What about Smoking and Recovery from Substance Use Disorder?

Smoking is the most preventable cause of death in our society.   It is responsible for about 419,000 US deaths each year.   Smoking accounts for 1/3 of cancer deaths. It is a major cause of heart disease and cancers of the lungs, mouth, pharynx, larynx, esophagus, pancreas, uterus, cervix, kidney, and bladder.   The average smoker shortens his life by fifteen years!

Nicotine and Addiction to Other Drugs & Alcohol

In 1988 the US Surgeon General reported that nicotine is just as addictive as heroin and cocaine. A “hit” of nicotine reaches the brain in seven seconds, twice as fast as a   syringe of heroin injected into the vein.   Recent studies have shown an irrefutable link between smoking cessation and success in drug treatment.   Some have indicated that alcoholics and drug addicts who also stop smoking are up to eight times more likely to remain clean and sober!   For this reason, practically all major hospital-based treatment facilities are now “smoke-free”.

There is an important spiritual principle in all of this.   Paul says, “I will not be mastered by anything” (1 Cor. 6:12).   Having one habit that maintains “mastery” over me means I don’t have complete victory in my life.   This is a foothold in my life for “the enemy” that makes me more susceptible to other forms of temptation — like using alcohol and drugs again!

Practical Ideas for Recovery Programs

A.   Make your building a “smoke-free zone –   Every year thousands of nonsmokers die from inhaling “passive smoke”.   So, setting up a special smoking area either in the building or outside will avoid risking the health of program workers, visitors, and clients.

B.   Let the staff show the way – Program employees must be good examples by not smoking themselves. For those who do smoke,   it might be appropriate to pay for whatever help they might need to stop.   Dividends of a “smoke-free” staff include a lower rate of absenteeism and lower health-related insurance expenditures.

C.   Make smoking cessation a definite component of your long-term program – Stopping smoking should not be a requirement for entrance into a recovery program.   It may be appropriate, though, as a prerequisite for graduation or for moving into a later phase of the program.   Just like other addictions, smokers need special support from classes, support groups, counseling, and other activities.  This can also include nicotine gum and patches. A number of recovering people have actually told me that quitting alcohol and drugs was easy compared to quitting cigarettes.   There are many good resources available including smoking cessation classes in the community,   literature, and videos from a variety of health organizations.   It may be possible to arrange for someone from one of them to do regular presentations on the topic for your residents.

D. Recognize the symptoms of nicotine withdrawal  Physiological symptoms include decreased heart rate, increased blood pressure, and brain wave changes.   Those who quit smoking often experience impaired physical coordination and a decreased ability to concentrate. Severe cravings for tobacco, sleep disturbances, irritability, anxiety, and gastrointestinal disturbances also may occur.   So, they need a lot of support and encouragement as they work through all this.

F.   When to encourage residents to quit smokingA long-term residential program is a special supportive environment.   This makes it a great place to tackle nicotine addiction.   All evidence points to the fact that the best time to begin quitting smoking is early in their stay.  For some, trying to quit too soon can be stressful enough to cause relapse.  However, if the proper support is provided, it can begin as soon as the individual feels ready to try.

Organizations that Provide Resources for People Who Want to Quit Smoking


Local  chapters and affiliates of these groups as well local hospitals are a potential sources of free literature and other educational resources and can point you to smoking cessation classes in your area.


Most statistical information for this article was taken from Smoking or Health   – It’s Your Choice by   Cathy Becker Popescu and J. M. Carey, American Council on Science and Health, New York, NY 1992   (select the link to access the PDF version)


NOTE:   If you have found approaches that have been especially successful, we want to hear about them!   Please contact me.




May/June 1996

Issues of Personal Boundaries in Counseling – Part I

What do you mean when you say that program staff members should practice “professional distance”?

Sooner or later, every rescue mission worker will face the fact that they are not able to help everyone who becomes involved with their program.  Recovery programs can have a very high turnover rate among their residents.  Among rescue mission workers, some have reacted to this situation by becoming discouraged, “burned out,” or even skeptical about the chances of any homeless addict “making it.”

  1. Why Professional Distance is Needed – Often, when people first hear the term “professional distance”, they think it means counselors are too cold, unloving, and uninvolved with those we counsel.  Actually, it is just the opposite!  Over-involvement on an emotional level causes counselors to lose their objectivity.  They cannot exercise proper judgment in their dealings with those with whom they are seeking to help.  Instead, counselors can practice favoritism toward some residents and even end up feeling rejected by them when they don’t respond favorably to their attempts to help them.Mostly, a lack of professional distance is manifested when workers have an improper sense of responsibility for the actions and decisions of their clients.  And, it is important to remember that, since so many of those we work with at rescue missions have a background of addiction and codependency, they know how to make others feel guilty about not “taking care of them.”

    Mission workers must be committed to being part of the solution and not a part of the problem.  Their own unresolved issues will inevitably hinder their ability to minister effectively to others.

  2. Professional Distance is All About Boundaries – To be a successful counselor in a rescue mission setting, an individual needs good personal boundaries.  This means allowing residents to be responsible for their own decisions and actions – and allowing them to experience the consequences fully.  My job is not to fix you. My job is to share what I found out and you can either take it or leave it. Whatever you do with what I’m sharing with you is your choice. I’m not going to own any of that for myself.  It’s being able to leave residents and their problems at the mission when we go home at night.
  3. Professional Distance Means Knowing When to “Let Go” – In over twenty years of ministry to troubled people, I have found that there are basically just two reasons:
1. They are not ready for the help we have to offer
2. They have problems we are not equipped to handle

At times, people may have more problems than a mission’s facility and staff is equipped to handle.  This can be especially true when we encounter individuals with severe mental problems.  For them, the most loving direction is certainly a good referral to a place where the help they need can be found.  So, staff members need to know; a) what resources are available in-house, and b) resources are available to meet residents’ needs in the community outside of the rescue mission.

On the other hand, there are people who simply are not ready for what we have to offer.  With mission program participants this usually shows up in the form of resistance.  One manifestation of resistance is a refusal to abide by expectations and rules to which they initially agreed when they first entered your facility or program.  Using alcohol and/or drugs while in the program is another form of resistance.  Keeping such people around can be both bad for them and unfair to those who do have a sincere desire for a new life.

Certainly, troubled people need a lot of love and compassion.  Yet on the other hand, like Jesus, rescue mission staff members do need, at times, to confront people who are in sin and denial.  Truth is always uncomfortable to the hard-hearted.  People continue to abuse alcohol and drugs (and persist in dysfunctional behaviors) as long as they feel the benefits outweigh the costs.  While it can be extremely difficult to dismiss certain people from a program, we really are doing what is best for them.  For those in denial about their problems, consequences can be their salvation!  People only recover from addiction when they learn to take responsibility (with God’s help) for their own actions and lives.  We cannot do this for them!

Responsibilities of the Rescue Mission Counselor

1. Take the time to determine the real needs of program participants.
2. Help program participants to identify these needs for them.
3. Help program participants overcome denial if they have and alcohol or drug problem.
4. Identify resources in the community that meet needs for program participants that may not be addressed at the program (e. g. legal aid, medical services, vocational training, and self help groups)
5. Help program participants to accurately evaluate their options and to see progress – establish “benchmarks” for measuring growth
6. Help program participants to develop new personal and social resources that will contribute to a positive life style.
7. Help program participants access needed resources that have been identified for themselves.
8. Help program participants develop strategies for handling problems which must be addressed by the individual rather than agencies.  We succeed when we are no longer needed.  We ought never to institutionalize (“missionize”) people.
9. Model a healthy godly lifestyle.  Be an example in word and deed of the principles you hope the program participants to adopt.
10. Help the program participants to learn to walk with the Lord on his own; listening to his conscience, personal prayer and Bible study, etc.

For other resources by Michael Liimatta see:

He has also contributed to the Christian Recovery Library

What Keeps People in Recovery?

1-hannaAs I have mentioned in an earlier article, I am firmly convinced that we must help people in residential programs to be come integrated into two vital communities – the Church  and the recovery community. There  is life after the residential recovery pro ­gram and if we don’t spend enough time and energy preparing our clients for it, we have done them a great injustice.

If we are truly successful, the program graduate leaves the mission as a newly so ­ber, struggling baby Christian. We must be sure that this new be ­liever knows where to find help when he/she experiences struggles, even 2, 5, 10 years and more in the future, no matter where they live.

A. Building Healthy Relationships Outside of the Program – There is a lot going on at rescue missions in the areas of life skills, employment, literacy and education, etc. But, an often-neglected aspect of preparation for life after the program is helping our residents to develop and maintain healthy relationships. Get ­ting involved with the wrong people is a major contributor to re ­lapse.   Inadequate relationship skills are  a tremendous source of stress for newly recovering people with they try to live with others. The truth is, most addicts come from dysfunctional fami ­lies. They already struggle with codependency long before their first use of drugs or alcohol. Getting high. for many, provides a temporary release from their lack of self-confidence and toxic shame issues that handicap them in their relationships with others. Guess what? Just because they stop using alcohol and drugs, all of this doesn’t automatically go away. Sobriety gives them a chance to finally begin to work on these issues. If they don’t, their chances of success are greatly diminished.

B. Role of the Church – The Church certainly offers a lot to recovering people by pro ­viding both spiritual and social support. SRI Gallup’s 1992 survey of   recovery from homelessness concluded that spirituality (a growing relationship with Christ) was the number one factor that con ­tributed to the success of those they studied. They noted, “This spirituality seems to not only strengthen a person individually, it also seems to be the basis for commonality in building relationships with other people.” So, we must be intentional about connecting mission program participants to a solid, healthy relationship with the Body of Christ, which is often one of the most difficult challenges we face in mission programs.

The solution lies in identifying those fellowships in our com ­munity that are most “recovery friendly” and to cultivate relationships with them. This could involve personal visits with their leaders, luncheon meetings and tours at the mission, and training programs specifically geared toward helping both pastors and lay people to understand and support our people as they become in ­volved in their congregations.

C. Getting Connected with Other Christians in Recovery – There is still another extremely valuable resource out there that has yet to be fully understood and utilized – the Christian who is himself in recovery! There is a wonderful phenomenon afoot that has been loosely called the “Christian Recovery Movement”. It has been manifested by literally thousands of support groups springing up in churches around the globe where Christ is the “Higher Power.” These groups are to be found in practically any major city of North America, and in some overseas – Overcomers Outreach, Alcoholics for Christ, Alcoholics Victorious, etc. There are no better people to serve as a “bridge” between the mission and the Church than believers who are themselves over ­coming addiction. They can relate in a very special way to the struggles of mission clients, because they’ve been through many of them.

We must find these people by visiting support groups our ­selves, contacting large churches in our cities to see if they have such programs, and in some cases sponsoring such groups our ­selves.   Like churches, support groups vary significantly, one from an ­other. So, I encourage program personnel to never send people to groups we have not personally visited. And, it’s impor ­tant to meet with the leaders of these groups to get to know them personally and help them to become familiar with the mission and its recovery program.


From RESCUE Magazine, June 1997, journal of the Association of Gospel Rescue Misisons