People smoke tobacco for the nicotine the plant contains. Due to its effects on the brain, nicotine has mood-altering properties. Unusually, it has both stimulant and sedative effects. It is highly addictive.
Smoking tobacco is prevalent among people suffering from mental ill health and Substance Use Disorder. Until fairly recently, the received wisdom was that to require people receiving treatment for addiction to withdraw from tobacco smoking while abstaining from their other drugs of choice would be asking too much of them. It was thought that attempting to recover from dependencies such as to alcohol, heroin or cocaine, for instance, was difficult enough. For a long time addiction treatment programmes therefore traditionally allowed, if not condoned, tobacco smoking by patients. However, as practice has developed, efforts are now made by treatment centres to restrict areas and times for the indulgence of the habit; in part to underscore the reality that smoking is an addiction and one with serious impacts on general health. Conveying such a message clearly and consistently in the context of an addiction treatment programme is essential.
Expert thinking has changed. It is now widely recognised that a programme aimed at recovery from other addictions presents a perfect opportunity to give up smoking also. Any truly integrated and holistic health approach deserving of that description should not avoid looking at a person’s tobacco smoking; not only from the point of view of addiction but also, given its significant longer-term effects, from the perspective of health restoration and promotion more generally. Even if a treatment centre or rehab does not ban smoking outright, it ought routinely to invite and proactively support its patients to take the opportunity to give up.
It is notoriously difficult to do so, largely because of the uncomfortable symptoms of withdrawal from nicotine, which are both physical and psychological in nature. The intensity of cravings that come in the early stages of detoxification are a major factor in a person’s resumption of smoking. The psychological durability of the habit may be attributed also to the comforting or stimulating rituals associated with lighting up. So, what better place to attempt abstinence than a facility offering both physiological and psychological therapies fully attuned to recovery from addiction?
There is another very good reason to quit smoking while in treatment for addiction to other substances. Evidence is accumulating to indicate that cigarette smoking, in particular, is a
contributory factor to relapse in those people attempting to recover from Substance Use Disorder. Or, looked at in another way, a person’s chances of a sustainable recovery seem likely to improve if they give up smoking.It seems that smoking may serve as a primer, trigger or cue for other addictive behaviours and some research has suggested that nicotine use may be implicated in cravings for stimulants and opiates.
