Treatment center confronts cigarette dependency along with substance abuse

March 15, 2013

Cigarettes kill more people than heroin, alcohol combined

Angela Severson hit rock bottom late last year. Driving while intoxicated one night, even though her license had been revoked, she drove her car into a ditch. Her father found her passed out in the car the next morning.

"I'm thankful I didn't wake up in jail," said Severson, 29, a single mother of three young boys. "I'm also grateful that I didn't hurt anyone. But I knew I couldn't wait any longer to get help."

Severson made arrangements to enter the L.E. Phillips-Libertas Treatment Center, a 46-bed detoxification, medically managed and residential facility. It is part of St. Joseph's Hospital in Chippewa Falls, Wis., which is an affiliate of Hospital Sisters Health System in Springfield, Ill.

Severson knew she needed to kick her liter-a-day vodka habit and stop smoking marijuana. Sometimes, she said, she would have as many as 10 joints in a day. When she couldn't get her hands on vodka, she would often drink a 12-pack of beer in a day.

What Severson said she wasn't expecting was to have to quit smoking cigarettes when she entered the facility last New Year's Eve.

But she didn't have any choice. L.E. Phillips-Libertas Treatment Center has been tobacco-free since May.

"I've smoked since I was 15," said Severson, who was first in detox, then residential treatment for a total of 28 days. "I quit in 2005 and then started again when I began working in a casino in 2008."

She continued: "Giving up the cigarettes in treatment was by far the hardest.

I haven't really had any alcohol or marijuana cravings so far, but I still miss my cigarettes."

Brenda Goettl, clinical supervisor of the treatment facility, explained that her staff finally decided it was time to start dealing with nicotine addiction along with the other addictions the center treats.

"About 80 to 90 percent of our patients entering treatment for substance abuse also smoke cigarettes," said Goettl. "The truth is many are dying more because of cigarettes than from heroin or alcohol addiction." In fact, according to the Centers for Disease Control and Prevention, more people die from tobacco-related illnesses each year than from the human immunodeficiency virus, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined.

"One thing that always bugged me, too," Goettl said, "was how many people started smoking when they came to treatment."

Goettl explained that the prevailing sentiment in the addiction field has been that patients seeking sobriety are giving so much up already that "making them give up cigarettes would be piling on. But the more we kept talking about it and the more we learned about brain disease and how the brain works, we began to understand we needed to treat all the addictions."

Smoking rates are two to four times higher among people with psychiatric and substance abuse disorders, according to the Center for Tobacco Research and Intervention at the University of Wisconsin. In addition, the center reports, "There is increasing evidence that nicotine dependence treatment does not jeopardize recovery from alcohol and other substances and may improve outcomes."

Dr. Bruce Christiansen, a researcher at the University of Wisconsin tobacco center, said many smokers fear that if they give up cigarettes they will develop new problems with depression, anxiety, drugs or alcohol, or that it will interfere with their recovery plans. "But the results show it's actually the opposite," he said.

Goettl said patients are made aware before they enter the treatment center that it is a no-smoking facility. "They will say, 'no problem,' then reality and cravings set in," she said. "We have discharged people who have sneaked cigarettes in and referred others to residential treatment facilities that allow smoking. For many people here, cigarettes were their first addiction."

The L.E. Phillips-Libertas center actively treats tobacco codependency using nicotine patches and other nicotine replacement therapies such as candy, relaxation techniques and exercise, Goettl explained.

At the beginning of the year, she and her staff instituted follow-up calls with patients a week after being discharged. "Most are saying they feel so much better and are in such better health. They like how they feel," said Goettl.

But conquering tobacco addiction for good is a challenge. Severson, who finished treatment on Jan. 30, said she is maintaining her sobriety, but has started smoking cigarettes again. "I'm smoking less than I was before I went into treatment, but I am smoking some," she said.

Goettl said L.E. Phillips-Libertas is one of only two treatment centers in Wisconsin that is smoke-free. "Our mission is to treat all people and give them the best quality care," she said. At L.E. Phillips-Libertas that means giving patients support in becoming free of addictions to all substances.


Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.