Smoking, recovery and mortality

smoke by kan!!!DJ Mac recently posted about smoking, recovery and mortality:

There’s not a lot of acknowledgement of the cruelest of ironies: that people in recovery from alcohol and other drug dependence will still die of addiction-related disease. The fact is that about one in two of them will develop fatal pathology like cancer or heart disease because of smoking. Others will be impaired by chronic, smoking-related conditions.

It just so happens that we the Dawn Farm Education Series just presented on Tobacco Cessation and Addiction Recovery. Here’s their stuff.




Related reading:

Smoke Screens

No Smoking - American Cancer Society's Great A...
No Smoking – American Cancer Society’s Great American Smoke Out (Photo credit: Wikipedia)


Bill White recently posted on tobacco use in recovery. He’s been way ahead of the field on this and challenges not only treatment providers, but recovering people as well:


People in recovery are dying from smoking-related diseases in large numbers, but they are also dying from conceptual blindness:  the failure to see the contradiction between claiming recovery status in the presence of continued addiction to nicotine.  Too many recoveries and too many lives are going up in smoke.


Anna David recently posted a first-person account of her path to becoming tobacco-free:


Then, when I was nine months sober, I met an older woman who’d been sober, it seemed, forever. She and I were at dinner with a few other sober friends after a meeting and I did what was routine behavior at that point: I went outside several times throughout the meal to smoke. And one of the times that I returned, this woman started, in the most direct and yet gentle way imaginable, confronting me about the fact that I smoked. People had of course brought the topic up with me before but there was something different about her approach. She said things that made a lot of sense—things like that every time I inhaled on a cigarette, I was telling myself that I hated myself and that getting sober but not quitting smoking was like switching seats on the Titanic. “Honey,” I recall her saying as she leaned forward on the table, “You’re putting a smoke screen between you and your Higher Power.” It was just the kind of thing that I would have mocked before sobriety but which made a lot of sense to who I was becoming. At the end of dinner, she offered to meet me at a Nicotine Anonymous meeting the following evening.


What what?

A new study looking at the comparative effectiveness of various coping skills for dealing with urges to drink in preventing relapse reports some counter-intuitive findings [emphasis mine]:

…relying on going to a meeting or talking to a sponsor or counselor when experiencing an urge was not correlated with improved drinking outcomes.


Ineffective skills in this population included exercising regularly, living with clean/sober people…


Two strategies were only helpful in the short run in this population: relaxation/meditation or smoking a cigarette. The smoking strategy is consistent with a past study where we found that the subset of patients who said they use smoking to cope with urges to drink were more likely to be sober a month later (Monti et al., 1995). For this subset, it may be useful to delay attempts to get them to quit smoking until after sobriety is well established.

Take 12 step facilitation off the table for a moment. Getting together with abstinent friends or talking to an abstinent mentor isn’t associated with improved outcomes?

They ignore the many studies finding that quitting smoking improves outcomes, cite one study and suggest that quitting smoking may be associated with with relapse and suggests delaying attempts to quit?

Exercise and living with other sober people ineffective too.

Yikes. Now that this has become “evidence”, I hope there are some follow-up studies.

Related articles

Quitting Smoking and Anxiety

A 21 mg dose Nicoderm CQ patch applied to the ...
(Photo credit: Wikipedia)


A recent study finds that quitting smoking reduces anxiety:


The study followed 491 smokers attending NHS smoking cessation clinics in England. All participants were given a nicotine patch and attended eight weekly appointments.

Of the sample, 21.6% (106 people) had a diagnosed mental health problem, primarily mood and anxiety disorders.

All participants were assessed for their anxiety levels at the start of the research, and were also asked whether their motives for smoking were ‘mainly for pleasure’, ‘mainly to cope’ or ‘about equal’.

Six months after the start of the trial, 68 of the smokers (14%) had managed to quit smoking – 10 of these had a current psychiatric disorder. The researchers found a significant difference in anxiety between those who had successfully quit and those who had relapsed.

All of those who had quit smoking showed a decrease in anxiety. People who had previously smoked to cope showed a more significant decrease in anxiety compared to those who had previously smoked for pleasure.


However, some people who tried to quit and failed became more anxious:


Among the smokers who relapsed, those smoking for enjoyment showed no change in anxiety, but those who smoked to cope and those with a diagnosed mental health problem showed an increase in anxiety


I wonder if another study looking at the natural history of attempts to quit smoking may offer a little insight into that increase in anxiety:


Within the month of the study, 32% of smokers had multiple episodes of intentions to not smoke, and 64% transitioned among smoking as usual, abstinence, and reduction status on multiple occasions. When participants reported that they intended not to smoke the next day, 56% of the time they did not make a quit attempt the next day. Just under half (44%) of quit attempts occurred on days with no intentions to quit the night before. Most quit attempts (69%) lasted less than a day. Reduction in cigs/day was as common as abstinence.


It’s striking how fluid motivation and attempts to quit are. Relapses don’t mean I’m a smoker. Quitting is a process. Many smokers probably constantly evaluate their status in that process.



Nicotine replacement ineffective

A 21 mg dose Nicoderm CQ patch applied to the ...

A recent study found nicotine replacement ineffective:

In the prospective cohort study the researchers, including lead author Hillel Alpert, research scientist at HSPH, and co-author Lois Biener of the University of Massachusetts Boston’s Center for Survey Research, followed 787 adult smokers in Massachusetts who had recently quit smoking. The participants were surveyed over three time periods: 2001-2002, 2003-2004, and 2005-2006. Participants were asked whether they had used a nicotine replacement therapy in the form of the nicotine patch (placed on the skin), nicotine gum, nicotine inhaler, or nasal spray to help them quit, and if so, what was the longest period of time they had used the product continuously. They also were asked if they had joined a quit-smoking program or received help from a doctor, counselor, or other professional.

The results showed that, for each time period, almost one-third of recent quitters reported to have relapsed. The researchers found no difference in relapse rate among those who used NRT for more than six weeks, with or without professional counseling. No difference in quitting success with use of NRT was found for either heavy or light smokers.

“This study shows that using NRT is no more effective in helping people stop smoking cigarettes in the long-term than trying to quit on one’s own,” Alpert said.

This is on the heels of a report that Chantix should be limited to patients who have been unable to quit with other methods.

The book Change Anything has stuck with me. The application of the model is still a little fuzzy to me, but he offers a model for change composed of six cells made up of two columns and three rows. The two columns are motivation and ability. The three rows are self/personal, social/others and structural/things/organizational. It offers a helpful way of organizing tactics, tools and strategies to change something and maintain change. And, by the way, as I learn and think more about it, 12 step recovery has evolved in ways that address all six boxes. Pretty cool.

NRT would fall into the box for structural ability but the quitter still has to attend to the other five boxes. I wonder if people using NRT are less likely to attend to other boxes for some reason.

It’s also possible that an approach that fills one box may limit approaches in other boxes. Studies have found that willingness to tolerate discomfort predicts success in quitting smoking. (personal ability) Could use of NRT indicate unwillingness to tolerate discomfort? Or, even, undermine willingness to tolerate discomfort?

Chantix should be a last resort

A new study suggests that Chantix should be a last resort tool for smoking cessation:

The psychiatric side effects of a popular quit-smoking drug make it too dangerous to use as a first attempt to kick the habit, according to a new study. The authors suggest the drug should eventually be taken off the market altogether.

The new study on the safety of varenicline (Chantix), appearing in the journal PLoS One, found that when compared with other smoking-cessation treatments, including nicotine replacement and the antidepressant bupropion (Zyban), varenicline was associated with significantly more cases of suicide, self-injury and depression. Varenicline was linked to 90% of 3,249 reported cases of self-harm or depression in people using quit-smoking drugs between 1998 and 2010, the study found, compared with 3% for nicotine replacement and 7% for bupropion.

…Dr. Curt Furberg, professor of health sciences at Wake Forest Baptist Medical Center and an author of the latest study, notes that his analysis found that varenicline resulted in many more cases of mental disturbances than bupropion. Given its safety profile, he argues that varenicline should be used only as a last resort for smokers who have tried other methods — including behavior modification, nicotine replacement and bupropion — and still can’t quit.

The Veterans Affairs Administration already uses varenicline by these guidelines, and Furberg approves of the policy. “They got it right,” he says. “They have restricted use of Chantix to a last-resort drug. They say when you try to get people to quit, and if you need a drug, start off with nicotine replacement and then Zyban. If they don’t work, then use Chantix. But if you do, you need to monitor mental status to see if people are suicidal in any way.”