Tobacco and Nicotine Addiction: A Treatment Opportunity for Psychiatrists

Introduction: The Problem

Sigmund Freud, the pioneer of psychoanalysis, and Bill Wilson, the co-founder of Alcoholics Anonymous (AA), made historic contributions to the field of behavioral health that have saved many lives. Sadly, their own lives ended in painful deaths as a result of their addiction to tobacco.

Freud believed that smoking cigars was essential to his creativity and productivity. His cigar use caused oral cancer for which he endured 33 surgical operations. When the pain became unbearable, Freud arranged with his physician, Max Schur, to give him a life-ending dose of morphine. For those interested in reading more about Freud’s complex and intense relationship with cigars, I recommend this blog post by the curator of the Freud Museum in London.

Wilson was a chain smoker and feared that stopping cigarette use would endanger his hard-earned recovery from alcoholism. In the influential AA “Big Book,” he wrote that continued cigarette smoking was “not a burning issue” for recovering alcoholics. As a result of his heavy tobacco use, however, Wilson developed severe chronic obstructive pulmonary disease that prevented him from using physical activity to moderate his depression. On his deathbed, he was so miserable from depression and difficulty breathing that he was asking his nurse for alcohol.

While the rate of tobacco use in the general population has fallen substantially, the reduction for people with behavioral health disorders has been much less. In the U.S., this group now accounts for approximately 40% of cigarette use and 50% of the 480,000 annual tobacco-related deaths. Tobacco-related illnesses are the most common cause of death for people in alcohol recovery and contribute to the lower life expectancy of people with schizophrenia. For those interested in a more detailed description of the problem, I recommend reading the 2020 Report of the U.S. Surgeon General on Tobacco.