Should Smoking Be Discouraged in AA?

They say if you can’t find your AA meeting, look for the building with a group of smokers outside. Cigarettes, along with pastries and coffee, have been associated with AA since the beginning. People recovering from alcohol addiction smoke at much higher rates than the general public. While estimates for smoking around the world are around 20 percent and steadily declining, more than half of AA members smoke.

Most of these smokers claim cigarettes reduce their depression, anxiety, and irritability. You could certainly argue that in the short term, the health risks of smoking are preferable to the life risks of drinking. After all, there’s no point worrying about lung cancer in 20 years if alcohol is an immediate threat to your health and safety. The long term may be a different story though. Does smoking help recovery more than it hurts?

Let’s leave aside for the moment the fact that smoking kills about 10 times as many people as alcohol every year. Smoking is highly correlated with the use of other substances. Studies have shown that about 75 percent of people struggling with addiction also smoke. This association can be dangerous. If you are used to smoking when you drink, smoking is a potent trigger.

Not only is smoking strongly associated with drinking, but it also has many sensory hooks. There’s the ritual of getting out a cigarette and lighting it, there’s the sound of the lighter or the smell of the match, the feel of the first inhale, and the smell of the smoke. The smells are especially potent and can trigger vivid memories and cravings more than anything else. Other triggering behaviours–going to a bar, spending time with friends who drink, and so on–are strongly discouraged, but smoking gets a pass.

One study from Columbia University’s School of Public Health analyzed nearly 35,000 cases and found that smoking almost doubled the risk of relapse. Around 11 percent of smokers relapsed after three years compared 6.5 percent of non-smokers. People who quit smoking at some point were in the middle at around eight percent. That means, if you quit smoking after you get sober, you reduce your chances of relapse by about 27 percent.

A common belief is that people who quit drinking don’t want to quit smoking, or that it’s too hard to do both at once. Studies have shown this is generally not true. And no one would suggest treating an opioid addiction while ignoring a cocaine addiction. It certainly is hard to quit smoking, but for more than half of AA members it might be one of the best ways to increase their chances of success.

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