Cigarettes clearly come entangled with health problems. Increased rates of lung cancer, respiratory problems, and other health-related issues have been well-known since the 1960s. Recently, however, the problems have shown to affect more than just your immediate health.

According to Maya Belitova, an Associate Professor at the Queen Giovanna University Hospital in Sofia, Bulgaria, addictions to caffeine and cigarettes can severely alter your trip to the Intensive Care Unit (ICU). Once there, the lingering addictions can do anything from exacerbate your symptoms to misdiagnosis.

With cigarettes, the problems came from agitation. Those who were addicted (with numbers varying across geographic region) were more likely to report the feeling, and subsequently experience the consequences. And what were the consequences? Amazingly, the agitation was more likely to have them suffer from dislodged intravenous tubes.

Intravenous tubes are an instrumental part of recovery when in the ICU. When these get dislodged, clearly they can lead to other problems.

Patients with addictions to caffeine suffered a different suite of problems. Rather than suffer from agitation and dislodged intravenous tubes, they were more likely to suffer from drowsiness, nausea, vomiting, headaches, and delirium.

The problems associated with caffeine addiction in the ICU are categorically different than those suffering from cigarette addiction. Most troublingly, they are more likely to lead to a misdiagnosis.

When you’re suffering caffeine withdrawals in the ICU, the symptoms are often mistaken for other ailments. Those they most commonly resemble are meningitis, encephalitis, and hemorrhaging. Needless to say, if your doctors think you’re experiencing any of these in the ICU, you will be drawn into more drastic procedures.

The most typical outcome of these misdiagnoses is unneeded MRIs and X-rays. Since these imaging technologies are by no means cheap, the added scans can compound the amount of money needed to cover the visit. As Belitova says, these tests “can cause patient harm, cost a lot of money, and [be] a waste of time.”

To try and deal with these different — and often unnoticed — problems, some studies have tried to implement substitution therapies. The hope is that these would help to assuage the symptoms of the patients’ addictions such that they wouldn’t yield the same problems. Substitution therapies, however, don’t always work.

For nicotine, substitution therapy has been shown to sometimes compound any delirium that the patient might be experiencing. When in the ICU, this can be severely detrimental. As her study found, the results could be as drastic as increasing the likelihood of dying.

For caffeine addiction, substitution therapy is a bit less dire and hasn’t shown as many negative downsides. Still, the evidence for the efficacy of either type of treatment has not been well established, so more studies would have to be done in order to say with certainty that they can help.

It’s also important to note where the problems might be most severe. In the United States, for instance, there are fewer people addicted to cigarettes than in Europe. Because of this, strategies for approaching these problems might be more advantageously implemented elsewhere.

While there is a prescience to rid those induced into ICU care of any extra problems they might encounter, we need to be careful with the way in which we do that. Clearly, the problem is not as simple as substitution therapy, for that has its own problems. More research must be done to help those in need. Hopefully this research is in the wings.