Smoking and Recovery


Smoking and other addictions go hand in hand. In treatment populations, it’s usual to find that about 80-90% of clients are current smokers, compared to, for example, 16% of the Scottish population and 14% of US citizens. Out of interest 25% of German adults smoke, 27% do in France and, incredibly, half of all Chinese men smoke. Nobody has done a survey on smoking prevalence in recovering populations in Scotland, but I would guess that it is significantly more than 50%.

From a public health perspective, these figures are terrible given that one in two smokers will die of a smoking-related condition. It’s a terrible irony that so many people in recovery will actually still die of an addiction. Do we tell patients/clients that they are more likely to die of a smoking-related cause than of heroin or alcohol addiction?

Let’s not forget, that this is an addiction that can be treated and overcome with consequent significant health benefits. Treatment services need to take some of the responsibility for failure to tackle this problem. Perhaps one of the reasons that smoking is not tackled in treatment and recovery is because of persistent myths. Can the evidence help scotch those myths?

Researchers from Boston took a look at the relevant evidence base in an NIAAA publication. It’s a gem of a read. They list the myths and what the research says about the myths.

Myth 1: Smoking is more benign than alcoholism.

Mortality statistics suggest that more people with alcoholism die from smoking-related diseases than from alcohol-related diseases. (Hurt et al, 1996) 

Myth 2: Smokers aren’t interested in stopping or can’t

There is no evidence to support this. In fact the evidence suggests that the majority of smokers (80%) want to quit and that addictions do not have to be tackled one at a time. (Prochaska et al, 2004)

Myth 3: Stopping smoking will make relapse more likely.

Not a bit of it. Participation in smoking cessation efforts while engaged in other substance abuse treatment has been associated with a 25 percent greater likelihood of long-term abstinence from alcohol and other drugs (Prochaska et al. 2004). Data indirectly suggest that continued smoking increases the risk of alcohol relapse among alcohol-dependent smokers (Taylor et al. 2000).


There are difficulties. Some evidence suggests it’s harder for alcohol dependent people to quit smoking than those without an addiction:

On average, compared with  smokers who do not abuse substances, alcoholic smokers are more addicted to nicotine, smoke higher nicotine cigarettes, smoke more per day, and score higher on nicotine dependence measures and on carbon monoxide assessment (Burling and Burling 2003; York and Hirsch 1995). Many smokers with alcoholism report that they use smoking to cope with their urges to use alcohol or other drugs (Rohsenow et al. 2005), so alcohol-dependent smokers may have stronger views about the benefits of continued tobacco use than do other smokers.

So, despite the challenges, not only can smokers quit in treatment, it might enhance their chances of staying sober! Are we all on the case and pushing for what is best for our patients/clients? Where are the key leaders in communities of recovery who are championing the cause?

I have a theory about this and it’s not going to win me many friends. So many of those in the recovery movement, in peer support and in mutual aid are not leading on this because as committed smokers they are still in the problem. This doesn’t get the rest of us off the hook though – we need to do better at helping get that 90% (treatment population smokers) down to the national average of 16% (or better – even lower still).

Public Health England have a useful publication on this. Worth a look.


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