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.
Below is the Abstract followed by the full text of the monograph.
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.
Abstract
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? Very few addiction treatment programs are tobacco free. That fact is odd on its face, given that “addiction treatment” could be thought of as addressing addiction as a central problem, rather than treating one substance use disorder while under-treating or ignoring another. This work will review recent findings on both the harms of use and the benefits of a tobacco-free model of addiction treatment. Perhaps in our generation we can make this change and no longer allow tobacco and nicotine to remain the last untreated substance use disorder during addiction treatment.
11/12/2025 update. I did a search and found that a full article write-up about the tobacco free monograph was posted at WRD news in Australia.
Here’s a link to their story: Revolutionary Tobacco-Free Addiction Treatment Shows 25% Higher Recovery Rates, New Research Reveals. September 26, 2025.
Recovery Review 
Brian, Thank you for this valuable contribution to treatment and recovery! Years ago, historian William White discussed the numerous early pioneers of alcohol recovery and treatment who later died of nicotine related causes. Your monograph, when adopted can help prolong the life of numerous individuals seeking recovery, whom you will never meet. Early in my career I worked in a residential facility with clients with co-occurring disorders. A growing concerns among staff was a client accidently starting a fire by falling asleep while smoking a cigarette in their room. A policy was initiated that staff would keep client cigarettes in the staff office and distribute them individually upon client request. Not smoking as often, clients were talking to their counselors more frequently and deeply about their feelings. In essence, with less smoking we were witnessing greater emotional recovery! Feeling overwhelmed by client increased verbalization, the staff reversed the policy and allowed clients to return to smoking in their room. We could have used the resources which you discuss in your monograph along with a little compassion fatigue/secondary trauma training as clients shared more of their pain. Again, thanks! Mark Sanders
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Mark, thanks so much for that kind of story and encouragement. Much appreciated. For real.
The way I put it elsewhere was as follows:
“Given the death rates from tobacco I wonder this…
I wonder about moving tobacco-free into every modality, service, level, and kind of care as they exist. Without changing them.
And I wonder what it would be like to be so good at it that it did not narrow the doorway or reduce access.
And lastly, I wonder what it would take for our field to grow that much and be that good at it.”
Thanks again, sir.
Peace.
Brian
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