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
1
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
2
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
3
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
4
#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Source
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
Sources
 General Service Office of Alcoholics Anonymous
 Narcotics Anonymous World Services
 Steven Schroeder, M.D. – Smoking Cessation Leadership Center, UCSFC
 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.
5
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
Worldwide
2,133,842 x 60% x 50% = 640,153 tobacco deaths
6
NA Tobacco Mortality
USA and Canada
140,000 x 60% x 50% = 42,000 tobacco deaths
Worldwide
280,0000 x 60% x 50% 84,000 tobacco deaths
7