• John Casper

Does stopping tobacco make recovery more difficult and relapse more likely?

We all have heard about the lives lost from the opioid crisis, but what about deaths from tobacco-related illnesses? We don’t hear much about that anymore. Make no mistake about it. Tobacco use remains a significant cause of disease and death. Tobacco causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. At least 16 types of cancer are related to tobacco use. Tobacco kills about one-half of its long-term users.

In the United States and Canada where rates are similar, the combined tally of annual opioid-related deaths has reached 56,074. This pales in comparison to the 528,000 tobacco related deaths for the two countries. Simple math shows that tobacco is killing 9.4 times as many people as the opioid crisis. Many people with a history of addiction continue to use tobacco in recovery. After attaining recovery from opioids, few consider the irony of tobacco use, a practice far deadlier than what they were doing. Do you think we might have a tobacco crisis?

Many in recovery desire to quit tobacco but claim to be waiting for more “clean time” and stability or claim that it is better to tackle one addiction at a time, but this is only procrastination. Intuition leading to the conclusion that stopping tobacco would make recovery more difficult and relapse more likely does not turn out to be true. This should not be surprising if we, as recovering persons, remember times when our own best intuition did not serve our best interests and that the disease of tobacco addiction naturally works to compel continued tobacco use and adverse consequences. Fortunately, recent experience dispels this “old school” belief by showing that tobacco cessation actually does enhance recovery.

Nicotine replacement treatment (NRT) in the form of topical patches, gum, or lozenges can assist in recovery from the tobacco crisis. Nicotine is NOT one of the 3000 harmful substances in tobacco and tobacco smoke causing disease and death. After decades of NRT there is no compelling evidence to suggest that nicotine delivered by these methods is harmful. Some use NRT as a bridge to nicotine abstinence while others use NRT indefinitely as a lesser harm alternative to tobacco as a form of medication assisted treatment. However, remember that nicotine is addictive and NRT is not recommended for people who have never used tobacco. Vaping or use of Electronic Nicotine Delivery Systems (ENDS) is not recommended as an alternative to NRT.

ENDS enhances the addictive nature of nicotine by extremely rapid delivery of nicotine vapors to the brain. ENDS also delivers toxic compounds derived from solvents and heavy metals. Never-tobacco users who use ENDS are more likely to become tobacco users and may be sensitized to develop other substance use disorders. ENDS users are developing irreversible lung disease. As time passes, more harmful effects of ENDS are being recognized. ENDS is part of the problem.

Dr. C.


Centers for Disease Control and Prevention (

Health Canada (

World Health Organization (

Substance Abuse and Mental Health Service Administration (

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