarettes May Damage Arteries.” (December 2013). Medical Daily. Accessed July 11, 2016.
- “Effects Of Cigarette Smoking History on Neurocognitive Recovery Over 8 Months of Abstinence in Alcohol-Dependent Individuals.” (November 2014). Alcoholism: Clinical and Experimental Research. Accessed July 11, 2016.
- “What’s in a Cigarette?” (n.d.) American Lung Association. Accessed July 11, 2016.
- “Cigarette Smoking and Risk of Alcohol Use Relapse Among Adults in Recovery from Alcohol Use Disorders.”(October 2015). Alcoholism: Clinical and Experimental Research. Accessed July 11, 2016.
- “Study’s Message To Recovering Alcoholics: Quit Smoking To Stay Sober.” (September 2015). Science Daily. Accessed July 11, 2016.
- “Smoking Cessation in Recovering Alcoholics: Fiction vs. Fact.” (April 1998). American Family Physician. Accessed July 12, 2016.
- “Nicotine Withdrawal.” (November 2015). HealthLine. Accessed July 12, 2016.
- “How Cognitive Behavior Therapy Can Help You Quit Smoking.” (May 2016). Everyday Health. Accessed July 12, 2016.
- “Are Smoking Cessation Treatments Associated with Suicidality Risk? An Overview.” (20160). Substance Abuse: Research and Treatment. Accessed July 12, 2016.
- “Smoking & Tobacco Use: Fast Facts.” (December 2015). Centers for Disease Control and Prevention. Accessed July 12, 2016.
- “Fact Sheets – Alcohol Use and Your Health.” (June 2016). Centers for Disease Control and Prevention. Accessed July 12, 2016.