I am delighted that the addiction treatment profession in New York (and hopefully elsewhere) will be integrating nicotine dependence treatment into their programs. In the past, smoking often was not addressed in treatment because of disputes over the risks and consequences of using tobacco products and resistance to treating another addiction. Today, there is no defensible reason for excluding nicotine dependence from addiction treatment.

In Wisconsin, we have one program that is completely integrated: the St. Joseph's Hospital program in Marshfield. Since 2002, this program has been a tobacco and nicotine free facility. It offers nicotine education and abstinent recovery believing that nicotine dependence is even more of a risk for addicted patients than alcohol and other drugs.

Richard Hurt, M.D., director of the Mayo Clinic's nicotine dependence treatment program, revealed in his recent research that tobacco-related diseases took the lives of more patients treated for chemical dependence than alcohol or all the other drugs combined. Those with alcohol and other drug disorders are smoking, getting sick, and dying at more than four times the rate of the general public who smoke.  This means that those untreated or unable to quit tobacco are losing from 10 to 20 years of their expected life span.

Some researchers estimate that 43 percent of all cigarettes are bought by people with substance-abuse and mental-health disorders. This result is an annual death toll of approximately 420,000 people from tobacco in the USA alone. It is really shocking to realize that as many as 200,000 alcoholics, other addicts, and those with mental-health disorders are dying unnecessarily every year from tobacco.

How can we ethically continue to treat alcohol and other drugs while we ignore the most lethal of them all, tobacco? Is it because we don't care enough? No, I believe it is because we haven't known how to treat nicotine addiction, and have not been asked to do it.

The addiction and mental health fields are only now beginning to step up to the plate and taking on this lethal addiction. New Jersey and New York are the leaders nationally in this work. More of us are planning to do the same. The addiction field cannot continue to look the other way and maintain its hard-won credibility.

Some are concerned that asking people to quit smoking or smokeless tobacco during treatment is a negative aspect of the new initiative in New York. That is a legitimate concern that can and will be addressed. For one thing, treatment programs are not demanding that patients quit smoking for life, only while they are in treatment.

We can't ensure that those we treat for alcohol or any of the other drugs will quit for life -- or any amount of time for that matter. We are simply asking that patients be tobacco-free while they are in treatment just as we expect them to be alcohol-free and drug-free during treatment. Patients will be supplied with medication and nicotine-replacement products while they are going through treatment. They will receive education, support and resources for staying tobacco-free, just as they as they receive the knowledge and skills they need to recover from alcohol and other drugs.

Yes, many will not be able to do this easily -- any more than it is easy to quit other drugs and alcohol. The point is that those of us in the addiction field are trained and expected to provide the means for quitting and getting patients into recovery. To ignore the drug that kills more of our patients than all the rest combined can no longer be tolerated. It is up to the addiction field to integrate nicotine into our programs as a drug of equal concern.

This will require a culture change in the addiction and mental health treatment fields. Now that there are evidence-based treatment practices for nicotine dependence, we can learn how to integrate this knowledge into our established and successful addiction practices. St. Joseph's Hospital is showing that when we wisely and fairly provide patients with the education and skills for quitting tobacco, patients respond accordingly and become willing to listen and begin the recovery process.

Our fears and resistance can no longer be justified. Bless the pioneers in New York and New Jersey who are leading the way. Let's not be deterred by the challenges ahead. Our patients deserve and need us to expand our treatment to include nicotine dependence services and tobacco free facilities. 

The addiction field has learned that we can treat alcohol and other drugs in the same programs. In 1972 who would have believed that? We learned how to treat prescription drug misuse and dependence. We are learning how to treat meth and the designer drugs coming into the market. We can master the skills for treating nicotine dependence as our programs embrace the changes necessary to expand our services.

Let us not be deterred by the challenges. Let's find out how to do it well and start doing it.

David "Mac" Macmaster, CSAC, CTTS, works at the St. Clare Center in Baraboo, Wisconsin.