Why alcohol and drug treatment workers smoke cigarettes

A grounded theory approach was used to explore the reasons why staff who work in alcohol and drug treatment services smoke cigarettes. Eleven in-depth interviews were conducted with staff in Victoria across a variety of service types and roles. Data gathered from the interviews were analysed and grouped into categories. From analysis of the interviews it appeared that cigarette smoking is given legitimacy in the alcohol and drug treatment field that reinforces its place in these services. Legitimacy was evident in three main ways - Permission, a Therapeutic Tool and Rewards. Permission to smoke was communicated by means which included the opportunity to smoke at work, the provision of smoking areas, the absence of no-smoking rules and policies, and an acceptance of smoking. Smoking was seen as a therapeutic tool that enhanced the treatment provided to clients. Some smokers saw cigarettes as a tool to convey empathy, develop rapport, promote a feeling of engagement and manage difficult clients. Smokers also received some rewards to reinforce their behaviour. There was a benefit of feeling an increased acceptance by other staff, increased socialising, work breaks, a reduction in perceived stress levels and the opportunity to readily satisfy cravings for nicotine that reinforced the smoking behaviour. Punishments, or negative rewards, for smoking were also described. These included being recipients of harassment or pressure from non-smoking staff and concerns about the impact of smoking on their health. These three categories of permission, therapeutic tool and rewards contribute to the legitimacy of smoking in this field and support the continued presence of this behaviour