Aa and na members Dying from Tobacco

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AA and NA Members Dying from Tobacco

By David Macmaster, CSAC, PTTS

It is projected 724,153 members of Alcoholics Anonymous and Narcotics Anonymous will die from tobacco 499,410 of them in the USA and Canada. 1
Attempts at encouraging these highly successful addiction recovery societies to address tobacco as an inside issue have been unsuccessful.

Both societies have traditions that discourage them from dealing with what they describe as “outside issues.” 2 Their traditions state that AA and NA have no opinion on outside issues; hence their names ought never be drawn into public controversy. 3

It appears these societies are blind to the challenge of death by tobacco. One explanation is that as many as 60% of them are addicted to nicotine while in recovery from other addictions. 4 They do not consider nicotine addiction to be an issue as important as recovery from the other addictions they joined AA and NA to recover from. 5

Mortality projections are from a review of 12 Step program membership estimates. 6 They are based on a formula for projecting the number of deaths from tobacco used by the Centers for Disease Prevention and Control and tobacco/nicotine dependence researchers. 7

Causes of death by tobacco include cardio-vascular diseases, lung, throat and other cancers, chronic obstructive pulmonary diseases/emphysema and bronchitis. 8
Tobacco kills 440,000 Americans every year. The largest single population block dying from tobacco are those suffering from substance dependence and mental health disorders as well as nicotine dependence. The death toll in these 2 high-risk populations is 44% of the total USA mortalities or 200,000 victims of their nicotine addiction and the harmful health consequences from smoking and using smokeless tobacco. 9
New York State reports they discovered 92% of all those admitted for substance use disorders in their state’s licensed addiction treatment programs were nicotine dependent as well as having the substance dependence disorders they were being treated for. By comparison the rate of smoking in the general population was below 20%. 10
Similar rates of nicotine dependence in patients admitted for addiction treatment were reported in Wisconsin and other states at from 80 – 90% indicating those with substance dependence may be as much as 4 times the risk of dying from tobacco as those in the general population. It has been reported these tobacco deaths result in the loss of up to 25 years of expected life spans. 11
This data suggests that even those with addiction/substance dependence disorders that received treatment or achieved alcohol and drug abstinence but continue to smoke and use smokeless tobacco are at high risk to get sick and die from tobacco caused and related diseases. Estimates of continued tobacco use of those in 12 Step program recovery and others in the “recovery community” suggest it may be 60% still using tobacco and are nicotine dependent. 12
They got clean and sober but are getting sick and dying from the addiction that was neither treated nor is part of their recovery program. What is the result of not addressing their nicotine dependence? Despite being “in recovery” they are dying at 3 times the rate of tobacco death in the general public.
There are estimated to be 1,384,699 members of Alcoholics Anonymous (AA) in the USA and Canada. AA is the largest of the 12 Step Programs. There are 2,133,842 AA members worldwide according to a January 2012 published report on the AA website. 13
The second largest 12 Step program in North American and worldwide is Narcotics Anonymous (NA.) Their published report for 2010-2011 indicates there are 27,883 NA groups and meetings in the USA and Canada; 53,039 worldwide. 14
Conservative NA membership estimates suggest there may be 20,000 NA groups in the U.S and Canada and 40,000 worldwide. An unknown number of these groups may hold more than one meeting a week.
Calculating a membership range of 5-10 members/group appears to be a conservative membership estimate. Taking 7 members/group for NA as an average, the US and Canada NA membership is estimated at 140,000 and worldwide 280,000 members
Neither NA nor AA keeps membership records so membership estimates are based on the number of registered groups and meetings and estimated attendance.
Two research studies that contain information on tobacco use in 12 Step Programs and those studied after treatment for addiction, report continued smoking and tobacco use after treatment and entry into recovery.
Dr. Peter R. Martin, director of the Vanderbilt Addiction Center asked 289 AA members about cigarette consumption. 56.9% smoked and of these 60% considered themselves to be “highly dependent on cigarettes.” The report is published in the October issue of Alcoholism: Clinical and Experimental Research. 15
In a longitudinal study of 575 adult smokers who completed intensive residential treatment for alcohol problems in the Midwest in 1995, 92 % were still daily smokers 12 months after discharge from treatment (Bobo 1997.)
Alcoholics Anonymous was founded in 1935 and began its membership growth from 100 in 1939 to millions in the 21st century. Narcotics Anonymous began in 1953 with most members located in New York and California. NA is now worldwide and growing as its membership is open to those with any addiction. AA has a singleness of purpose focusing on alcohol dependence.
It is unknown and will never be known how many AA and NA members died from tobacco since these two important societies began their healing recovery missions. It is not unreasonable to assume the death toll from tobacco is in the hundreds of thousands if not millions.
We can predict the death toll of those in these fellowships that will die from smoking and using smokeless tobacco with the science we now have available. Three quarters of a million AA and NA members worldwide that are alive now will die from tobacco in the years ahead. Half a million of those that will die from cigarettes and smokeless tobacco live in the USA and Canada.
The founders of AA, NA and their early members did not know the true threat of tobacco and its nicotine addiction. That is no longer true and has not been true for some time. AA and NA are two of our most effective programs supporting long-term recovery from substance dependence disorders. It is time for them to move from their historic tobacco cultures to tobacco-free cultures.
Both AA and NA have traditions that permit their programs to change when an issue is placed for consideration by a “group conscience” and approved by their general/world conferences.
The challenge is for AA and NA to apply wise “group conscience” to understand the death of hundreds of thousands of their members from tobacco is unacceptable. Tobacco and its nicotine dependence is an “inside issue” for these societies and not an outside issue to be avoided if the deaths of hundreds of thousands of their members are to be prevented.

Citations and Sources




WINTIP Mortality Study, 2012


Correspondence Records, Smoking Cessation Leadership Center


AA and NA Traditions


Vanderbilt Addiction Center Study


NA opinion on outside issues, email correspondence


WINTIP Mortality Study, 2012


Centers for Disease Prevention and Control Publications


Centers for Disease Prevention and Control Publications


Smoking Cessation Leadership Center Prevalence Presentation


New York State Smoking Prevalence in the General Population, 2011


St. Clare Center Nicotine Prevalence Study, 2002; Smoking Cessation Leadership Center Mortality Study, National Tobacco Conference on Tobacco or Health, 2010


Vanderbilt Addictions Center Study


Alcoholics Anonymous, January 2012


Narcotics Anonymous, 2011


Dr. Peter Martin, Vanderbilt Center Study


  • General Service Office of Alcoholics Anonymous

  • Narcotics Anonymous World Services

  • Steven Schroeder, M.D. – Smoking Cessation Leadership Center, UC- SFC

  • Coffee and Cigarette Consumption and Perceived Effects in Recovering Alcoholics Participating in Alcoholics Anonymous in Nashville, Tennessee

  • Michael S. Reich, Mary S. Dietrich, Alistair James Reid Finlayson, Edward F. Fischer, and Peter R. Martin

  • Socio-cultural Influences on Smoking and Drinking

  • Janet Kay Bobo, PhD and Corinne Husten, M.D.

Reviewed by:

  • Steven Schroeder, M.D., Director-Smoking Cessation Leadership Center/UC-SFC

  • Michael Miller, M.D. Past President American Society of Addiction Medicine (ASAM) and Medical Director, Rogers Memorial Hospital/Herrington Center, Oconomowoc, Wisconsin

  • Eric Heiligenstein, M.D., Medical Director Wisconsin Nicotine Dependence Integration Project (WINTIP) and Clinical Director, psychiatry, University Health Services, University of Wisconsin, Madison

  • Steven Kipnis, M.D., Medical Director Office of Alcoholism and Substance Abuse Services (OASAS) New York State

  • William White, Author Slaying the Dragon and Senior Research Consultant at Chestnut Health Systems

  • Anne Miner, PhD, University of Wisconsin School of Business, Madison

  • James Wrich CEO & Co-Founder, Solidarity Work Life Solutions, EAP and addiction leader

  • Norman Hoffman, PhD Treatment Outcomes Researcher

  • Tony Klein, New York State tobacco integration pioneer and trainer

The formula for calculating tobacco death projections is (Estimated membership/population x percent using tobacco x 50% mortality rate = tobacco deaths.)
AA Tobacco Mortality
USA and Canada
1,384,699 x 60% x 50% = 415,410 tobacco deaths
2,133,842 x 60% x 50% = 640,153 tobacco deaths
NA Tobacco Mortality
USA and Canada
140,000 x 60% x 50% = 42,000 tobacco deaths
280,0000 x 60% x 50% 84,000 tobacco deaths

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