Bill W., principal author of Alcoholics Anonymous, planned to write another book titled After Sobriety, What? Unfortunately, that project was cut short by Bill’s death from emphysema-the legacy of a lifetime of heavy smoking.

Today there’s a new answer to Bill’s Question: After sobriety based on freedom from alcohol/drugs comes the issue of addressing tobacco addiction.

Of course, quitting tobacco is not a requirement for quitting alcohol and other drugs. People can achieve a satisfying sobriety even if they continue smoking. At the same time, many alcoholics/addicts do try to quit tobacco, and many of them succeed.

Today the single greatest cause of disease and premature death in America is tobacco use. Each year, diseases related to tobacco kill 430,000 Americans. Nearly ¼ of American adults are smokers. 3,000 children and adolescents become regular tobacco users every day.
The U.S. Public Health Service pegs the annual cost of tobacco-related death and disease at $100 billion. Hard drinkers and drug users are stereotyped as heavy smokers, and research supports that view. Studies indicate that:

  • Between 80 and 95% of addicts smoke cigarettes, a rate that is more that three times that for the general American population.
  • Nearly 70% of addicts are heavy smokers (smoking more than a pack a day).
  • Heavier drinkers puff their cigarettes more and draw in more smoke with each puff.

Unfortunately, heavy smoking and heavy drug use create a life threatening synergy: Using both cigarettes and alcohol over the long term increases health risks more than using either of them alone.

When compared to people who neither smoke nor drink, smokers are 7 times more likely to develop mouth and throat cancer; drinkers are 6 times more likely; and those who smoke and drink are 38 times more likely.

Other research indicates that nicotine addiction is the number one killer for people in recovery from other chemical addictions. Moreover, research also indicates that people who continue to use nicotine while abstaining from alcohol or other drugs relapse twice as frequently as those who quit the nicotine early in recovery.

For all of these reasons, successful recovery means having to address nicotine too. My clients understand that they will not graduate from the addiction treatment program successfully until they are nicotine abstinent.

Options for Quitting increase

According to the federal government’s latest guidelines for health professionals, current treatments for tobacco dependence offer the “greatest single opportunity to staunch the loss of life, health, and happiness caused by this chronic condition.”
The bottom line is that smokers who want to quit have more options than ever before. The guidelines list four kinds of nicotine replacement therapies: Nicotine gum, the nicotine inhaler, nicotine nasal spray, and the nicotine patch. These treatments aim to reduce withdrawal symptoms, allowing people to consume nicotine in highly controlled and steadily decreasing doses.

In addition, replacement therapy provides nicotine without the toxins found in cigarette smoke.
These guidelines also recommend 3 non-nicotine medications to reduce withdrawal symptoms: Wellbutrin (zyban), the most commonly prescribed non-nicotine medication to deal with tobacco dependence, and clonidine and nortriptlyline, 2 second-line medications that require more medical supervision. The guidelines endorse counseling for everyone trying to quit.

I have found that Zyban and counseling seem to work best for young people, and that the patches are ineffective if not dangerous. Consult with your physician when considering any of these guidelines.

Changes your body goes through when you quit smoking. (NATAC 1998)

Within 20 minutes of last cigarette:
Blood pressure drops to normal
Pulse drops to normal rate
Body temperature of hands and feet increases to normal

Within 8 hours:
Carbon dioxide level in blood drops to normal
Oxygen level in blood increases to normal

Within 24 hours:
Chance of heart attack decreases

Within 48 hours:
Nerve endings start to regrow
Ability to smell and taste enhances

Within 48 ‑ 72 hours:
Nicotine leaves the body

Within 72 hours:
Bronchial tubes relax, making breathing easier
Lung capacity increases

Within 2 weeks to 3 months:
Circulation improves
Walking becomes easier
Lung function increases up to 30%



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