You’ve done it. You’ve made the commitment to getting clean, and now you are ready to start a healthier, happier, and sober life, a life free of dependency. Does that commitment mean that it’s time to get rid of all the crutches in your life right now? Does a life that is truly free of dependency mean that you must renounce all the chemical substances that for years have helped you get through the day? Does it mean throwing away that last carton of cigarettes or even giving up your morning coffee?
It’s not uncommon for people in early recovery to abstain from nicotine and caffeine as well as illicit drugs and alcohol. Indeed, an increasing number of addiction treatment programs require that patients do so as a precondition of their enrollment in treatment (1, 7). But should they?
This article examines the issue of nicotine and caffeine abstinence for those in early recovery. It also explores the reasons why giving up these substances while you’re also learning to live a life free of drugs and alcohol may not be the best idea after all.
Arguments in Favor of a Fully “Clean” Rehab
It’s not difficult to understand why there is so much interest in nicotine and caffeine cessation for patients entering drug or alcohol treatment (2, 3, 4, 5, 6). Addiction recovery, after all, is all about cultivating physical, mental, emotional, and spiritual wellness. You can’t be truly healthy, the reasoning goes, if you need a drug–any drug–to keep you happy and help you function.
Getting clean, according to this logic, means breaking free of every dependency and giving your body only what it needs to keep healthy and strong. Caffeine and smoking cessation, then, are often linked to a holistic model of addiction recovery in which drug and alcohol detoxification and abstinence are just one prong of a sober lifestyle, a lifestyle that also encompasses nutrition, sleep, physical activity, and social, psychological, and spiritual wellness (7, 8). It is for these reasons, perhaps, that so many patients in early recovery exhibit significant interest in joining a smoking cessation program concurrent with the treatment of their primary substance dependency (4, 5, 7, 8).
There is, indeed, some evidence to support the benefits of quitting smoking and abstaining from caffeine when you’re going through the detox process and navigating the early days of your sobriety. Both caffeine and nicotine are proven stimulants and can increase anxiety, irritability, tremors, and sleeplessness in heavy users (10, 11, 12). Because these are symptoms that are also often associated with the withdrawal from alcohol and certain drugs, such as opioids and cannabis, abstaining from caffeine may decrease the symptoms of drug detox.
Of course, there’s also the issue of dependency. To be sure, smoking, dipping snuff, and pounding coffee and Red Bull often do not inflict the immediate physical, social, and emotional harms that are associated with illicit drug use or binge drinking. However, that in no way means that these substances are harmless or non-addictive. Indeed, both caffeine and nicotine exhibit similar processes of dependency as do other addictive drugs, though typically with less virulent outcomes.
Heavy caffeine consumers, for instance, will often develop a tolerance for the substance, meaning that they will need to consume ever higher amounts to get the same “boost” a single cup of coffee or one energy drink once gave them (12).
Similarly, nicotine dependency often functions very much like drug and alcohol dependency. The desire to abstain is often overwhelmed by physical cravings and the profound discomforts of withdrawal. Nicotine users frequently relapse, despite their recognition that the drug is causing them physical harm and may well shorten their lives. Even in the face of serious medical conditions, such as cancer, emphysema, cardiovascular disease, or chronic obstructive pulmonary disease (COPD), persons who are nicotine-dependent often struggle to quit, even when they know their addiction is likely killing them (13, 14). In this way, they very much resemble the illicit drug user who fears that each hit will be their last or the alcoholic who wonders if they will survive their next binge.
It’s little wonder, then, that a wholly “clean” rehab would make sense to many. The reality, though, is that the issue is not nearly so cut and dry.
The Flip Side: Why Getting Clean Takes Time
Eliminating caffeine, nicotine, and other drugs of dependence when you’re entering treatment for a substance use disorder (SUD) has logic to it. After all, if you don’t eliminate every crutch from your life, aren’t you risking trading one addiction for another?
Unfortunately, there is significant evidence that the integration of abstinence programs that address dependencies beyond those of drugs and alcohol often meets with limited success. For instance, in a study of the sustainment of smoking cessation programs in in-patient drug and alcohol dependency treatment centers, Knudsen et al. (2013) found that nearly 40% of programs were discontinued within two years of the initial study (9).
While Knudsen et al. take these findings as a sign that better protocols are needed to support these programs over the long term, the results also may well support the views of those who oppose the concurrent treatment of primary and secondary dependencies. In other words, these findings could indicate that attempting to kick every dependency at once could decrease your chances of abstaining from any.
The risks of attempting a nicotine or caffeine cessation protocol are especially significant for those in early recovery. For instance, Heckman et al. (2018) found that high levels of cessation fatigue are strongly correlated with relapse among smokers within the first six weeks of cessation (15). The researchers found that the greater their “emotional exhaustion,” the less likely they were to meet the seven days abstinence milestone.
Importantly, the Heckman et al. study centered on a cohort of subjects who were involved in smoking cessation only. There is no evidence that the subjects were experiencing comorbidities, such as alcohol or drug dependency, or psychiatric disorders, such as depression and anxiety. And still, the researchers found that their levels of emotional exhaustion increased over time.
If cessation fatigue were such an issue among those seeking to abstain only from nicotine, how much more amplified will the emotional impacts be when you’re also trying to withdraw from “harder” substances, such as drugs and alcohol?
In addition, there is ample evidence to indicate the frequent co-existence of SUD and mood disorders, ranging from depression to generalized anxiety to post-traumatic stress disorder (PTSD) (16, 17). That means that when you are withdrawing from the substance that you once relied on to self-medicate in the presence of your psychological symptoms, those symptoms are bound to recur, requiring you to confront them while you develop healthy new coping skills. By suddenly eliminating caffeine or nicotine as well, you are practically inviting the exacerbation of these mental and emotional symptoms, making them more difficult to address in the critical early days of recovery (18, 19). For example, there is ample evidence that nicotine and caffeine withdrawal in dependent persons leads to significant sleep disturbances (18, 19). But, when you are in the early phases of drug or alcohol recovery, poor quality sleep dramatically increases your risk of relapse (20, 21).
There are other risks associated with the attempt to go “cold turkey,” tackling secondary dependencies while addressing the primary addiction. As has already been shown, relapse rates can be very high among those with nicotine or caffeine dependence. Smokers often must attempt to give up their tobacco many times before they actually succeed. Each relapse takes a toll not only on your body but also on your mind and spirit. When you try to abstain but fail, you lose a little bit of self-confidence, at least for a while (22).
It’s this loss of self-confidence, no matter how brief it may be, that is so dangerous for those in the early stages of drug or alcohol treatment. You’re never more vulnerable than when you are learning to live without drugs and alcohol. The physical toll of detox combined with the mental and emotional impacts of repudiating what was once your primary coping mechanism will, inevitably, leave you raw. You need every ounce of motivation, strength, and self-belief you can muster if you are going to power through. Indeed, motivation and self-efficacy are among the most important determinants of your long-term success in addiction recovery (23, 24). If you take on too much too soon, you risk setting yourself up for failure.
How Bayshore Can Help
At Bayshore, we understand that everyone’s journey to sobriety is unique. We recognize that there is no one-size-fits-all strategy for addiction recovery. Because of this, we take pride in collaborating with our clients to define the personalized treatment plan that is right for them. As such, we do not impose nicotine or caffeine abstinence policies on our residents, preferring instead to respect our clients’ right to make their own choices on their own terms in regard to the use of “soft” substances such as these.
Our caring team of multidisciplinary mental and physical healthcare providers, addiction specialists, nutritionists, and life coaches are uniquely qualified to provide education, support, and medical and psychiatric care. We offer assistance, advice, and expertise in helping clients define their own health and lifestyle goals, using our vast experience and robust training to help smooth the path to sobriety that our clients determine is best for them and the people they love. Contact Bayshore today to discuss how we can help you on your road to recovery.