Julie Miller's Mental Health Blog

“N” is for Nicotine

Posted on: May 25, 2010

Years ago, in my first real, paying job in the mental health field, I gave an educational lecture to substance abuse clients about “nicotine.”  Never have I been accepted in such a chilly and sullen manner.

The other therapists I worked with asked me how it went as this was the first time any lecture of this type had been given at that facility.  I replied, “It’s a good thing I base my self-esteem on my weight, and not how well the clients like my lectures.”

I later learned that one of the clients who heckled me the most was a tobacco farmer from Kentucky.  Okay, so I figured maybe it wasn’t me.

I then started a nicotine cessation program at that facility, an inpatient drug/alcohol/dual diagnosis rehab.  The first hurdle was overcoming the staff resistance to addressing issues about tobacco smoking and chew.

The weekly client groups at first were voluntary, the clients assigned by their primary therapist.  It was like pulling teeth to get a therapist to assign a client to the group.  The belief was “one thing at a time,” meaning, don’t quit tobacco when you’re trying to quit drinking and/or drug use.  It’s too much.  Get this stuff handled, and then you can consider quitting smoking.

That is not my perspective, and research does not support this old-fashioned belief.  The Big Book of AA suggests that newly sober members keep drinking their coffee, eating their candy bars, and smoking their cigarettes to help them stay sober, to not make any big changes that threaten their sobriety.

That was in the 1930s.  We have the technology now to help folks get off these drugs.  We have the research that demonstrates the importance of abstinence from these drugs in sobriety.

So why do we still hold to the old belief so solidly in the recovery field?

At least some of it is that some recovering professionals in the field still smoke.  And many of those who are techs or otherwise not professionals but involved in the substance abuse recovery field still smoke.

Research I found many years ago indicated that over 75% of recovering addicts and alcoholics smoked or chewed tobacco, well over the national average, which was around 20% at that time.  The leading cause of death of recovering addicts/alcoholics is tobacco-related.

What a crime….  individuals work so hard to get clean/sober, and then they just die from some other drug that no one encouraged them to stop using because they should take it “one thing at a time.”

It is true that not all mental health/recovery professionals hold to this old belief, but many do.  Anyone of us who finds that belief unlivable, offensive, old fashioned and uninformed have a responsibility to continue to try to educate those who are poorly informed or resistant.

What about you?


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