Recovery Community: Have We Let Smoke Get in Our Eyes?

by Marlene M. Maheu, Ph.D.

Bill W. was lifted to the podium in his wheelchair, oxygen tank at his side. He was dying of lung disease. A brave, relentless visionary gave his last professional address about alcohol dependency, only to die from lung disease related to cigarette smoking. He died from nicotine addiction. Our collective, societal denial about the urgency of treating nicotine dependency is only now beginning to lift.

In 1988, Surgeon General Koop boldly stated, "The pharmacological and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine."

Hallmarks of addiction are becoming painfully evident as research unveils facts such as: 60-90% of all alcoholics are also nicotine addicts. How can this be true? Let's look at the criteria for addiction as related to nicotine. Nicotine dependent individuals experience increased tolerance; preoccupation with the substance; continued use despite impairment; withdrawal symptoms upon cessation; and cause harmful effects to others (passive smoke).

Why are the medical and recovery communities slow to respond? We have been raised with tobacco use as the norm. We are in denial. Our parents and grandparents smoked. Smokers lighting dried leaves and inhaling smoke is not recognized as deserving the same attention as a heroin addict sticking a needle in an arm. Family members are just beginning to recognize their rights and to voice them.

It is interesting to note that when asked, family members have a lot to say. A recent study of more than 2,600 children found 80% of children with smoking parents worry that their parents are harming themselves by smoking; 74% worry their parents' smoking harms other family members; and 48% worry about a possible fire resulting from parental smoking.

The tobacco industry spends 2.5 billion dollars advertising their products every year. This amount far outweighs dollars spent to counteract the effects of such large scale promotional efforts. The tobacco industry campaigns to convince our youth and minority groups to view smoking as suave, sophisticated and sexy. They are successfully recruiting millions to their ranks annually.

As professionals, we haven't been trained to see the problem. Our graduate professors rarely mention nicotine dependence as a serious issue worthy of treatment efforts. While our Diagnostic and Statistical Manual contains two diagnoses related to nicotine addiction, clinicians are reluctant to include these codes in formal diagnoses or psychological test reports.

It doesn't even seem to occur to us to mention these diagnoses in case presentations and discussions. It doesn't seem important enough to mention, yet it kills more people per year than AIDS, heroin and morphine, cocaine & crack, alcohol, auto accidents, fires, suicide, and homicide COMBINED.

As professionals, we are grateful to have our clients quit other chemical dependencies, and encourage them to "not rock the boat" by quitting tobacco use as well. Not only are we uninformed, but we are frightened to look at the problem. We don't know how to deal with it, so we minimize it.

Medical professionals rely on counselors to spend the time necessary to address complex issues often present with the "relapse prone;" whereas counselors rely on medical professionals because symptoms manifest most clearly in the physical realm with patients. Our professional groups are just beginning to work cooperatively on inpatient issues; outpatient issues such as nicotine treatment requires a level of cooperation not currently established.

Manifestations of nicotine dependence are slower to develop than for other chemical dependencies; and are unidentified as tobacco related. For example, social and occupational impairment are minimally present for smokers/chewers. Physical conditions such as stroke, heart attack, pancreatic cancer are not recognized as directly linked to tobacco. Nicotine's ability to exacerbate symptoms of numerous other disorders ranging from diabetes to chronic pain is not common knowledge. Smokers/chewers, their families, and treating professionals rarely recognize the connections.

Even when recognized, the connection between nicotine and physical disorders is not given much audience. As professionals, we don't often treat these issues seriously. Death due to a parent's tobacco use is more easily accepted than death due to a parent's heroin use....

It is time to wipe our eyes, throw open our windows and take a good look at reality. Smoke has been blinding us for decades. Many of our clients, as well as precious role models, are dying from the effects of nicotine dependency. Treatment for nicotine dependency is often difficult, but quite available for those who are willing to look for solutions and courageously take action.


Contact your local chapters of the American Lung Association and the American Cancer Society for a large selection of free and low-cost materials. For structured training in how to intervene with tobacco users, call the Nicotine Recovery Institute.

Numerous reports are available from:

Department of Health and Human Services Centers for Disease Control
National Center for Chronic Disease Prevention and Health Promotion
Office of Smoking and Health
Stop K-50
1600 Clifton Road NE,
Atlanta, GA 30333


Nicotine Dependency Treatment: - New Opportunities for Psychologists

Other Resources

Dr. Maheu is an author, speaker, and researcher. She is the lead author of E-Health, Telehealth & Telemedicine: A Guide to Program Startup and Success co-written with Pamela Whitten and Ace Allen, published by Jossey-Bass: San Francisco.

Infidelity on the Internet is Dr. Maheu's second book and she's currently working her third, tentatively titled "The Mental Health Professional Online: New Questions and Answers."

For more information about her speaking schedule, see this page: