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The Connection Between Smoking Cigarettes and Substance Abuse

Many individuals undergoing inpatient or outpatient addiction treatment are cigarette smokers as well. Most addiction treatment centers allow their clients to smoke because of a belief that the additional withdrawal symptoms from sudden cessation of nicotine may add to the challenges of detox. Less than 1/3 of addiction treatment centers offer evidence-based stop-smoking programs to their clients.1

However, not only is nicotine a highly addictive substance in and of itself, research is making clear the connection between smoking cigarettes and substance abuse, including the role of cigarettes as a gateway drug and a higher likelihood of relapse among smokers who achieve sobriety.

Let’s explore these connections and the advantages of stopping smoking as part of the recovery process.

Is There a Connection Between Cigarette Smoking and Drug Addiction?

There are numerous connections between smoking and mental health issues, including addiction. Used in combination, the physical effects can be severe. Just some of the documented links between cigarette smoking and having a substance use disorder include:

  • People with mental health or substance use disorders are more likely to smoke cigarettes.1
  • Those who have these disorders die five years sooner on average than those who do not.1
  • Nicotine may be used to mask symptoms of mental illness, leading to higher rates of smoking among this group.1
  • Smoking cigarettes almost doubles the chance of relapse in the first three years following treatment for substance use.2
  • Nicotine use makes individuals more likely to start using other drugs, including marijuana, cocaine, and alcohol.3

Myths About Smoking and Substance Use

There are some common misconceptions about cigarette smoking and drug use, which can stand in the way of patients in outpatient drug rehab centers or sober housing from getting the help they need to stop smoking. Some of these perpetuated myths are that:

  • “People in substance abuse treatment are not interested in quitting smoking or would not be able to quit if they tried.”
  • “Quitting smoking slows down or prevents recovery from addiction or mental illness.”
  • “Nicotine is necessary for self-medication.”
  • “Effort spent on dealing with an addiction to nicotine is not the right use of treatment time or resources.”

In reality, smoking cessation has not been shown to interfere with addiction treatment, and it can be managed alongside the detox from other substances. When asked, many people in recovery are interested in safely breaking their addiction to cigarettes, but these myths play a role in preventing them from taking that step.

Does Smoking Cigarettes Make Relapse More Likely?

A prominent study has shown that those who smoke cigarettes following a detox program are about twice as likely to relapse in the three years following treatment. Of those who kept smoking during those three years, 11% relapsed into substance use, compared to 8% of those who quit smoking and only 6.5% of those who had never smoked cigarettes.2

Suspected reasons for this connection include a theory that cigarettes may be a trigger for drug use, causing cravings for opiates and stimulants. The study found that stopping smoking during or following inpatient or outpatient addiction treatment did not increase other drug use, and it suggested that doing so may improve abstinence over the long term.

Is Nicotine a “Gateway” Drug?

There does seem to be a strong connection between smoking cigarettes and illicit substance use. Teenagers who smoked were found to be three times more likely to engage in underage drinking, eight times more likely to smoke marijuana, and twenty-two times as likely to use cocaine than non-smoking teenagers.3 Smoking cigarettes was also linked to other high-risk behaviors and youth violence.

Quitting Smoking During or after Addiction Treatment

man is quitting smoking and is refusing cigarette offer

Some of the reasons that individuals and treatment programs should consider adding smoking cessation to their treatment plans include:4

  • Quitting smoking improves outcomes, with those who quit smoking being 25% more likely to abstain from drug and alcohol use.
  • Lowering risk factors of heart attack associated with cigarette smoking, such as high blood pressure and hardening of the arteries.
  • Studies supporting the willingness of those who smoke to participate in smoking cessation groups and programs.
  • Medicare and many insurance policies covering smoking cessation counseling, making this service financially feasible.

How Addictive Is Nicotine?

Many people become addicted to cigarettes early in life, with smoking rates for teenagers and young adults being higher than any other age group. As many as 20% of high school students are regular smokers,3 which will increase their likelihood of substance use and addiction.

It is believed that many teenagers and young adults use nicotine as self-treatment for mental health disorders. Compared to the 20% rate for all high school students, as many as 90% of individuals who have a co-occurring mental health disorder smoke.3

Once tobacco use starts, addiction sets in quickly. While it was long thought that it takes 2-3 years to become addicted to nicotine, recent studies now show that, especially for young people, addiction can begin in as little as two days to one month from smoking their first cigarette.3

Smoking as few as 100 cigarettes (five packs) produces physical and psychological withdrawal when nicotine use is stopped.3

The younger a person is when they start smoking, the more likely they are to become addicted and the less likely they are to be able to quit smoking successfully.3

Smoking Cessation Treatment Options

There are many effective methods to stop smoking or treat nicotine addiction. The FDA has approved several medications for smoking cessation, and behavioral therapy also has been proven successful. The more individualized and focused the treatment plan, the more successful it is likely to be.

Some of the methods that are effective for stopping smoking include:5

  • Nicotine replacement therapy (NRT). This treatment involves replacing the addictive nicotine component of cigarettes with another source, which can be stepped down over time. Patches, sprays, gums, and lozenges are the most common sources of NRT.
  • Bupropion. This antidepressant medication has been shown to improve successful quitting rates and works by slowing down the reuptake of certain brain chemicals. It is as effective as nicotine replacement therapy.
  • Varenicline. This medication reduces nicotine cravings by stimulating the same receptors in the brain but at a lower level, leaving them unable to respond to nicotine. It has been shown to be more effective than either NRT or Bupropion used alone.
  • Nortriptyline. This is another antidepressant that may be used for smoking cessation and has been shown to be as effective as nicotine replacement therapy.
  • Combinations of medications. By pairing together nicotine replacement therapy with other medications, some of the most effective quit rates can be achieved. Prescribing varenicline in combination with NRT was proven more effective than varenicline alone. Adding bupropion to varenicline was also shown effective for those who had a severe addiction to nicotine.

businessman with broken chains in sunset

Finding Complete Healing from Addiction

Living free of addiction requires more than just achieving sobriety from drugs or alcohol. Caring for and supporting your overall wellness is a necessary part of living a full and rich life after addiction treatment. Choosing a treatment facility that offers supportive programs and partnerships to achieve all of your recovery goals will get you well on your way to restoring your mind, body, and spirit.

We offer a broad suite of services to ensure that our clients have all the tools and resources they need to stop their addictions to all kinds of substances. With intensive outpatient therapy, detox facility partnerships, and RECO Institute’s sober living residences, your road to recovery can be complete and all-encompassing.

Quitting smoking as part of your recovery plan will decrease your risk of relapse, improve your overall health, and help eliminate the family cycle of smoking and addiction. If you are wondering how to get started on this journey in Delray Beach, Florida or nearby, contact us at RECO Intensive for comprehensive outpatient addiction treatment.


  1. https://www.cdc.gov/tobacco/disparities/mental-illness-substance-use/index.htm
  2. https://www.bu.edu/sph/2017/03/13/cigarette-smoking-linked-to-increased-risk-of-substance-use-relapse/
  3. https://pediatrics.aappublications.org/content/124/5/e1045
  4. https://mdquit.org/tobacco-information/substance-use-disorders
  5. https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-are-treatments-tobacco-dependence

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