Should You Quit Smoking While Recovering from Addiction?

One stereotype commonly associated with people recovering from substance use disorders is that they are constantly drinking coffee and smoking cigarettes. At least one study suggests there may be some truth to this particular stereotype. The study of nearly 300 AA members in the Nashville area found that nearly 57 percent smoked cigarettes, compared to only about 14 percent of Americans overall.

By now, we’re all aware of the negative health effects of smoking but many in recovery tend to regard it as the lesser evil--it’s clearly bad, but if it helps keep you sober, maybe it’s worth the health risks down the road. However, it’s not clear that smoking does help you stay sober, and there may also be other reasons to consider giving up smoking at the same time you give up drugs and alcohol.

Smoking and Relapse

As noted above, smoking in recovery is a bit of a gambit: You’re accepting possible risks down the road to hedge against a present threat. The assumption that smoking can help prevent relapse is largely based on the idea that it can help manage negative affect--more on that below--but research suggests there may be more important factors in play. 

One study of more than 34,000 adults found that smoking was correlated with a much higher risk of relapse. Researchers from Columbia University examined three years’ worth of data from the National Epidemiologic Survey on Alcohol and Related Conditions, or NESARC, and found that among people who had struggled with substance use issues in the past, those who smoked were nearly twice as likely to relapse as those who didn’t--about 11 percent and 6.5 percent, respectively. Those who started recovery as smokers but later quit had a relapse rate somewhere in the middle, about 8 percent.

With so much data and such a large disparity between smokers and non-smokers, this is one of the more compelling studies related to addiction. However, it does leave some questions unanswered. Although the study controlled for a number of factors, including demographics, mood, anxiety, alcohol use disorders, and nicotine dependence, it may be that smoking correlates with more serious substance use issues. And this was a population study, not an intervention. Despite these limitations, there may still be reasons to think smoking increases relapse risk, including those below.

Smoking Can Trigger Cravings

Perhaps the biggest reason to think smoking may increase risk of relapse is that it is often a powerful trigger. For example, people quite often drink and smoke at the same time. Smoking is a perfect trigger because it has a distinctive taste, smell, and motor pattern associated with it.

So, for example, if you had been in the habit of coming home from work, lighting a cigarette and pouring your first drink of the evening, you may find yourself craving a drink after you light a cigarette. Identifying and avoiding triggers is especially important early in recovery and smoking may be a potent one.

Smoking Kills More People

Since the rationale for smoking involves a risk calculation, it’s a good idea to look at the actual numbers. In 2018, more than 67,000 people died of a drug overdose, and each year, about 88,000 people die from alcohol-related causes. That’s about 155,000 deaths a year combined. By comparison, more than 480,000 people die from smoking-related causes each year. These include lung cancer, heart disease, stroke, diabetes, respiratory infections, and COPD. 

For many people, a serious health scare--perhaps an overdose, a heart problem, or a diagnosis of liver disease--is what finally convinces them to get sober. It makes little sense to trade one serious medical issue for another.

Even if the trade buys you an extra 10 or 15 years, diminished quality of life is almost certain. Other people decide to get sober because of the way their substance use affects their families. Similarly, it’s worth considering how a protracted struggle with cancer, heart disease, or emphysema would affect your family.

Smoking and Unresolved Issues

In the study of Nashville-area AA members, smokers typically reported that the reason they smoked was to reduce negative effects, such as depression, anxiety, and irritability. While these are all common problems early in recovery, they may also be symptoms of untreated mental health issues, such as major depression or an anxiety disorder.

‍Mental health issues affect at least half of people with substance use disorders and they must be treated simultaneously for recovery to succeed long term. One shortcoming of mutual aid groups such as AA is that they can’t offer mental health treatment. So, if you are smoking more specifically to ward off depression or anxiety, it’s possible that you need to talk to a doctor or therapist about getting to the underlying cause.

Quitting and Willpower

Finally, quitting smoking might give you a slight boost in willpower. While it’s not a good idea to rely on willpower alone to recover from a substance use issue, it does play a supporting role and it can be handy in a pinch. One line of psychological research suggests that willpower is a faculty that can be strengthened with use.

A study on--of all things--smoking cessation found that participants who were asked to avoid sweets or squeeze a hand gripper for two weeks were more successful at quitting smoking than participants who were given a task that required no willpower. It’s possible you get a similar boost in willpower from quitting smoking, which can transfer to greater adherence to your recovery plan and longer abstinence from drugs and alcohol. 

Quitting smoking isn’t easy, but then, neither is overcoming any addiction. People with multiple addictions are expected to quit them all at the same time--with the exception of cigarettes. Although most addiction treatment programs don’t currently offer help quitting smoking, you can always decide to do it yourself. Given the other challenges of recovering from addiction, early recovery may be the least difficult time to quit smoking and it may improve your chances of a long recovery. 

At The Foundry, we know that recovery from addiction isn’t only about abstaining from drugs and alcohol, but rather about making changes that help you live a healthier, more fulfilling life. We provide a supportive recovery environment and use a variety of evidence-based methods to help our clients succeed long term. To learn more, call us at (844) 955-1066.