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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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