Smoke Job

With a new regulation that struck some observers as counterintuitive, if not downright counterproductive, New York became the first state in the country to ban smoking at all addiction recovery centers. The regulation, passed by the state's Office of Alcoholism and Substance Abuse Services, encourages integration of nicotine addiction into treatment plans for other chemical addictions and make all state-accredited facilities completely smoke-free environments. "New York is leading the way and it is to be commended for that," says Michael Miller, president and board chairman of the American Society of Addiction Medicine. "People who have other drug addictions should be encouraged to stop smoking." Indeed, a 2004 study in the Journal of Consulting and Clinical Psychology found that smoking cessation during addiction treatment was associated with a 25 percent better chance of maintaining long term abstinence from alcohol and drugs.

But many addicts say they rely on cigarettes to help them through the treatment of their other, more problematic addictions. "This policy is saying that if someone [in New York] wants to quit heroin, but is not ready to give up cigs, well, sorry but you can't get treatment," says Tony Newman of the drug law reform advocacy group Drug Policy Alliance, which opposes the ban. If living from cigarette to cigarette is what it takes to get a more dangerous monkey off your back, Newman argues, then shouldn't the treatment facilities turn a blind eye to tobacco? "It's an important and confusing topic," concedes Drew Pinksy, better known as Dr. Drew, the addiction medicine specialist cohost of the nationally syndicated radio show Loveline. Newsweek's Brian Braiker called Pinksy, who was also featured in the VH1 reality show "Celebrity Rehab," at his treatment center in Pasadena, Calif., to discuss the role cigarettes can play in addiction recovery — and whether he thinks New York's ban goes too far. Excerpts:

Were you aware of this ban?
I was not but it's interesting because in California you're not allowed to smoke indoors. I remember 15 years ago when I made my unit a non-smoking unit, not only did I have mutiny from the patients, I had mutiny from the staff! The staff all smoked. You would have thought I was asking they all have their leg cut off for me. Then California stepped in and made everything non-smoking except certain areas outdoors. Since those days some literature has come in [that has shown] generally if people stop smoking at the same time they stop their drug of choice, their outcome is a little better. However there is almost a folklore in the recovering community that you deal with your worst demon first, then deal with your other demons later.

Some are worried that people who need help for drugs and alcohol in New York won't pursue treatment because they aren't ready to quit smoking.
I understand that, and it's a reasonable concern. However, I'd be surprised if that really becomes an issue.

I seem to recall that in "Celebrity Rehab" that at your treatment center, your patients smoke.
Oh yeah, I can't make them stop. I tried. By the way, I put every single one of them on a medication that helps them stop. None of them stopped during their treatment. In the profession of addiction medicine, we are trying to raise an ethos that if we don't deal with the nicotine addiction as well, we are really doing a disservice to our patience. While heroin is what's threatening their life in the moment, ultimately nicotine is what's going to take their lives.

You're not about to kick your patients out for smoking.
Patients rights require us to give the patients an area to smoke. In California you're required to let the patients smoke!