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 is the third 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 # 3 in the lead-up to me publishing the full monograph, is a small sub-section simply called “Raising Doubts About Not Changing”, followed by the Acknowledgements and Disclaimer.
The fourth and final installment in this introductory series will come out on Friday August 22, 2025.
From “Raising Doubts About Not Changing”
Third, consider a very recent within-subjects study examining 2652 subjects from 2013-2018 with a history of SUD, changing from current to former smoker, found a positive association with SUD recovery and a 30% increase in odds of recovery. The authors concluded that smoking cessation “could be used as a tool to assist recovery processes and improve health among adults with an SUD.”[1]
Fourth, consider reasons gleaned from findings outlined within this monograph, such as:
- High rates of tobacco use in individuals being treated for other substance use disorders
- Greater morbidity and mortality in individuals who use tobacco and other substances
- Higher relapse rates in patients who do not stop using tobacco
- Patient and staff exposure to second-hand smoke
- Increased risk of initiating tobacco use in non-tobacco using patients
In our organizational change process, we went through stages of change over a series of years as an organization. Eventually, we made the decision, including a decision at the emotional level, to get in alignment with both our own values and the evidence – to treat the core disease.
And in so doing, we recognized that cessation might be little more than an attempt to control one’s tobacco use disorder (and that quitting would be diagnostic, not prognostic).
And so, we decided not to use a cessation framework, but to use a wellbeing or recovery framework instead.
[1] Parks MJ, Blanco C, Creamer MR, et al. Cigarette Smoking During Recovery From Substance Use Disorders. JAMA Psychiatry. Published online August 13, 2025. doi:10.1001/jamapsychiatry.2025.1976.
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.
Disclaimer
Nothing in this document should be taken or held as clinical instruction, clinical supervision
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