Tobacco-free and smoke-free addiction treatment: monograph introduction

I’ve completed a monograph that calls for change in the addiction treatment arena. It focuses on our need to modify our settings and services to a tobacco-free and smoke-free model of care.

This post will serve as the first in a small series of excerpts from the monograph. The intent of posting these excerpts is to build interest among readers in the topic and in reading the monograph itself.

Below, as installment one in the lead-up to me publishing the full monograph, is the Preface, followed by the Acknowledgements and Disclaimer.

The next installment in this introductory series will come out on Monday August 18, 2025.

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Preface

“Taking a new step, uttering a new word, is what people fear most.”  Fyodor Dostoevsky

The reader of this monograph will find newer research results concerning tobacco-free addiction treatment, real-life stories from the professional side of the desk about changing addiction treatment to a tobacco-free model of services, and information from older studies across a wide variety of related sub-topics.  All of these are provided with the hope that they will establish a context as the remainder of the material is considered. 

The work includes much newer research results concerning nicotine, vape, pouch, and synthetic analogs of nicotine.  It also contains information about the current regulatory environment in the USA related to nicotine, nicotine analogs, and their delivery systems.

As the document progresses further, the obvious incongruence between the aim of addiction treatment (and our related professional goals and obligations) on the one hand, and our practices related to tobacco use and nicotine misuse on the other hand, will be introduced.  In doing so, the work will also explore factors that might be contributing to our stuckness as a field.

Three one-page stories are told in the first-person.  These stories are relevant to the content and convey key messages.  Read these three stories if nothing else; they are listed in the table of contents. 

Toward the end some practical resources will be provided.  Finally, organizational change management strategies that can help guide the change to tobacco free addiction treatment services will be offered.  These are somewhat structured yet are also loose enough that they might be of practical use to most readers.

The monograph can be read through in its entirety.  If so, the reader will encounter a relatively wide range of topics, sub-topics, and to some extent styles of writing.  Some portions are generally academic in style, some are clinically focused, and others are anecdotal and told in the first person.  The intent of the document is to provide the reader a relatively more comprehensive view of the topic handled from various perspectives. 

Some readers may find more interest or value in some sub-topics than others.  With this in mind, each section is written to stand alone and not necessarily require the context of the other sections in order to be understood.    

Who are the intended readers of this monograph?  The intended readers are the clinical staff, administrative staff, and leadership of primary SUD treatment services and settings.  And those pursuing clinical credentials or academic goals relevant to that work as well.

The reader should note that most of the citations in the footnotes contain active hyperlinks to the referenced sources, especially in the digital object identifier (DOI).  These are provided for convenience and ease of access.

Here are two facts and one question to consider, followed by a 0-10 rating scale question.

1. A large, long-term study found that over half of people who went to substance use treatment died from an illness caused by tobacco use.  That is to say, more people die from tobacco use after undergoing addiction treatment than who die due to returning to use of the substance that sent them to treatment.[1]
2. When addiction treatment is delivered in a tobacco-free model of care, recovery rates are 25% higher on average.[2]
3. If someone dies of emphysema due to continuing to smoke cigarettes during and after the treatment of their alcohol use disorder, did we really treat the person’s addiction illness, or did we merely treat an alcohol use disorder?[3]

And so, on a scale from 0 to 10, how important is it to treat tobacco use in a patient with a substance use disorder, and why?  Hold your answer in mind as you read this monograph.  

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[1] Bandiera FC, Anteneh B, Le T, Delucchi K, Guydish J (2015) Tobacco-Related Mortality among Persons with Mental Health and Substance Abuse Problems. PLoS ONE 10(3): e0120581. doi.org/10.1371/journal.pone.0120581.

[2] Prochaska JJ, Delucchi K, Hall SM. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. J Consult Clin Psychol. 2004 Dec;72(6):1144-56. doi: 10.1037/0022-006X.72.6.1144.

[3] Coon B.  (2014).  An addiction treatment campus goes tobacco-free:  Lessons learned.  Addiction Professional. 12(1): 18-20.  https://www.hmpgloballearningnetwork.com/site/addiction/article/addiction-treatment-campus-goes-tobacco-free-lessons-learned.

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Acknowledgements

I would like to thank the following people for their review of earlier drafts of this manuscript and providing their feedback, suggestions and encouragement:  Kim Bayha, Sandy Ellingson, Trina Fullard, Bob Lynn, Philip T. McCabe, David McCartney, Joseph Najdzion, Jason Schwartz, Mary H. Ward, and William L. White.

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Disclaimer

Nothing in this document should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care.