Editor’s Note: This is the first installment in a two-column series designed to address alcoholism and nicotine addiction as co-addictions, and provide practical pointers on how to assist your clients in recovery in conquering their addiction to nicotine.

As an addiction professional, you are no doubt aware of the deadly consequences of nicotine addiction. You may not, however, be fully appreciative of the full extent to which your clients in recovery are at prime risk of suffering from the devastating consequences of this ubiquitous addiction.

Cigarette smoking is unquestionably the leading cause of preventable illness and death in the United States today. The role of smoking as a major contributing factor in lung cancer, heart disease, emphysema, osteoporosis, and numerous other diseases is well established. Cigarette smoking causes approximately 440,000 deaths each year in the United States alone. It is estimated that an additional 65,000 non-smokers die annually from the consequences of excessive exposure to second-hand smoke. On average, male smokers cut their lives short by 13.2 years, and female smokers lose 14.5 years (HHS, 2004; National Cancer Institute, 1999; American Cancer Society, 2005).

A closer look at alcoholism and nicotine dependency
A growing body of evidence suggests that alcoholism and nicotine dependency are co-addictions — that is, both addictions seem to go hand in hand (Bobo, 1989; DiFranza & Guerrera, 1990; NIAAA, 1998; NIDA, 2003; Falkowski, 2003). A nationwide survey of smoking behavior among both alcoholic and non-alcoholic subjects concluded that the relative risk of alcoholism is close to 10 times greater for smokers than for non-smokers. Significantly, this research involved a sample of several thousand subjects (Kozlowski, 1993).

The National Institute on Alcohol Abuse and Alcoholism reports that between 80 and 95 percent of alcoholics smoke cigarettes, and that approximately 70 percent of alcoholics are heavy smokers, smoking more than one pack of cigarettes per day. Altogether, practicing alcoholics comprise approximately one-third of all smokers (NIAAA, 1998). These statistics are also highly applicable to persons addicted to illicit drugs, as most contemporary addicts are addicted to multiple substances, including alcohol. Sadly, many — if not most — alcoholics and addicts carry their pattern of habitual smoking with them into their recovery from addiction to their primary drugs of choice.

Various theories have been posed to explain why alcoholism and nicotine dependency are such closely intertwined co-addictions (Bobo, 1989; DiFranza & Guerrera, 1990; NIAAA, 1998; Gulliver, 1995; Wise, 1988). As nicotine is a stimulant and alcohol is a depressant, it has been suggested that many alcoholics smoke heavily, in part, to counter to depressive effects associated with excessive drinking. Chronic use of alcohol and nicotine contributes to cross-tolerance, or decreased sensitivity to the effects of both substances. Cross-tolerance, in turn, leads to increased consumption of both alcohol and tobacco to obtain the sought after effects.

Common myths surrounding smoking and recovery
Historically, many people working in the addictions field have held some rather erroneous assumptions regarding cigarette smoking and recover. Briefly stated, some of the more prevalent myths include the following:

Myth Number One: Cigarette smoking is a minor addiction that pales in comparison to the deadly consequences of alcoholism and illicit drug use. Statistically, some 440,000 Americans die annually from causes directly attributable to cigarette smoking. In comparison, alcoholism accounts for an estimated 125,000 to 150,000 deaths each year; heroin accounts for an estimated 4,000 deaths; and cocaine accounts for an estimated 2,000 to 4,000 deaths (HHS, 2004; NIAAA, 1998). Without intending to minimize the tragic consequences of alcoholism and addiction to illicit drugs, nicotine is by far the most dangerous of all drugs in terms of its association with preventable death and devastating illness. In reality, the argument among some treatment professionals that cigarette smoking is a comparatively “minor” addiction boils down to a rationalization to justify their own smoking behavior.

Myth Number Two: Attempting to quit smoking can sabotage your recovery from your primary addiction. Despite nicotine’s highly addictive properties, a growing body of evidence challenges the conventional wisdom of some treatment professionals, who argue that attempting to quit smoking is tantamount to jeopardizing one’s sobriety. A number of well constructed studies of recovering alcoholics who attempted to quit smoking have failed to find that the subjects’ efforts to quit smoking interfered with their sobriety maintenance (Bobo, Schilling, Gilchrist & Schinke, 1986; Sees & Clark, 1993). In fact, some studies suggest that heavy smoking may be associated with increased risk to relapsing to drinking and drug use. While freeing themselves from their addiction to nicotine can be challenging to your clients in recovery, there is no convincing evidence that the attempt to quit smoking will undermine their efforts to maintain abstinence from alcohol or illicit drugs.

Myth Number Three: Most recovering alcoholics/addicts really don’t want to stop smoking. This is yet another myth that fails to stand up to scrutiny. Numerous studies focusing on subjects in recovery from alcoholism and drug addiction reveal that while the majority of subjects were reportedly habitual smokers, the overwhelming majority of smoking subjects also reported a strong desire to free themselves from their addiction to nicotine (Falkowski, 2003; Sees & Clark, 1993; Newport, 1998).

In summary, a compelling body of evidence suggests that your clients in recovery from alcoholism and drug addiction are at high risk of suffering untoward consequences from their co-addiction to nicotine. Furthermore, in all likelihood, the greater majority of your clients who are currently smoking would really like to quit. Next month’s column will focus on providing practical pointers on how you can play a proactive role in actively supporting your co-addicted clients in freeing themselves from their deadly addiction to nicotine — our nation’s most dangerous drug.

John Newport, PhD, holds combined doctorates in psychology and public health, is a wellness counselor, freelance writer, speaker and consultant based in Santa Ana, CA. He is author of The Wellness-Recovery Connection: Charting Your Pathway to Optimal Health While Recovering from Alcoholism and Drug Addiction. For more information visit www.wellnessandrecovery.com.

References
U.S. Department of Health and Human Services (HHS). The Health Consequences of Smoking: A Report of the Surgeon General - 2004. Washington, D.C.: U.S. Government Printing Office.
National Cancer Institute (1999). Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph No. 10. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute (1999): NIH Publication 99-4645.
American Cancer Society. The Choice is Smoking or Health. American Cancer Society Web site: www.can
cer.org, 2005.
Bobo, Janet K. “Nicotine Dependence and Alcoholism Epidemiology and Treatment.” Journal of Psychoactive Drugs 21 (1989): 323-329.
Di Franza, Joseph R., and Mary P. Guerrera. “Alcoholism and Smoking.” Journal of Studies on Alcohol 51, no. 2 (1990): 130-135.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol and Tobacco. Alcohol Alert 39 (1998).
National Institute on Drug Abuse (NIDA). NIDA Info Facts: Cigarettes and Other Nicotine Products. NIDA Web site: www.nida.nih.gov/infofax/tobacco , 2003.
Falkowski, Carol L. Addressing Nicotine Addiction - When is the “Right Time? Counselor (August 2003): 12-17.
Kozlowski, L.T. et al. (1993). Patterns of Alcohol, Cigarette, and Caffeine and Other Drug Use in Two Drug Abusing Populations. Journal of Substance Abuse Treatment, 10, 171-179.
Gulliver, Suzy Bird, et al. (1995). Interrelationship of Smoking and Alcohol Dependence: Use and Urges to Use. Journal of Studies on Alcohol 56 (1995): 202-206.
Wise, R.A. The Neurobiology of Craving: Implications for Understanding and Treatment of Addiction. Journal of
Journal of Abnormal Psychology 97 (1988) 118-132.
Bobo, Janet K., Robert F. Schilling, Lewayne D. Gilchrist, and Steven Paul Schinke. The Double Triumph: Sustained Sobriety and Successful Cigarette Smoking Cessation. Journal of Substance Abuse Treatment 3 (1986): 21-25.
Sees, Karen Lea, and H. Westley Clark. When to Begin Smoking Cessation in Substance Abusers. Journal of Substance Abuse Treatment, 10 (1993): 189-195.
Newport, John. Influence of a Wellness-Oriented Lifestyle on Successfulness of Recovery from Chemical Dependency. Doctoral Dissertation: California Coast University, Santa Ana, CA, 1998.

This article is published in Counselor,The Magazine for Addiction Professionals, August 2005, v.6, n.4, pp.47-48.

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