Walk into almost any Alcoholics Anonymous meeting or drug and alcohol rehabilitation program and clouds of cigarette smoke are likely to engulf you, if not in the rooms then at the outside doorways.

The irony is not lost on Elizabeth B. Stuyt, M.D., who specializes in addiction psychiatry. Like many others in the field, Stuyt long has wondered: Can people really be said to be in recovery from drug and alcohol abuse if they continue to use tobacco addictively?

She believes not. Which means that anyone entering the Circle Program must check their butts at the door, along with any alcohol and illicit drugs. The program is a 90-day inpatient treatment regimen Stuyt runs as the Colorado Mental Health Institute in Pueblo for adults with serious mental illness and chemical dependency.

The two-year old program, though unusual in its location at a state psychiatric hospital, builds on an approach that slowly has been gaining ground. The movement to treat nicotine dependence at the same time as other chemical dependencies began about a decade ago.

It was largely pioneered by two men: Terry A. Rustin, M.D., assistant professor of the University of Texas Health Science Center in Houston, who took a 23-bed addiction treatment program tobacco-free in 1991; and Richard Hurt, M.D., director of the Mayo Clinic's Nicotine Dependence Center, which now has a program for simultaneously treating nicotine and chemical dependency.

While grassroots efforts are underway in several states, New Jersey regulators have been the most active. Residential health-care facilities in the state that provide substance abuse treatment must be tobacco-free and must screen, assess, treat and conduct discharge planning in connection with tobacco as well as any other drugs and alcohol as a condition of licensure.

Both the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) have recognized the value of addressing tobacco dependency as a treatment issue.

Nonetheless, the addiction field largely has resisted the move toward treating chemical and nicotine addictions at the same time. The traditional view has held that addressing the nicotine addiction might endanger the chances of recovery from illicit drugs or alcohol. And, the argument goes, asking addicts to refrain from tobacco use is just too much at a time when other major live changes are occurring.

But by permitting the use of tobacco in treatment, "you're still allowing people to mood-alter," said Bernice Order-Conners, LCSW, special populations coordinator with the Tobacco Dependence Program in New Brunswick, N.J. "The behaviors associated with tobacco are all the same behaviors associated with drug and alcohol use."

Opposition also comes from the counselors, many of whom smoke and are themselves recovering from alcohol or drug abuse. Some interpret the movement as an indictment of their own recovery -- or at the very least, of their desire to smoke during the workday.

But Connors sees it instead as an opportunity for a change in practive based on new research, which is starting to underscore the benefits of abstaining from nicotine at the same time as other drugs or alcohol.

Studies published since 1993 by Stuyt, Hurt, Rustin and others suggest that recovery rates for alcoholism and drug addiction improve among successful tobacco quitters.

Stuyt writes in a study published in the 1997 American Journal on Addictions, Vol. 6, No. 2, that tobacco users who quit the use of nicotine as well as their drug of choice maintain longer periods of sobriety after inpatient treatment than those who continue to use tobacco on a daily basis. The difference between the two groups is even more significant when the main drug of choice has sedative qualities, as in alcohol or opiates.

The results lead to the speculation that "the long-term concomitant use of a sedative and a stimulant (such as nicotine) may set up a balance in the brain such that when one is stopped but not the other, a 'craving' emerges to reestablish the balance, putting the patient at risk for relapse," Stuyt writes.

"It seems that the alcohol-dependent patient who abstains from alcohol but continues to smoke may have entered a vicious cycle." The nicotine receptors need to be occupied by enough nicotine to desensitize them or stabilized by the addition of alcohol, Stuyt writes, adding, "with this in mind it seems highly possible that it is actually nicotine withdrawal that functions as a relapse factor by alcohol, promoting the urge to drink."

Proponents of tobacco-free recovery, of course, also cite the health risks of smoking. More than 80 percent of alcoholics and drug addicts smoke cigarettes, compared with 25 percent of the non-addicted population.

"Tobacco-related diseases are the leading cause of death in patients previously treated for alcoholism and/or other non-nicotine drug dependence," Hurt wrote in 1996.