Smoke Job

I've heard nicotine ranks among the most difficult habits to kick.
And to stay away from, absolutely, like any addiction. But they are going to get nicotine- and tobacco-related diseases. That's just going to happen. All my 20-year sober patients die of lung cancer because they don't stop smoking. Have I really helped? I guess I did if they have a flourishing life in the meantime. I share the concern that [this ban] may drive people away from treatment. Really what it will do, I bet, is drive people to come to treatment only when they're really desperate. Which, by the way improves outcome — when you have someone really ready to work, they get better.

Right. But then everyone else who's not quite as ready may not get help.
It's a serious issue. It's a really serious concern. Let's put it this way, I don't think I would have made this law. It's a bold law; I understand where they're going with it. I'm just not sure I would have done it. Maybe we could do some study that says "would you be less likely to come to treatment if you couldn't smoke." Of course, they'd all say yes.

Do you see this as potentially spreading to other states?
If people started spending their energy here, I'll be kind of upset because we have other issues.

Like what?
Just getting resources for treatment. You can't keep anybody in treatment for more than three to five days out here. Insurance won't pay for it. There are no beds available. There are no resources. And no one holds insurance's hand to the fire about this. Doctors have absolutely zero say over how long you treat an addict. That's a whole other story.

Is there a culture of restriction at treatment facilities? For example, what is the tolerance for lesser vices like caffeine, or sex?
Sex is a no; relationships are what take people out. Caffeine is not actually a stimulant. It removes a nervous system depressant so the brain can feel stimulated. Addicts will always put things in their mouth. They always try to alter [their perception] automatically — that's their orientation. Of course we want that behavior to stop. However, there's no evidence that caffeine alters their course [of recovery]. We used to say the same thing about nicotine. Now there is evidence that we should be focusing on stopping nicotine early.

Instead of after, say, crack?
Most of them get to the cigarettes eventually. The fact is, most of the people serious about their sobriety have to take a look at nicotine. And they usually do. Is this [ban] going too far? I just don't know.

© 2008