Everyone knows that smoking cigarettes is bad for you. A single cigarette contains 69 chemicals known to cause cancer. Smokers die, on average, 10 years earlier than nonsmokers. And for every person that dies, another 30 live with serious smoking-related diseases of the lungs, heart and other parts of the body.
It’s no surprise that 69% of adult smokers say they want to quit, according to a study from the Centers for Disease Control and Prevention.
Yet in the alcohol and drug addiction treatment world, helping people quit smoking has traditionally been a low priority. Giving up alcohol, drugs and cigarettes was too much to expect, the thinking went. Some even believed that recovering addicts needed cigarettes as a crutch to help them cope with cravings for drugs and alcohol.
“Quitting smoking is one of the best things anyone can do for their health and longevity – people in recovery from drug and alcohol addiction included,” Dr. Dalal said. “We now know that quitting smoking doesn’t compromise recovery. In fact, it can strengthen it.”
Nicotine Stimulates the Brain’s Reward System
Fifty years of research has shown that nicotine, the addictive substance in tobacco, is a very potent chemical. Nicotine passes from the lungs into the brain in under 7 seconds.
Like other addictive drugs such as prescription opioids and heroin, nicotine stimulates the brain’s reward center. The brain’s reward center exists to reinforce behaviors that are beneficial to the survival of the species – making it pleasurable to eat when hungry, drink when we’re thirsty, bond with our children and have sex.
Nicotine attaches itself to the neurons of the brain’s reward center, triggering the release of the neurotransmitter dopamine. The release of dopamine is what makes people feel good despite having just inhaled dirty, smelly smoke. The dopamine release also drives the urge to repeat the behavior.
Beyond that basic mechanism, subsequent research has revealed that nicotine works on multiple pathways in the brain, altering the levels and action of multiple neurotransmitters that produce long-lasting changes in the brain and a compulsion to smoke.
How Quitting Smoking Can Strengthen Recovery
One of the goals at Positive Sobriety Institute is to start returning the brain’s reward system to a state of balance, through abstinence from alcohol and drugs. Eating a nutritious and satisfying diet, along with holistic therapies, such as yoga and meditation, can also help.
Quitting smoking is another step in allowing the brain to heal. “Smoking keeps that whole reward pathway really turned up,” said Dr. Frances Langdon, an internal medicine physician at Positive Sobriety Institute. “You need to eat right, exercise, get the right amount of sleep, and quit smoking. All of that is part of managing the disease of addiction.”
There’s another reason for quitting smoking in recovery. Eliminating cigarettes can reduce a significant psychological trigger for drinking or drug use. Alcoholics often smoke when they drink, and drink when they smoke. Drug addicts may smoke cigarettes at the same time, with the same people, or in the same situations, as when they used drugs.
“What a lot of folks will say is, ‘My tobacco use is connected to my alcohol use or my crack cocaine use.’ Tobacco is very powerful and can be a gateway to use of those other substances,” Dr. Dalal said.
“It’s an old wives tale that you have to tackle one thing at a time,” added Dr. Langdon. “If you don’t tackle the nicotine, it’s more likely patients will relapse into their drug of choice.”
A Variety of Tobacco Cessation Tools
At Positive Sobriety Institute, patients are offered the opportunity to incorporate tobacco cessation into their treatment plan shortly after they’ve detoxed from alcohol and drugs and have entered into the intensive outpatient or partial hospitalization treatment program.
Early recovery is an ideal time to quit smoking, Dr. Dalal said. While in treatment, patients have access to a full array of treatment services and support. “During active treatment, they’re able to focus on their health and have the support from their treatment team and their peers in group therapy to make those changes,” she said.
Withdrawal symptoms are generally not as severe as for other drugs, but quitting smoking can lead to irritability, feelings of anxiety or restlessness, and cravings. Patients can choose to use a variety of nicotine replacement options, include nicotine gum, patch, lozenge or inhalers, to get through the initial quitting period.
Chantix (varenicline) is a prescription drug that interferes with nicotine receptors in the brain, decreasing the pleasurable effects of nicotine and reducing withdrawal symptoms. Research also shows that antidepressant medications such as bupropione (Wellbutrin, Zybam) can also help people say goodbye to cigarettes for good.
The #1 Reason to Stop Smoking? You’ll Feel Great
Addicts in recovery have some unique reasons to quit smoking. But one of the main reasons to toss that last pack of cigarettes into the dumpster is the same as for everyone else – you’ll feel better.
Well before it leads to life-threatening diseases, smoking decreases quality of life. After quitting, your car, home and clothes smell better. Your sense of smell improves. Your skin and fingernails look healthier. You’ll breathe easier and cough less. Blood pressure drops, and you’ll recover quicker from colds and the flu.
“Tobacco often gets overlooked in drug and alcohol treatment. People don’t pay a lot of attention to quitting smoking, but in some ways it deserves the most attention,” Dalal said. “Tobacco is the leading cause of preventable death – more than alcohol and more than motor vehicle collisions.”