Rehabs Permit Tobacco but Not Marijuana

Stephen Bitsoli — September 4, 2018

Man smoking; image by Kruscha, via Pixabay, CC0.

Alcohol and drug rehabs usually don’t allow the use of cannabis, whether smoked, vaped, eaten or applied topically. (One exception—there may be more—is a substance abuse clinic that uses marijuana as a sort of medication-assisted treatment.) That’s perhaps not surprising. The last thing an addict needs is anything addictive and harmful.

Alcohol and drug rehabs usually don’t allow the use of cannabis, whether smoked, vaped, eaten or applied topically. (One exception—there may be more—is a substance abuse clinic that uses marijuana as a sort of medication-assisted treatment.) That’s perhaps not surprising. The last thing an addict needs is anything addictive and harmful.

Except there is little evidence that marijuana is either addictive or harmful. It at least is not addictive physically by most accounts, and any harm it poses seems limited to use by the young (how young is in dispute), those with a genetic predisposition to mental illnesses such as schizophrenia, or (as with virtually any substance) to frequent, excessive users. Apart from these cases, there seems little need for rehab for weed.

Another indisputably harmful substance is frequently allowed at rehabs, however, despite being undeniably addictive and socially unacceptable: tobacco. A report released in May by the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) found that “only 35 percent of substance abuse treatment facilities in the 50 states, Washington, DC., and Puerto Rico reported having smoke-free campuses”.

That’s hard to understand when smoking was banned in all federal prisons in 2015, and 96% of hospitals adopted a no-smoking standard established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) a year after it was established in 1993. As of July 31, smoking also is banned in all public housing.

Not only does tobacco contain nicotine, a drug about as addictive as heroin (some say more addictive), but it also causes cancer and respiratory diseases. Studies also have found that using tobacco during rehab reduces the chances that the patients will get or stay sober. A study released in 2014 found that alcohol-dependent individuals who smoked recovered much more slowly than those who had never smoked, based on tests of their speed at mental tasks.

Yet despite high cigarette costs and ostracism from most public buildings, tobacco smokers persist in their habit. They are clearly addicts. Thirty-two percent of those who try a nicotine cigarette become dependent as opposed to 17 percent of those who try heroin and 9 percent of those who try marijuana.

By comparison, marijuana, though vilified by many in government and law enforcement—such as U.S. Attorney General Jeff Sessions—as a gateway drug and almost as bad as heroin, is benign. Although it is often smoked in cigarette form like tobacco, it doesn’t seem to have any of the carcinogenic side effects. Marijuana even may have cancer-inhibiting properties.

Medical marijuana cigarette and buds in a prescription container; image by Circe Denyer, via publicdomainpictures.net, CC0.

Marijuana’s medical uses are fairly well-documented, though perhaps not to scientific rigor. Its continued presence on Schedule I of the Controlled Substances Act (CSA)—which indicates that it has a high potential for abuse and no currently accepted safe medical use—is belied by those who depend on it to control pain, treat post-traumatic stress disorder, and prevent nausea and epileptic seizures.

Of course, tobacco is still legal, while marijuana is completely illegal at the federal level and in something like 20 states, too. Take away the states that permit medical use only, and the number jumps to about 40. So, unfair and illogical though it may be, it’s not completely unclear why most rehabs don’t permit marijuana use.

Why tobacco is allowed is less understandable, despite its legality. Alcohol also is legal but is not permitted. True, smokers do not usually become intoxicated from tobacco smoke, but its other health risks and potential for addiction are huge.

Last November the four largest cigarette makers in the U.S. began broadcasting—under court order—mea culpas about how smoking kills more people than drugs and alcohol and a litany of other causes combined, and that not only are cigarettes addictive but that they were designed to create and sustain addiction.

One Canadian recovery center, in explaining why it doesn’t ban smoking, acknowledged the hypocrisy in calling itself “abstinence-based”, but justified it by saying its “clients” might not comply, leading to worse problems, such as leaving the rehab property to sneak a smoke or failing at rehab because they believe—wrongly, “but try telling clients that”—that they can’t quit drugs or alcohol at the same time as nicotine.

The opposite may be true. Ac cording to David Sack, MD, “to effect lasting change and improve their health, recovering addicts are best served by applying new, healthy coping skills learned during treatment to all other issues as well, including addictive behaviors like smoking.”

A common but under-reported addiction problem is a dual diagnosis or co-occurring disorders. Often a patient has another mental illness in addition to addiction that may be related. One problem might even lead to the other, such as trying to self-medicate for a medical problem. If both problems aren’t treated at the same time, they may recur. The same seems to apply to multiple addictions.

That may not matter if the patient won’t do it. A 2011 study from the Journal of Social Work Practice in the Addictions found that while “quitting tobacco and hard drugs at the same time ups the odds patients will stay clean in the long run,” instituting a smoking ban resulted in only about half as many patients completing rehab. Even staff at these centers revolt at the idea of a smoking ban.

Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction. seems to think that treating the “problem drug” may be enough. Total abstinence is a moralistic idea, she says, that has hurt the addiction field. If there are no negative consequences of drug use, it should be no one else’s business.

The sad truth, according to addiction specialist Dr. Drew Pinsky, is that even when they’re being treated for heroin, “ultimately nicotine is what’s going to take their lives.”

Marijuana probably won’t cause lung cancer, though it may cause other respiratory problems including chronic bronchitis. There is evidence, too, that it can help ease addicts off of opioids and—by offering an alternative with low-risk of addiction—prevent addiction to painkilling prescription opioids in the first place.

Sure, more research would be preferable, but with the CSA and the federal government only allowing limited cannabis research—and only provided by the federal pot farm at Ole Miss—that is almost impossible. If the World Health Organization changes cannabis to a less restricted status, as is being considered, that may change. No further research is needed to determine nicotine and tobacco’s status.

Rehabs Permit Tobacco but Not Marijuana

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