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January 17, 2019

Tobacco treatment is not intended to be harm reduction. It is treatment

Some health officials are slamming the new smoking ban at city-funded inpatient addiction treatment programs. Here's the reality

Opinion Smoking Ban
01162019_no_smoking_sign_Flickr Eddie Welker/via Flickr Creative Commons

No smoking sign.

Some public health officials and social workers have ironically displayed an outcry against Philadelphia's new smoking ban at city-funded inpatient addiction treatment programs. Many say this move is a gross overstep and further limits the autonomy of the individual going into treatment. Some even suggest it will be more difficult to get those struggling with recovery into treatment and argue the new rule is out of touch with reality.

As a tobacco treatment specialist, a behavioral health professional, and a person in recovery, I will explain the reality.

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First, it is nothing less than hypocritical for a health professional to advocate against the ban. But many continue to do so, specifically during their exchanges with clients and patients where they lose leverage. Here, the ability to incentivize particular actions with instant gratification no longer exist. This does not help resolve the addiction problem in Philadelphia, nor does it truly or genuinely honor the autonomy of the individual. Smoking is a maladaptive coping skill for a traumatized population that already uses maladaptive coping skills.

Second, not treating tobacco use while concurrently treating other drugs does not help our patients' outcomes. As health professionals, we ought to focus on bringing the best quality of life to our patients. If a patient achieves sobriety and recovery to die of nicotine addiction a decade later, we failed as professionals.

Third, the ban by no means limits the autonomy of the individual. It is important to keep this initiative into perspective. The fact of the matter is, no one is saying that the patient cannot smoke. They are simply stating the patient cannot smoke at this particular place at this current time. That is an important difference, especially under a constitutional lens.

Lastly, some have suggested this new policy is coercive and forceful when it is anything but.

If the issue at hand were alcohol (another legal substance), and an alcohol ban were to be implemented in a place to treat those struggling with problematic opioid use, would there be an outcry? Would there be statements such as “they are not ready to stop drinking and it should not be a barrier for that person seeking to treat their problematic opioid use”? Of course not, the argument is about cigarettes and cigarettes kill more.


The reality is many people are afraid and just want to help, but enabling is not helping. No one is going to be kicked out from treatment due to smoking. People will be treated for their smoking with effective forms of therapy. The treatment setting is an ideal place to start this, the patient can be enrolled in nicotine replacement therapy (NRT), and be prescribed other drugs such as Chantix or Wellbutrin, and can even receive counseling for their nicotine use.

The reality is not treating tobacco use is nothing less than negligence from an entire field of professionals who claim to desire to help. It is no one single professional’s or agency’s fault. We as a city need to change the concept of recovering from “drugs and alcohol” to recovering from “alcohol, tobacco, and other drugs”. No protest was displayed when the City of Philadelphia’s Recovery Walk was deemed to be smoke-free. That was an event priming the entire initiative. Where was the outcry leading up to this?

Data from projects I have participated with and facilitated for have demonstrated very few patients consider leaving treatment. Through the use of medication-assisted therapies, we have effectively attenuated many of the unwanted symptoms of withdrawal from other substances. We are medically capable of replicating this with tobacco use.

I ask us, as professionals, to be guided by the facts despite nervous speculations. I ask us, as professionals, to fully embrace recovery in all forms and promote it ethically and responsibly. If the determining factor of someone entering treatment depends on a pack of Newport Menthol 100s, then we need to consider a new approach for the benefit of our clients. Let us truly respect the autonomy of our clients by not using a legal addiction as leverage or persuasion to enter treatment.

This ban is not a barrier, it is a step to enhance recovery through evidence-based best practices.

Jonathan J. Koehler, B.Sc., A.Ap.Sc. is an addiction professional and tobacco treatment specialist in Philadelphia.

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