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Building a Smoke-Free Life in Recovery

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Five decades ago, tobacco was everywhere in America. It was perfectly normal to enter a smoke-filled restaurant for dinner, encounter lit cigarettes on an airplane, or sit in a smoky waiting room before a doctor's appointment. Then, in 1964, the U.S. Surgeon General released a landmark report on Smoking and Health, the first to definitively link smoking with lung cancer and heart disease. For the first time, the public became aware of the indisputably harmful effects of tobacco use on health, and over the decades vigorous and sustained efforts have helped prevent more than 8 million deaths.

Even after 50 years, tobacco use continues to harm the health and threaten the lives of millions of Americans, killing more than 440,000 people each year. While rates of use among the general public have declined, tobacco use among one group has not fallen apace with the rest of the country. Individuals with substance use disorders smoke at disproportionately higher rates than the general population. In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that 75 percent of people aged 12 or older who received treatment for a substance use disorder at a specialty facility in the past year reported smoking cigarettes in the past month, compared with 24 percent of the general population. Last year, the National Survey on Drug Use and Health found that although adults with mental illness or substance use disorders account for only 25 percent of the population, they smoked 40 percent of all cigarettes smoked in America. Smoking is the leading preventable cause of death in the United States, but morbidity and mortality rates among those with substance use disorders are even greater.

These findings, as well as research demonstrating the desire of individuals in treatment to quit smoking and that quitting smoking supports recovery, have resulted in a reversal of both policy and clinical approaches to treating substance use disorders and nicotine dependence. In the past, the prevailing thought held that people in treatment and early recovery should establish a firm foundation in recovery before attempting to stop smoking. We assumed that quitting smoking might jeopardize recovery from alcohol and other drugs, which discouraged many people who wanted to stop smoking from attempting to quit. Some were even encouraged to keep smoking, thinking it would ease the early recovery process. Compounding this problem was the significant number of treatment staff who also smoked and used smoking with clients to cement the therapeutic alliance.

Research in recent years has driven a reversal of old tobacco policies, and we must continue to integrate smoking cessation as part of the treatment and recovery process. The majority of clients entering treatment want to quit smoking and quitting increases the chances for long-term recovery. Treatment programs have been able to successfully integrate practical policy and programmatic changes that include smoking cessation for both staff and clients. Looking forward, we can expect smoking rates to decline as Affordable Care Act implementation expands access to prescription cessation medications shown to be effective in helping people quit. Smoking does not have to be a part of the recovery process. The skills people gain from recovering from substance use can be invaluable in quitting smoking as well.

Those of you who know me know that while I have enjoyed long-term recovery from substance use, I continue to struggle with my own nicotine addiction. I have made many attempts to quit smoking over the years, driven by the conviction that I did not get saved from one addiction only to die of another. So, as we begin a new year, I have promised myself that I will attempt to quit in 2014, and ask all of you in recovery who still smoke to consider joining me. We have so much to live for.

Fifty years ago, the Surgeon General made history with his office's report on Smoking and Health, permanently realigning the country's perspective on a public health epidemic. We do not have to wait another 50 years to make real progress in helping people with substance use disorders achieve full and healthy lives, free of tobacco.

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