It is projected that nearly three-quarters of a million members of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) will die from tobacco-related causes, according to a 2012 study from the Wisconsin Nicotine Dependence Integration Project (WINTIP), with nearly half a million of those individuals residing in the United States and Canada. Attempts at encouraging AA and NA, highly successful addiction recovery societies, to address tobacco as a central issue have been unsuccessful so far. Both societies have traditions that discourage them from dealing with what they have described as “outside issues.”
The Traditions of AA and NA state that the organizations have no opinion on outside issues, and that therefore their names ought never be drawn into public controversy. Informal evidence indicates that their members often do not consider nicotine addiction to be an issue that is as important as recovery from the addictions that they joined AA and NA to recover from, or they see nicotine addiction as something to be addressed later.
The New York State Office of Alcoholism and Substance Abuse (OASAS) reports that 92% of those admitted for substance use disorders in state-licensed addiction treatment programs are also nicotine-dependent. By comparison, the rate of smoking in New York state’s general population is below 20%, according to 2011 data.
Similar rates of nicotine dependence have been reported among patients admitted for addiction treatment in other states.
Those with substance dependence have as much as a four times greater risk of dying from tobacco use as those in the general population. Research has shown that these tobacco deaths result in a loss of up to 25 years from expected life spans.
These data suggest that even those with substance use disorders who receive treatment and maintain abstinence from alcohol and other drugs but continue to smoke or use smokeless tobacco are at high risk to get sick and die from tobacco-related causes. It has been estimated that 60% of those in 12-Step programs and others in the “recovery community” are still using nicotine and are addicted. People “in recovery” are getting clean and sober but are still getting sick and dying from tobacco addiction that was neither professionally treated nor viewed as part of their recovery program.
It is probable that the original members of the 12-Step recovery community and even those in 12-Step recovery today have not been aware of the scope of the tobacco problem in their societies. Lack of awareness of these issues might explain their reluctance to address tobacco more realistically.
This has widespread effects on a large community. Data on participants in mutual-help programs suggest that there are currently approximately 1.4 million AA members in the U.S. and Canada. The second largest 12-Step organization in North America and worldwide behind AA is NA; its published report for 2010-2011 indicates there are 27,883 NA groups and meetings in the U.S. and Canada.
Two research studies that contain information on tobacco use in 12-Step Programs and among those studied after treatment for substance addiction report continued tobacco use after treatment and entry into recovery.
Peter R. Martin, MD, director of the Vanderbilt Addiction Center, asked 289 AA members about cigarette use. A total of 56.9% of these individuals smoked, and of the smokers, 60% considered themselves to be “highly dependent on cigarettes.”1
Also, in a longitudinal study of 575 adult smokers who completed intensive residential treatment for alcohol problems in the Midwest in 1995, 92% were still daily smokers 12 months after discharge from treatment.
It is unknown—and never will be known—how many AA and NA members have died from tobacco-related causes since these two important societies began their healing recovery missions. It is not unreasonable to assume that the death toll from tobacco stands in the hundreds of thousands, if not millions.
Based on mortality rate data we now have available, we can estimate the death toll from smoking among those currently in these fellowships. A reasonable estimate is that around 725,000 current AA and NA members worldwide will likely die from tobacco-related causes in the years ahead.
What can be done?
The founders of AA and NA and their early members did not know the true threat of nicotine addiction. That is no longer the case for today’s members. AA and NA are two of our most effective programs supporting long-term recovery from substance dependence. It is time for them to move from their historic tobacco cultures to tobacco-free cultures.
Remembering the unfortunate deaths of AA’s and NA’s founders from tobacco-caused or -related diseases highlights the high cost of not addressing this issue. Data indicate that all four of the founders of these two societies died of tobacco-related illnesses.2
Both AA and NA have Traditions that allow their programs to change when an issue is placed for consideration by a “group conscience” and approved by their general/world conferences. Advocates for tobacco recovery believe it would constitute a positive step for AA and NA to apply wise “group conscience” to respond to the continued death of hundreds of thousands of their members from tobacco use.
Unless nicotine dependence becomes an “inside issue” for these societies, the preventable deaths of AA and NA members will continue. Family members will suffer and grieve. The recovery community will lose too many of its role models.
It is time for all programs that treat substance dependence to integrate nicotine dependence into their treatment and recovery services. Research published by Douglas M. Ziedonis, MD, MPH, of the University of Massachusetts Medical School, and others shows that recovery from other addictions and nicotine addiction can occur at the same time, and that relapse is less likely when this occurs.
It is time for the recovery community and its advocacy associations to work vigorously to provide tobacco-free environments for all those who are afflicted with substance use disorders. Death by tobacco is preventable. Treatment works and recovery is possible for nicotine dependence, just as it is for dependence on alcohol, opiates, cocaine and other substances. It is time for another shift in the recovery culture.
David “Mac” Macmaster, CSAC, PTTS, has been an addiction specialist in Iowa and Wisconsin since 1975. He is co-founder and managing consultant for the Wisconsin Nicotine Treatment Integration Project (WINTIP) in Madison, Wis. The author would like to thank the following for their contributions to the content: Steven Schroeder, MD; Michael Miller, MD; Eric Heiligenstein, MD; Steven Kipnis, MD; William White; Anne Miner, PhD; James Wrich; Norman G. Hoffmann, PhD; and Tony Klein. Macmaster’s e-mail address is email@example.com.