Counseling Today, Online Exclusives

The culture of smoking in substance abuse recovery

By Bethany Bray December 12, 2016


Editor’s note: This online exclusive is a companion article to Counseling Today’s December feature “What counselors can do to help clients stop smoking,”


Less than half of substance abuse treatment centers in the United States have tobacco cessation programs, according to the U.S. Centers for Disease Control and Prevention. At the same time, the rate of smoking is much higher for those with mental illness or behavioral health problems than it is in the general population.

Despite all of the known health risks associated with smoking, many inpatient or rehabilitation facilities still give smoking breaks as a reward or as part of behavior modification programs, says Greg Harms, a licensed clinical professional counselor (LCPC), certified addictions specialist, and alcohol and drug counselor with a private practice in Chicago.

“There’s such a culture of smoking in mental illness treatment and substance abuse recovery. Historically, it was thought as helpful – an outlet that wasn’t their main addiction (alcohol, illegal zxqdghr2kiw-stas-svechnikovdrugs, etc.). This persists even to this day,” says Harms. “Doctors will still ignore the smoking issue. It just doesn’t get addressed. It’s really part of the culture at day programs, treatment programs and nursing homes.”

There’s a longstanding myth among helping professions – particularly those in the addiction and rehabilitation specialties – that smoking is “not as bad” as other addictions, says Ford Brooks, a licensed professional counselor (LPC) and professor at Shippensburg University of Pennsylvania.

This school of thought is exemplified in the fact that the co-founders of Alcoholics Anonymous, Bill Wilson and Bob Smith, both died of smoking-related illnesses (cancer and pneumonia), says Brooks.

“They were sober, but they were chronic smokers,” he says.

Practitioners often overlook a client’s smoking to focus on seemingly “bigger” problems, such as alcohol dependence, severe mental illness or illegal drug use, says Brooks. But smoking poses its own significant health risks, from lung disease to cancer, he notes.


Smoking quitlines: A lifeline for practitioners and clients

In the U.S., each of the 50 states, the District of Columbia, Puerto Rico and Guam have telephone “quitlines” that offer information and live support to callers who are looking to stop smoking.

American Counseling Association member Gary Tedeschi, clinical director of the California Smokers’ Helpline, urges counselors to call their state’s quitline themselves if they have questions or are looking for guidance to help a client through the quitting process.

Tedeschi, a national certified counselor and licensed psychologist, also encourages counselors to connect their clients with a local quitline. The service can offer more frequent and targeted contact for clients outside of counseling appointments. It also may help those who are less likely to open up in face-to-face meetings in a counselor’s office, Tedeschi adds.

Staff members who speak to quitline callers are well-trained and able to coach people through the quitting process, says Tedeschi. They also contact each caller again after the initial conversation to provide follow-up support.

Tedeschi says the phone counselors at his quitline call people several times – even if it’s just a brief check-in – during a person’s first week of quitting to reduce the chance of relapse.

“It’s a free service, it’s convenient and [it] helps people deal with the ambivalence they may feel about behavior change,” Tedeschi says of telephone quitlines. “Once they make initial contact, we will proactively follow up. We don’t have to wait for them to return [to a counseling office] or call back. They might be ambivalent about quitting or changing, but we’re not.”


Find out more at or call 1-800-QUITNOW






Bethany Bray is a staff writer for Counseling Today. Contact her at


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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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