Editor’s Note: The material presented in this column was adapted from the author’s recently released book The Wellness-Recovery Connection: Charting Your Pathway to Optimal Health While Recovering from Alcoholism and Drug Addiction (Health Communications, Inc., 2004).

In the preceding column I focused on alcoholism and cigarette smoking as co-addictions. This column emphasizes practical tips concerning how you, as an addiction professional, can actively support your clients in recovery in freeing themselves from the deadly grips of nicotine addiction.

The National Institute on Alcohol Abuse and Alcoholism reports that 70 percent of alcoholics are heavy smokers, smoking more than one pack of cigarettes a day. Unfortunately, a high proportion of alcoholics and addicts carry their addiction to nicotine over with them into their recovery. Due to the highly addictive nature of nicotine and your clients’ histories of addiction to alcohol and other mind-altering substances, your clients stand to benefit from a strategic approach to smoking cessation that is custom-tailored to the special needs and circumstances of people in recovery. The following pointers are presented with this in mind.

Commitment: It is important to help your clients process why they want to stop smoking, and to fully embrace their primary reason for wanting to quit. Be prepared to hear your clients beat up on themselves, as they recount their previously failed attempts. At this juncture, I like to remind clients that as nicotine is, in fact, a heavily addictive drug, a history of previous efforts at quitting is par for the course. To help clients anchor themselves in their determination to stop smoking, I encourage them to identify and reflect on their primary reason for wanting to quit. Encourage your clients to write this down, always carry it with them, and refer to it whenever they are tempted to “light up” after they have quit smoking.

Medical Support: Advise your clients to discuss their desire to quit with their primary physicians and elicit their support. As doctors are intimately familiar with the deadly consequences of smoking, they tend to be very supportive of a smoker who earnestly desires to quit. In counseling a heavy smoker who has unsuccessfully attempted to quit on numerous occasions, suggest that your client discuss with their doctor the possibility of using nicotine replacement therapy to help ease the discomfort of withdrawal. (Caution: Nicotine replacement therapy should only be used under medical supervision — this is especially true for anyone with a history of chemical dependency.)

Group Support: Encourage your clients who are ready to quit smoking to enroll in low-cost smoking cessation programs employing a group support model. Many local chapters of the American Cancer Society and American Lung Association offer excellent programs, often in conjunction with hospitals and health plans. These programs can be especially helpful for clients working 12-step programs, as they are already receptive to peer support programs emphasizing a self-help approach.

I also like to encourage clients to fully utilize their 12-step support system to help them “over the hump” in quitting smoking. Linking up with a sponsor who is a recovering alcohol/addict who successfully quit smoking can be extremely helpful. If your client’s primary sponsor is still smoking, suggest that your client form a secondary sponsorship relationship with a special “stop-smoking sponsor.” Also encourage clients to double up on 12-step meeting attendance during the initial weeks of nicotine withdrawal (be sure to remind them to attend non-smoking meetings), and to consider attending Nicotine Anonymous meetings.

Supporting Your Clients During Nicotine Withdrawal:
•Help your clients ease their psychological discomfort by reframing their withdrawal symptoms — remind your clients that coughing, occasional spells of irritability and other symptoms of nicotine withdrawal can appropriately be viewed as positive signs that their bodies are detoxifying themselves from nicotine. Encourage clients entering nicotine withdrawal to visualize themselves as non-smokers, who are just beginning to enjoy being free from nicotine for the rest of their lives.
• Encourage your clients to avoid “people, places and things” that may trigger the urge to smoke.
* VERY IMPORTANT — Strongly urge your clients to fully exploit the many tools of wellness — particularly physical exercise, meditation and other stress reduction techniques, and eating nutritious foods — to help them successfully navigate nicotine withdrawal. Among other things, these wellness-oriented behaviors can serve as strong “positive addictions,” to help fill the void previously occupied by their addiction to nicotine (Glasser, 1976). A wellness-oriented lifestyle is an extremely powerful antidote to any negative addiction, and exercise, stress management and sound nutrition are integral components of successful smoking cessation programs.
• Suggest to your clients that they reinforce their commitment to smoke-free living by frequently rewarding themselves along the way. If you are a recovering former smoker, be sure to share with your clients your own struggles in kicking the habit, together with what worked for you.

Dealing with Slips and Relapses: Many clients who attempt to quit smoking become discouraged by slips and relapses. A slip is a momentary setback where your client has one or two cigarettes. Advise your clients to view such slips as valuable teachers, asking — “What can I learn from this?” If a client relapses and returns to habitual smoking, gently remind them that most smokers quit smoking several times before they finally quit for good. Support your client in his or her efforts to redouble their determination to quit, contract with them to set a new quit date, and help them rally their support system.

While people in recovery face special challenges in quitting smoking, a growing body of evidence suggests that the majority of these smokers really want to quit (Sees and Clark, 1993; Newport, 1998). By encouraging your clients in recovery to fully embrace their desire to stop smoking, and by actively supporting them through nicotine withdrawal, you can help them strengthen their recovery by freeing themselves from the grips of the world’s most deadly drug.

References
Glasser, William. Positive Addiction. New York: Harper & Row, 1976.
National Institute on Alcohol Abuse and Alcoholism.
National Institute on Alcohol Abuse and Alcoholism. “Alcohol and Tobacco.” Alcohol Alert 39 (1998).
Newport, John. Influence of a Wellness-Oriented Lifestyle on Successfulness of Recovery from Chemical Dependency. Doctoral Dissertation: California Coast University, Santa Ana, CA, 1998.
Sees, Karen Lea, and H. Westley Clark. “When to Begin Smoking Cessation in Substance Abusers.” Journal of Substance Abuse Treatment 10 (1993): 189-195.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2005, v.6, n.5, pp.44-45.

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