At most meetings, people are hanging out and socializing beforehand and afterwards. Sometimes this is called the meeting before the meeting or the meeting after the meeting. It’s a great way for newcomers to meet people and for friends to catch up with each other, to find out how other people are doing. If you didn’t get to share during the actual meeting, you can always talk to someone afterwards. Something you’ll notice at these informal meetings is that many people are smoking. If you’ve ever been to treatment you’ll see the same thing, lots of smokers. At the facilities I’ve been to and from what I’ve heard from other people, nicotine isn’t included as a drug that needs to be abstained from as part of the program. In my experience, it isn’t really pushed by too many NA or AA members either. While I was in treatment, I would say that at least half of all the patients smoked, maybe even more. The amount of people smoking at the meetings I’ve been to is also quite high, even at large meetings.
I’m not sure why there is this high rate of smoking in the addiction recovery community. It might be the simple fact that an addict is an addict and nicotine is an addictive chemical. There’s a high rate of smoking in active addiction and that carries over into recovery. In rehab I’ve seen that even people who aren’t really smokers are smoking. I think part of that is because smoking can help facilitate social interactions when being introduced into a group of people that you don’t know. When you’re in recovery infancy in rehab, your nerves are usually quite raw and smoking can help calm them.
Most AA and NA members will certainly applaud you for quitting smoking but they won’t put much pressure on you to stop. Smoking can cause all manner of health problems and can eventually cause an early death. It is an addictive substance, however nicotine doesn’t really get you high. Often times it is mood-altering but not really mind-altering. It would be incredibly difficult to overdose on nicotine. I forget where I read it but the article stated that the amount of cigarettes you would need to smoke to overdose on nicotine would cause you to die of asphyxiation long before you could ever actually overdose. You could probably do it by covering your body with nicotine patches but no one wants to do that. I’m sure people who have committed robbery have spent some of that money on cigarettes but I doubt most people commit crime specifically for cigarette money. A nicotine habit will not destroy your life like heroin or cocaine or alcohol can. Emphysema or lung cancer will cause pain and maybe an early death but smokers generally aren’t wreaking havoc in their lives because they’re under the influence of nicotine.
So what does science say about addicts and alcoholics who smoke cigarettes? The CDC has some statistics on smoking in general. In 2017, 14 out of every 100 adults aged 18 years or older smoked cigarettes. That rate was slightly higher in men than in women. Prevalence among age groups was highest in ages 45-64. Smoking percentages were measured across race, education, income, marital status, region of the country, and others. The lowest rates across all the demographics were people with high levels of income and education. One of the highest rates among all the demographics were people with “serious psychological distress”. That was more than double the overall 14% rate of smokers among the population at 35%. It is noted on the CDC website that serious psychological distress is based on the Kessler psychological distress scale.
The Kessler scale was developed in 1992 by Ronald Kessler, a professor at Harvard University. It was originally used in a national health survey and from what I read, it looks like some clinicians and mental health practitioners use it with their patients as well to help determine if a patient has some sort of mental/emotional disorder. The scale is a simple 10 question survey with a range of scores from 1 to 5 for each question. A higher score indicates a greater likelihood of suffering from a mental disorder.
I found it interesting that many people with serious psychological distress are smokers. There is a high level of comorbidity among addicts and alcoholics. The simple definition of comorbidity is two or more disorders occurring at the same time, usually interacting and mutually making the other one worse. According to the National Institute on Drub Abuse (NIDA), about half of people with mental illness will experience a substance abuse disorder and vice versa. The exact reason for this is not known but there are a few theories. Drug abuse shares common risk factors with other mental disorders. People with mental disorders may use drugs and alcohol for symptom relief and develop a substance abuse disorder as a result. Substance abuse can lead to mental disorders as drugs and alcohol affect and change brain chemistry over time.
I don’t think that nicotine is usually thought of when considering drug abuse disorders. Again, smoking cigarettes can cause serious health problems but it won’t derail your life in the same manner as meth and heroin. However, it seems like nicotine may act like other drugs in the sense that people smoke to relieve stress and other symptoms caused by mental disorders. For some reason, I don’t know why, I liked smoking cigarettes when I was in active addiction. For me, it did help just a little bit when I was stressed in those intervals between being high and getting more dope. That feeling always makes me think of the part in the movie Trainspotting when Mark’s parents lock him in his room to kick. He says something to the effect of not feeling the dope sickness yet but it’s in the mail. That’s the best way I’ve heard to describe that feeling. That terrible race against the clock, that impending feeling of doom because you know how awful you’re going to feel if you don’t score.
I read an article that estimated 85% of alcoholics in recovery are smokers. It is an older article and that number may be high but from my own experience, many people in recovery are smokers. Accordingly, people in recovery are at a much higher risk for lung and heart disease than the general population. The article also points out that drinking and smoking frequently go together for a lot of people and smoking can increase alcohol cravings. Another article from NIDA cited research showing smokers are at a higher risk for relapse than non-smokers. I’m not sure how true that is, I think pinning down an accurate number for this theory would be difficult to prove.
In recovery, we’re trying to lead a healthy life and eliminate the addictive behaviors that are easy to fall into. That can be hard to do. Quitting smoking is hard enough on its own and when it seems like everyone around you is smoking, it is that much harder. I’ve heard that quitting cigarettes can be more difficult than quitting hard drugs and I believe that to be true for some people. It can also be difficult when we’re comparing cigarettes to our drug of choice. Smoking seems by far the lesser of the two evils. We might tell ourselves that we have enough on our plates trying to stay clean, smoking is okay. Even if that theory mentioned above does hold water, I think deciding to quit cigarettes in early recovery should be a personal judgment call. If you feel like trying to quit smoking at the same time as quitting drugs is too much, hold off. Like we say in the program, one day at a time.
There are alternatives as well. I chewed nicotine gum or used the lozenges when I quit smoking. Without them, I would have had a much harder time. I know people who have said those things didn’t work for them when trying to quit. There is also a ritual and oral fixation that comes along with smoking, it isn’t just the nicotine. It’s like the needle cravings that intravenous drug users get after getting clean.
Smoking is counterproductive to the healthier choices we’re trying to make in recovery. So is overeating, too much exercise, or too much social media. It’s important to remember that no one works a perfect program. The most important thing we do every single day is not picking up that drug or drink. If we are working a good program, good decisions in regards to these other areas of our lives should eventually happen naturally. One day at a time.