Patients` high risk for nicotine dependence requires more attention

It has been reported that people who have alcohol and drug use disorders and enter addiction treatment programs smoke cigarettes at rates around four times the rate of smoking in the general population, and get sick and die from tobacco use at high rates as well. Why? What explains this? What is the “vulnerabilty factor”?

What is it about alcoholics and other drug addicts that makes them so much more vulnerable to sickness and death from tobacco than everybody else? Is it brain chemistry? Environmental factors? Genetics? Personality?

Whatever the cause(s) of this vulnerability, the compelling facts are that this particular population of Americans crossing racial, cultural and class lines is dying at an astonishing rate without much attention to that reality. The revelation that we don't appear to have a satisfactory explanation for this discrepancy is new to most in the public health field.

Studies from New York and Wisconsin indicate that patients entering addiction treatment services have a nicotine dependence (tobacco use disorder) in extremely high numbers. New York state reviewed 100,000 admissions to its addiction treatment programs and discovered that 92% of patients met nicotine dependence diagnostic criteria. A study of 52 residential and day treatment programs at the St. Clare Center in Baraboo, Wis., revealed that 85% of patients met nicotine dependence criteria.

The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have determined that half of those who smoke into middle age (or for 20 years) will die from tobacco-caused or -related diseases. Others who don't die from tobacco use have a reduced quality of life and poorer health.

Who has the science to explain this vulnerability factor for individuals with alcohol and drug addiction? Is this phenomenon worth studying, and who is ready or able to do the research? It is believed that half of the current smokers are at life-threatening risk. Finding effective interventions for this underserved population would seem to be a priority if the epidemic level of death from tobacco is to be reduced.

Isolating and identifying the vulnerability factor is a challenge seeking solutions through credible research. Hundreds of thousands in the “death by tobacco” pipeline need and deserve a way out that reduces or eliminates their vulnerability. I welcome Addiction Professional readers' thoughts and information on this critical topic.

David “Mac” Macmaster, CSAC, PTTS, is co-founder and managing consultant for the Wisconsin Nicotine Treatment Integration Project (WINTIP) in Madison, Wis., an initiative coordinated by the University of Wisconsin School of Medicine's Center for Tobacco Research and Intervention. Macmaster has been an addiction specialist in Iowa and Wisconsin since 1975, with roles including addiction counselor, program director, interpersonal skills trainer, and prevention specialist.