Addiction patients and untreated alcoholics and addicts – all of whom are more likely to be smokers - are dying at four times the rate of the general population, according to the federal Centers for Disease Control and Prevention. The sad truth is that addicts who also have a nicotine-dependence disorder lose between 10 and 20 years of their expected life span.

While the general public is smoking at a rate of 18-32 percent in the United States, between 80 and 90 percent of individuals presenting for addiction treatment are smoking. It's likely that the same is true for those in recovery from alcoholism and other drug dependence.

Unfortunately, virtually none of the counselors and other staff at addiction-treatment programs are trained in nicotine-dependence treatment. We have not included nicotine dependence treatment in our programs, even though they are designed specifically to develop abstinence-based treatment outcomes and long-term recovery. 

Today's addiction-treatment programs came into existence in the 1970s. At the time, nicotine dependence was not seen as an addiction comparable to alcoholism or addiction to the other drugs of abuse that emerged in the 1960s.

In fact, smoking was the norm in 12-step meetings and treatment programs, and casual observers could be excused for thinking that the way to get clean and sober was to smoke, drink lots of coffee, and scarf down candy when cravings hit. 

In other words, a strange positive relationship with tobacco became a part of treatment and recovery. An enduring irony is that both founders of Alcoholics Anonymous and the founder of Narcotics Anonymous died from tobacco-related diseases, not their other addictions.

We know better about tobacco now, but there has not been a natural and collaborative relationship between addiction treatment and those involved in tobacco prevention and control.

Only recently has a new wisdom begun to take shape. A growing number of addiction practitioners now understand that a nicotine-dependence component must be added to addiction treatment. For example, NAADAC, the national organization representing 11,000 addiction counselors, now supports the inclusion of tobacco and nicotine dependence in addiction-treatment programs.

Tobacco-control experts use evidence-based practices to treat nicotine dependence in the general population. Addiction treatment providers have learned how to develop abstinence-based treatment plans for those dependent on alcohol and other drugs.

It makes sense in the interest of improved public health that the tobacco and addiction treatment communities become active partners in the struggle to address and treat alcoholism and other drug dependence.

The inclusion of tobacco/nicotine interventions in addiction treatment began in New Jersey, which passed pioneering legislation to integrate nicotine-dependence treatment into residential addiction programs and requires six hours of nicotine-dependence education as a requirement for addiction counselor certification.

New York has launched a program integrating nicotine dependence into all levels of addiction treatment, and similar work is being done in Maine, Massachusetts, and Ohio. In Wisconsin, where I work, grant money was recently awarded to develop a plan for integrating nicotine treatment into our addiction and mental-health programs.

Ethically and morally, the addiction-treatment field cannot ignore the pressing need for nicotine-dependence treatment, which will unquestionably save the lives of the people we serve. 

We cannot tolerate the fact that we successfully help patients to get clean and sober from alcohol and other drugs, only to watch them die horribly from the drug we didn't treat, nicotine. 

Now that we know better, it is time to do better.

David "Mac" Macmaster, CADCIII, is an addiction counselor at the St. Clare Center in Baraboo, Wis., and a member of the Sauk County Tobacco Free Coalition.