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Therapy and Cigarettes

Natalia J. Garland

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In the not too distant past it was an unquestioned custom that therapists and patients could smoke cigarettes in the therapy session. I remember co-leading groups in which the other therapists and most patients smoked. The agency had a rule that no more than three people could be smoking at the same time. Usually, three people would indeed be smoking and others would be waiting to light up the moment someone took their last puff.

I can even remember reading in a social work textbook where the author favored letting patients smoke in order to make them feel relaxed. This author then went on to suggest that the therapist also light up as a way of establishing rapport with the patient. Smoking cigarettes was viewed as some sort of bonding experience.

Things have certainly changed. You have probably guessed that I am a non-smoker. Sitting in those smoky group sessions used to give me bad headaches and make me feel sick. I would go home at the end of each day smelling like stale tobacco. My dry-cleaning bill was enormous. Cigarettes spoiled what was otherwise a very pleasant workplace.

The odd thing is that I never objected to being exposed to second-hand smoke. It never even occurred to me to object. Second-hand smoke was not a concept in those days, and nicotine addiction was as American as apple pie. Smoking cessation was not really a clinical issue. Actually, many therapists considered smoking cessation to be too difficult for most patients. Regarding alcoholics in early recovery, smoking was considered a comparatively minor problem. And, I can recall token-economy programs in which schizophrenic patients were rewarded with cigarettes (as well as with soda and candy).

Many smokers nowadays would object that unfair restrictions have been placed on them. However, smokers' rights were taken for granted for many years. It was the duty of non-smokers to accommodate them. Now, with our knowledge of cancer and the dangers of second-hand smoke, clean air is considered more essential. Most public buildings are designated as non-smoking areas, including hospitals and mental health agencies. As it turns out, patients can and do sit through their therapy sessions without smoking.

There is only a small number of non-smoking A.A. meetings. It seems that most alcoholics are also addicted to nicotine. Occasionally, I have had a non-smoking alcoholic patient who has told me that their participation in A.A. is limited because they cannot tolerate the smoke-filled rooms. I half-believe them. I believe them because I know the impact of cigarette smoke on my own sinus passages. I do not believe them because I know that the serious recovering alcoholic will do whatever it takes to stay sober.

Far from providing a commonality between patient and therapist, a cigarette in the hand serves as a prop and as a barrier to real communication. Moreover, cigarettes do not relax people. One cigarette will only temporarily satisfy the addictive craving, and then another is needed and then another.

The experts today are saying that if cigarettes were a new product being introduced on the market, it would never receive F.D.A. approval. There would be no cigarettes, period. Few people seem to be able to smoke for pleasure and not become addicted. Recently, the F.D.A. ruled NicoWater illegal. NicoWater was a bottled water containing nicotine. The F.D.A. also removed nicotine lollipops and lip balm from the market.

But we seem to be stuck with cigarette addiction. Cigarette smokers risk health problems, but do not seem to reap the negative psychological and social consequences as do addicts of cocaine or heroin. The impetus for smoking cessation, therefore, has to come from a deep personal resolve or from a strong commitment to total recovery. The difficulty of this is not to be underestimated.

In the meantime, patients will keep lighting up as soon as the session is over and they exit the building. Non-smokers' rights are finally being given respect, and I am thankful for that, but nicotine addiction remains a powerful condition that goes largely untreated. Ultimately, perhaps there is a special bond between smoking therapists and patients: the cruel bond of lung or throat cancer. (Written 08/05/02 - Revised 12/01/03)

Until we meet again..............stay sane.

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Copyright 2002, 2003 Natalia J. Garland