Smoking and Recovery Just Don't Mix
Posted on Wednesday, January the 23rd at 6:17pm
By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II Throughout my professional addiction treatment career I have been an advocate for people stopping all addictions when they decide to get into recovery. This includes smoking and chewing tobacco. Unfortunately, many of my colleagues do not agree—in fact, many of them are using nicotine addictively themselves. I am writing this paper in an attempt to present objective reasons why people in recovery from alcohol and other drugs should also be in recovery for their nicotine addiction—and that nicotine recovery is possible and preferable. Part of my motivation is because I cannot stay silent when people I care about are dying from this addiction and they do not yet see that they have other choices. Fortunately, many addiction treatment programs are now starting to address this problem and have began to initiate nicotine addiction treatment plans. Unfortunately, many programs—including some of the biggest and best—are afraid to go nicotine free. The rational is that people will not come to the program. I remember this same argument being used by Bar and Restaurant owners in California when people were trying to make those establishment smoking free. Many cried that they would lose their businesses. What actually happened was more people started going to restaurants and the business at bars was not impacted at all. Many addiction treatment programs that went nicotine free discovered the same thing. A recent Alcohol Alert from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) stated that until recently, alcoholism treatment professionals have generally not addressed the issue of smoking cessation, largely because of the belief that the added stress of quitting smoking would jeopardize an alcoholic’s recovery. This report goes on to state that research has not confirmed this belief. Following the lead of other health facilities, many addictions treatment facilities are becoming smoke-free, providing a "natural experiment" on the effectiveness of dual recovery programs. Initial evaluations suggest that no-smoking policies are feasible in this setting but additional research is needed. The report concludes with a summary by NIAAA Director Enoch Gordis, M.D.; Alcohol and Tobacco--A Commentary. Alcohol and tobacco are frequently used together, may share certain brain pathways underlying dependence, and because of their numerous social and health-related consequences, are a continuing source of national public policy debate. Many alcoholism treatment professionals have not actively pursued smoking cessation among their patients based on the belief that the stress of quitting smoking while undergoing alcoholism treatment might cause relapse. As a physician who has seen the ravages caused by both alcoholism and smoking, I am pleased that we now have research evidence showing that both can be treated simultaneously without endangering alcoholism recovery. As basic science learns more about how alcohol and nicotine act singly and together within the brain, new treatments for alcohol and nicotine dependence will follow. Finally, society has attempted to minimize the consequences of using both alcohol and tobacco through public policy actions, including health warning labels, restrictions on advertising, and age restrictions on use. Unlike tobacco, however, moderate use of alcohol has certain health benefits. The implications of this are discussed in Alcohol Alert No. 16, "Moderate Drinking," which may be found on NIAAA's Web site at http://www.niaaa.nih.gov. Another reason that smoking is a problem is that many people who are chemically dependent have developed either HIV or Hepititus C Virus (HCV), usually directly from their addictive and/or self-destructive behaviors. When these people get into a recovery process many continue to use nicotine—which has serious negative health implications for people with HCV. The following information below is from an article by Jill Cadman in 2002. The study reported in Ms. Cadman’s article appeared in the April 8, 2002 issue of the Archives of Internal Medicine. About four million people in the U.S. have the hepatitis C virus (HCV). HCV can cause an infection of the liver that is usually spread through blood contact with an infected person. Many HIV-positive people are also infected with HCV. If not treated, hepatitis can cause cirrhosis (scarring) of the liver. This can lead to severe sickness or even death. A new study has found that people with HCV should avoid smoking cigarettes and drinking alcohol because both habits can further damage their livers. The study used levels of the liver enzyme ALT to check for liver damage. (Higher ALT levels can be a warning sign of liver damage.) The researchers found that drinking alcohol and smoking more or less doubled the risk of having high ALT levels. People who smoked a pack or more of cigarettes each day and frequently drank alcohol had a risk of elevated ALT levels that was seven times higher than for those who did not drink or smoke. The researchers who conducted the study stated that people who have HCV "are strongly advised not to smoke and drink alcohol to reduce the possible risk for aggravating (their) liver dysfunction." A person with HIV and HCV can become very sick. The added strain that HCV puts on the immune system makes it even harder for the body to fight diseases and infections. If you have HIV and HCV, you need to get regular medical attention for both conditions. You can also help take care of your body by avoiding habits, such as smoking and drinking, that can make you worse. So why do people keep smoking or using chewing tobacco even when they know it is dangerous to their health? In addiction, using nicotine could also help perpetrate an addiction relapse, but this also does not seem to lead people to stop. One reason is the automatic and unconscious defense mechanism called denial. Please find in the table below an exercise I developed that was adapted from the Denial Management Counseling Workbook by Terence T. Gorski and Stephen F. Grinstead. | The following is a list of the denial patterns that are most frequently used by people who are addicted to nicotine. A denial pattern is a way of thinking, communicating with others, and acting that keeps you and those around you from focusing on your nicotine abuse/addiction. This list was created to address the serious problem of healthcare professionals who still use a medically harmful and addictive substance and/or have clients who although are in recovery continue in this other addiction. It is especially problematic for substance abuse professionals to continue an addiction while attempting to help others overcome their addictive disorders. | | Before reading the list, take a moment to become calm, centered, and relaxed. Take a deep breath. Hold it for a moment. Then exhale and relax. As you read the description of each denial pattern out loud, listen carefully and ask yourself if you have ever used are using or could use a denial pattern like that to keep from thinking about, talking about, or taking action to stop your nicotine abuse/addiction. | | Instructions: Rate each of the denial patterns listed below on a scale of 0 (meaning I haven’t and don’t use this at all, and probably will never use it at all) to 10 (meaning I have used it a lot, I currently use it a lot or I could use it a lot in the future). | | | | 1. Avoidance: Somewhere deep inside of me I am afraid that I might have a problem with nicotine abuse/addiction. But I don’t want to think about it or talk about it. I’ll do almost anything to avoid looking at what nicotine abuse/addiction is really doing to me and those I love. I believe that if I can keep my mind on other things and keep people from prying into my life where they don’t belong, everything will be fine. | | Avoidance by Playing Dumb: There is a part of me that pretends not to know or understand what I am doing to myself. Sometimes this gets so strong I start believing I really don’t know what’s going on. | | Avoidance by Saying Nothing: Sometimes I avoid thinking about and talking about my problem with nicotine. I just won’t say anything about it. It’s private and no one has a right to know anything about it. I’m good at keeping people from talking about my nicotine abuse/addiction. I don’t have to say a word. When someone starts to bring it up, I give them a look that makes them back off. Then I start talking about something else - anything else. I am so good at saying nothing about my problems that many people have no idea how often I abuse nicotine. | | Avoidance by Distraction: Sometimes I have to create a distraction to keep myself or others from seeing how much of a problem with nicotine that I really have. If I can change the subject or bring up something else that is more interesting people won’t know that I have a problem. Sometimes I feel like a master of distraction because it is so easy for me to get people to focus on things that have nothing to do with my nicotine abuse/addiction. I can swamp them with thousands of useless bits of information. I can give them long and confusing answers. I can change the subject to things that are easier for me to talk about. I can get impatient and tell them about all the important things I have to do. I might even tell them to leave me alone because it’s none of their business. I know that if I can just keep from thinking or talking about what’s really happening with my nicotine abuse/addiction, I’ll be OK. | | Avoidance by Uproar: Sometimes I have to create a crisis to keep myself from thinking about and talking about my nicotine abuse/addiction. If anyone tries to push me into talking about my problems, I’ll play uproar by creating a bad crisis and making sure that they get sucked into it. Some people are even afraid to talk with me because they know that if they push me too hard, I'll make something really bad happen. | | 5. Total Denial: When others try to corner me, I tell the big lie. I don't have a problem with nicotine abuse/addiction. No! Not me! Absolutely not! I don't use too much! I don’t abuse my nicotine ! I’m not addicted! I never get sick or have problems because of nicotine . I am so good at convincing other people that there is nothing wrong that sometimes I actually start believing it myself. When they believe my story a part of me feels really good because I beat them. Another small part of me feels disappointed. There is a small part that wants others to know what is really happening. There is small scared part inside of me that wants help. | | 6. Minimizing: Sometimes my nicotine abuse/addiction gets so bad that I can’t convince myself or others that I don’t have a problem. When this happens I minimize. I make the problems seem smaller than they really are. Yes, I had a small problem with nicotine abuse/addiction. But it only happened that once. It will never happen again. Besides, the problem just wasn’t as bad as people think it is. | | 7. Blaming: When my problems get so bad that I can’t deny them, I find a scapegoat. I tell everyone that it’s not my fault that I have nicotine abuse/addiction. It’s somebody else’s fault. I only abuse nicotine because of my spouse or job. If you had a spouse or job like mine, you’d abuse nicotine too! It seems that as long as I can blame someone else—anyone else—I can keep coping the way I have until that person changes. I don’t have to be responsible for stopping. | | 8. Rationalizing: When there is no one around to blame, I use irrational thinking to create plausible explanations for my nicotine abuse/addiction. Sometimes I’ll start intellectualizing. I’ll try to explain the problem away. Sometimes I’ll pretend to know a lot about nicotine abuse/addiction. I’ll quote articles that I read in the newspaper or heard on the news. I’ll give the impression that I know so much about nicotine abuse/addiction that I could never have a problem. The problem is, I never apply what I know to myself. | | 9. Comparison: I start to focus on other people instead of myself. I find others who have more serious problems than I do. I compare myself to them. I tell myself that I can’t be addicted because I’m not as bad as they are. I know what an addict is! An addict is someone who uses nicotine a lot more than I do! An addict is someone who has a lot more nicotine related problems than I do. An addict is someone who is not like me! I tell myself that I can't be addicted because there are other people who have worse problems with nicotine abuse/addiction than I do. | | 10. Manipulating: When my nicotine abuse/addiction boxes me into a corner, I start to manipulate. I try to use the people who want to help me. I try to get them to handle all of my problems and then get them to leave me alone so I can keep coping the way I have. I'll let them help me, but only if they do it for me. I want a quick effortless fix. If I they can’t fix me, I blame them for my failure and use them as an excuse to keep using the way I have been. I won’t let anyone make me do anything that I don’t want to do. If they try, I'll get use, blame them, and make them feel guilty. | | 11. Recovery By Fear: I began to realize that my nicotine abuse/addiction can destroy my life, hurt those that I love and eventually kill me. The threat is so real that I convince myself that I can't ever use nicotine again. I convince myself that this fear of destroying my life and killing myself will scare me into permanent sobriety. Since I know how awful my life will be if I continue to use, I just won't won’t drink nicotine anymore. If I quit everything will be fine. Since everything will be fine, I won't need treatment or a recovery program. I’ll just quit. | | 12. Compliance: I start going through the motions of getting help. I do what I’m told, no more and no less. I become compliant and promise to do things just to get people off of my back. I find excuses for not following through. When I get caught, I tell people that I did the best that I could. I blame them for not giving me enough help. I tell people how sorry I am. I ask for another chance, make another half hearted commitment, and the cycle of compliance starts all over again. | | 13. Having A Flight into Health: I manage to stay away from nicotine for a while and things start to get a little bit better. Instead of getting motivated to do more, I convince myself that I’m cured and don’t need to do anything else. I tell myself that I had nicotine abuse/addiction problems, but I got into recovery and put it behind me. | | 14. Diagnosing Myself as Beyond Help: I start to feel that I’m hopeless. It seems like I’ve tried it all and nothing has worked. I don’t believe that I can change and a big part of me just doesn’t want to try anymore. It seems easier just to give up and stop trying. When people try to help me I brush them off by telling them that I’m hopeless and will never recover. I dare people to try and help me. When they do I give them a hard time. They try to work and end up failing in spite of their best efforts. I don’t understand why people keep trying to help me. It would be easier if they just let me keep using. Can’t they see how hopeless I am? | | 15. The Democratic Disease State: I convince myself that I have a right to continue to use nicotine even if it kills me. Yes, I’m addicted. Yes I’m destroying my life. Yes, I’m hurting those that I love. But so what! I have the right to use nicotine however I want. No one has the right to make me stop. Since my abuse/addiction is killing me anyway, I might as well convince myself that I’m dying because I want to. | | Your Personal Denial Pattern List | | Review the Denial Pattern Check-list and select three denial patterns that you have used or are using. Write the generic title of the three denial patterns below. Then create your own brief creative personalized title for each—Please use a short word or phrase that has emotional impact upon you. | | A. Denial Pattern #1: _________________________________________________ | | Personal Title #1: _________________________________________________ | | B Denial Pattern #2: _________________________________________________ | | Personal Title #2: _________________________________________________ | | C. Denial Pattern #3: _________________________________________________ | | Personal Title #3: _________________________________________________ |
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