Nicotine is a highly addictive drug, and according to the last report by the Surgeon General , smoking continues to be the primary cause of preventable death in the US. Nonetheless, it is not common to check-into a residential treatment center for nicotine addiction treatment, although smoking rates are more than double among people with drug and alcohol addictions and other similar demographic characteristics .
Most of the people seeking treatment for drugs or alcohol addiction also smoke cigarettes. And a significant number of those will continue to smoke after being discharged. This represents a problem that has been addressed by the Surgeon General, and it is clearly reflected in all health guidelines in the country: all healthcare professionals should offer smoking cessation aid to any person who reports smoking.
One of the major concerns in any addiction treatment is the relapse risk within the first year of being discharged. The evidence shows that “continued smoking for smokers and smoking initiation for non-smokers was associated with greater odds of SUD (substance use disorder) relapse” .
At the end of 2015, smoking rates among people in treatment for SUD was 84 percent . By offering smoking cessation intervention at the beginning of other addictions treatments, such as alcohol and opioids, better outcomes are to be expected. Why? Because evidence shows that, even if it may represent a bigger obstacle at the beginning, the outcome is clearly better.
The real harm is not to address this problem. Treatment centers should clearly have a smoke-free policy, and offer specific guidelines to help people quit smoking while treating other drugs.
If you are a smoker in an addiction treatment program, or you have recently completed one, you should be aware that smoking can cost you your hard-won long-term recovery. Evidence shows  that smokers working a program of recovery have a higher risk of relapse. The same mechanisms underlying smoking (triggers, cravings, automatic-pilot) are present in all other addictive behaviors, therefore in order to mitigate the risk of relapse, you should consider quitting smoking as well.
When you are in need of treatment for drugs or alcohol, you probably think that cutting cigarettes at the same time may be too much to handle. Do you think you are ready to take a step forward and be free of addiction for good? Only a few treatment centers will offer you a comprehensive approach and ask you to quit smoking, so bring forth the best of yourself to achieve long-term sobriety. If you are in this situation, it means you know the path substance use will take you on. It may be hard, but it is, without any doubt, rewarding.
2- Guydish J et al. An international systematic review of smoking prevalence in addiction treatment. doi.org/10.1111/add.13099
3- Weinberger A et al. Cigarette smoking is associated with an increased risk of substance use disorder relapse: A nationally representative, prospective longitudinal investigation. J Clin Psychiatry, 2017 February. doi:10.4088/JCP.15m10062.