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Why many in recovery are dying of addiction

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Emphysema

How many recovering people smoke cigarettes? In Scotland, just under a fifth of the population smoke, but in treatment populations the rate is between 60-90%. Travellers looking for mutual aid meetings will often be guided by the group of smokers outside the church hall. Some of those people in long term recovery are dying of addiction.

There’s a bit of an elephant-in-the-room-thing going on here. There’s not a lot of acknowledgement of the cruellest of ironies: that people in recovery from alcohol and other drug dependence will still die of addiction-related disease. The fact is that about one in two of them will develop fatal pathology like cancer or heart disease because of smoking. Others will be impaired by chronic, smoking-related conditions.

There’s a nice little paper on this at NIAAA where some of the fallacies around this are busted. Here’s what they say:

“Myths surrounding concurrent treatment for smoking and alcoholism also include the ideas that smoking is a benign problem relative to alcoholism, that patients with comorbid alcoholism have either no interest or no ability to quit smoking, and that patients will relapse to alcohol if they quit smoking.”

Turns out none of that is true. What’s astonishing is that about 8 out of ten smokers will tell you they would like to stop. I wonder if the acceptance of smoking in the membership of mutual aid meetings is a barrier to quitting, a sort of normalisation of an unhealthy behaviour. We all do it, so it must be okay. It’s not okay, because some are dying of addiction to cigarettes and the failure of recovering people to address this is surely an oddly persistent and peculiar example of denial.

smoking-2Overcoming denial, as everyone who has made the transition to recovery knows, is hard work. Smokers in recovery from alcohol and other drugs may want some help with the process. American Family Physician published a great article in 1998 which laid out the myths and the facts about smoking for recovering people. It is a brilliant tool and I recommend it to you.

Maybe switching to e-cigarettes will help, but as Jason Schwarz at Addiction and Recovery News says: not so fast! E-cigarettes are not without risks too, though these are more subtle. We’re not sure yet what the balance of risks is.

Here’s a powerful incentive though to those going through treatment. Prochaska and researcher colleagues found that those who quit smoking in treatment had a 25% reduced risk of relapse to alcohol and other drugs. Now that’s worth sticking in your pipe…

[A version of this blog was published in May 2014]

    3 Responses to "Why many in recovery are dying of addiction"
    1. Peter Sheath says:

      I’ve been banging on about this for ages. Most of the people we work with are going to die from smoking and or alcohol related diseases and yet we are are so reticent around helping them to desist. Treatment is often made up of myths and anecdotal evidence with lots of workers failing to change as a result of training or develop themselves professionally.

      It’s still widely accepted that it’s somehow unethical to address all the substances that someone is using concurrently so things like smoking are not seen as priorities and put down as something to be tackled when everything else has been dealt with. However the main elephant in the room, in my humble opinion, is the acceptance of chemical coping mechanisms amongst the workforce. In most areas at least 50% of the team will smoke, binge drinking is almost celebrated and lots are prescribed psychotropic medications.

      I train people and one of the boundary exercises I do is around smoking and drinking. Most smokers and drinkers really argue their position to defend their habits and I often wonder how they can remain objective and work in the clients best interest with these strong values just below the surface.

      • djmac says:

        It’s a tricky one – how professionals use alcohol, tobacco and other drugs. It would make for a fascinating study. There is already evidence that doctors and nurses who smoke are less likely to give advice around quitting, so personal attitudes clearly can affect professional behaviour in this regard.

    2. Jo says:

      Hello both :),

      I think there is a danger of people switching off if the message is too puritan and preachy. Not everyone who takes drugs or/and drinks has an addiction problem. Not sure what the point is about staff taking medication and there should be appropriate governance to manage staff smoking & binge drinking inside & outside of work. I understand advocating for people in recovery and feeling passionate about people dying from addiction, me too, but there is also something about tolerance and acceptance of other people’s choices that I want to say.

      I recently spent time in an abbey with some beautiful catholic cistercian monks who are friends/brothers of my husband who had lived at the abbey previously. The monks had taken vows of poverty and were excited at our offer to go outside the abbey to eat. When we got to the cafe they excitedly ate a sausage roll, and I was really surprised because they don’t eat meat as part of their vow. Of course I had to mention this and It was really lovely as they said we are just people who do things we shouldn’t sometimes. We then went on to talk about religion and I was so humbled by their acceptance and interest of my perspectives which I must admit are quite wooly. The whole experience was food for my soul and it renewed my respect for difference and acceptance of other peoples choices.

      Compassionately,

      Jo

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