New York Bans Cigarettes for Addicts

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!

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.