Why Some Addiction Treatment Centers Don’t Allow Smoking

Medically reviewed by

Dr. Gerardo Sison

March 29, 2019

Nicotine is a highly addictive substance linked to nearly half a million deaths in the United States annually. And yet, it is the least likely to be treated in the traditional addiction treatment setting. The role of addiction treatment centers is to help individuals overcome a substance use disorder, sometimes treating co-occurring disorders or polysubstance abuse at the same time. Nicotine, as with any addiction, has some implicit ramifications including deteriorating physical or mental health, social isolation, and financial and legal burdens. Each of these may be lessened or eliminated through drug treatment.

Despite concerns that treating drug or alcohol addiction with co-occurring nicotine addiction may lead to higher rates of relapse, research has demonstrated that comprehensive programs providing pathways to overcome both an addition to other drugs and alcohol as well as programs for smoking cessation may improve recovery outcomes.

Despite this, data collected from the 2012 National Survey of Substance Abuse Treatment Services, revealed less than half of all treatment facilities offered support to individuals desiring to quit smoking during treatment. Another report from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicated only one in 10 facilities ban smoking altogether. These treatment facilities were more likely to be located within states with stringent public smoking bans and were more likely to be larger, residential public facilities.

Additionally, someone with an addiction to nicotine is far more likely to suffer from a co-occurring mental health disorder. The awareness that multiple factors contribute to a substance use disorder are changing how drug and alcohol addiction is treated. Research indicates comprehensive treatment plans that address underlying mental disorders, co-occurring abuse of substances like nicotine, as well as improving coping mechanisms for individuals facing addiction, improves long-term recovery success rates.

Smoking And Risk of Death

As of 2014, an average of 480,000 people die annually from smoking or being exposed to someone regularly who smokes, compared with 88,000 alcohol-related deaths in the United States. The numbers put the severity of tobacco use in perspective. Tobacco, though a legal substance, is killing an astonishing average of 1,300 people each day, far more than alcohol, cocaine, heroin, and methamphetamines combined.

Someone in treatment is more likely to die from complications related to smoking or exposure to secondhand smoke than from any other substance of choice, which has some treatment facilities taking the legal substance far more seriously than before.

Mental Illness And Effects Of Nicotine On The Brain

Rates of cigarette smoking in populations with mental illness is nearly double the rate of the general population. There are many factors that may contribute to this increase, including changes in the biochemistry of the brain that make a person with mental illness more susceptible to addiction.

Nicotine mimics the naturally occurring neurotransmitter, acetylcholine, which inhibits nerve cell activity within the heart, lowering the heart rate. Nicotine also impacts glutamate neurotransmission in the brain. Glutamate has an excitatory effect, much like acetylcholine, increasing cognitive function, and improving–at least temporarily–memory and focus. Increases in both acetylcholine and glutamate result in a release of dopamine.

Dopamine is the neurotransmitter associated with the reward centers of the brain. Dopamine is released from a part of the brain known as the nucleus accumbens any time someone experiences something the brain associates with survival, like eating, drinking water, or having sex. It’s that satiated feeling you get after eating your favorite comfort food. Nicotine increases dopamine at higher levels, leading to cravings for the substance similar to those for food or water.

This combined cardiovascular, neurological, and dopaminergic effect may explain why someone with a mental disorder, especially one associated with paranoia or anxiety, might be drawn to nicotine for the both the excitatory and inhibitory impact on the nervous system.

What the Research Suggests About Addiction Treatment And No-Smoking Policies

Alcohol addiction and co-occurring nicotine addiction are a prevalent pairing. While treatment centers are keen to address other forms of poly substance abuse, they have historically permitted smoking, despite the known health risks. The perception that addressing nicotine and alcohol addiction would result in higher relapse rates is not indicated through multiple studies. In fact, some studies support higher rates of recovery at six months, than those with untreated nicotine addiction.

Research also indicates that the majority of people in treatment for an addiction to a different substance expressed a desire to quit smoking. And that drug treatment is the best time and place to end a nicotine addiction, as long as the treatment program offers a level of support for smoking cessation.

Quitting Smoking Has Many Positive Effects Including:

• Increased life span
• Decreased risk of tobacco-related illness and cancer
• Decreased financial burden from cigarette purchases, or treating related illnesses
• Increased oxygen to the brain
• Decreased blood pressure
• Improved circulation

Quitting smoking while in drug treatment can increase a person’s lifespan by 25 years, decrease the financial burden of paying for cigarettes, improve circulation and blood pressure, increase circulation and oxygenation of the blood, and reduce the overarching burden from tobacco-related illness or cancer.

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