Importance of Combining Smoking Cessation with Substance Use Disorder Treatment
Why should tobacco cessation services be offered within substance use disorder treatment?
The percentage of people receiving treatment for substance use disorder that smoke cigarettes is quite high, with reports ranging between 67 - 98%,1 much higher than the 17.8 % of the general population in the U.S. who smoke.2 Research predicts that people who smoke will lose at least 10 years of their life due to smoking.3 who smoke and receive treatment for substance use disorders are more likely to die from Clientssmoking- related diseases than from complications of substance use.12
Given this significant relationship between substance use disorders and tobacco use, the US Department of Health and Human Services recommends a combination of treatments to address nicotine use concurrently with other problem drug use.10 However, most substance use disorder treatment providers do not offer nicotine treatment. 5
Would focusing on smoking cessation during the treatment of other substance use disorders possibly worsen the likelihood of people quitting substance use?
In a review of several clinical studies, smoking interventions provided during the time of addiction treatment led to a 25% increase in 10 Thus, addressing an alcohol user’s nicotine consumption at the same time can be effective in maintaining treatment goals and preventing relapse.11Offering smoking cessation services can improve treatment outcomes among clients in treatment for other substance use disorders. For example, as nicotine and alcohol are often paired by users, the use of one can serve as a trigger for the other.likelihood of abstinence from both alcohol and illicit drugs.6 The benefits of reducing smoking during substance use disorder treatment may also help recovery efforts for the long term. A recent study found that people with alcohol use disorders who quit smoking reduced their rate of relapsing on alcohol three years later.7
But substance use disorder clients may not want to quit smoking, or attend smoking cessation groups even if offered, right?
Like other people who smoke in the U.S., most people who smoke and receive treatment for substance use disorder are knowledgeable about the harmful health effects and are interested in quitting.10 Many studies support the willingness of smokers to receive treatment for cessation within their substance use disorder treatment setting.8,9 Studies also have found that client discharge rates did not increase after smoking cessation efforts were implemented.9
What are some things substance use disorder treatment sites should know if they are interested in starting smoking cessation services?
As part of a wider push to address nicotine use within substance use disorder patients, Medicare now offers smoking cessation counseling benefits that include two tobacco cessation attempts per year for enrolled patients.
Before implementation efforts are initiated, barriers should be addressed. For example, addictions counselors who smoke themselves are less likely to discuss smoking cessation with their clients .13 Programs that have successfully adopted smoking cessation services for clients, often have parallel cessation services for their staff. Overall, smoking cessation efforts are more easily implemented when treatment providers feel supported and when staff recognize the importance of providing smoking cessation services.
I want to learn more. Where should I look?
• Help with organizational implementation: Treating Tobacco Dependence Practice Manual: A Systems Change Approach
• Treatment Provider Toolkit: Tobacco Treatment for Persons with Substance Use Disorders
• SAMHSA advisory resources:
• SAMHSA fact sheet and links to additional resources: Tobacco and Behavioral Health: The Issue and Resources
• CDC info. on quitting tobacco and behavioral health outcomes: Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions
1. Guydish, J., Yu, J., Le, T., Pagano, A., & Delucchi, K. (2015). Predictors of Tobacco Use Among New York State Addiction Treatment Patients. American journal of public health, 105(1), e57-e64.
2. Jamal, A., Agaku, I. T., O’Connor, E., King, B. A., Kenemer, J. B., & Neff, L. (2014). Current cigarette smoking among adults—United States, 2005–2013.MMWR Morb Mortal Wkly Rep, 63(47), 1108-1112.
3. Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., ... & Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine,368(4), 341-350.
4. McClure, E. A., Campbell, A. N., Pavlicova, M., Hu, M., Winhusen, T., Vandrey, R. G., ... & Nunes, E. V. (2015). Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study. Journal of substance abuse treatment,53, 39-46.
5. Knudsen, H. K., Studts, J. L., Boyd, S., & Roman, P. M. (2010). Structural and cultural barriers to the adoption of smoking cessation services in addiction treatment organizations. Journal of Addictive Diseases, 29(3), 294-305.
6. Prochaska, J. J., Delucchi, K., & Hall, S. M. (2004). A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of consulting and clinical psychology, 72(6), 1144.
7. Weinberger, A. H., Platt, J., Jiang, B., & Goodwin, R. D. (2015). Cigarette Smoking and Risk of Alcohol Use Relapse Among Adults in Recovery from Alcohol Use Disorders. Alcoholism: Clinical and Experimental Research,39(10), 1989-1996.
8. Guydish, J., Ziedonis, D., Tajima, B., Seward, G., Passalacqua, E., Chan, M., ... & Brigham, G. (2012). Addressing Tobacco Through Organizational Change (ATTOC) in residential addiction treatment settings. Drug and alcohol dependence, 121(1), 30-37.
9. Williams, J. M., Foulds, J., Dwyer, M., Order-Connors, B., Springer, M., Gadde, P., & Ziedonis, D. M. (2005). The integration of tobacco dependence treatment and tobacco-free standards into residential addictions treatment in New Jersey. Journal of substance abuse treatment, 28(4), 331-340.
10.SAMHSA. (2020). Tobacco And Behavioral Health: The Issue And Resources. [PDF File] Retrieved from https://www.samhsa.gov/sites/default/files/topics/alcohol_tobacco_drugs/...
11. Maddux, J.-M., & Chaudhri, N. (2017). Nicotine-induced enhancement of Pavlovian alcohol-seeking behavior in rats. Psychopharmacology, 234(4), 727–738. https://doi-org.proxy-bc.researchport.umd.edu/10.1007/s00213-016-4508-2
12. Dios, M. A., Cano, M. Á., Childress, S., Vaughan, E., Cerna, Y., & Niaura, R. (2016). Smoking Status and Substance Use Treatment Outcomes Among Spanish Speakers Enrolled in Substance Abuse Treatment. Journal of Clinical Psychology, 72(10), 1037–1048. https://doi-org.proxy-bc.researchport.umd.edu/10.1002/jclp.22302
13. Parnell, A., Box, E., Biagioni, N., Bonevski, B., Anwar, M. J., Slevin, T., & Pettigrew, S. (2020). Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study. Australian & New Zealand Journal of Public Health, 44(2), 116–120. https://doi-org.proxy-bc.researchport.umd.edu/10.1111/1753-6405.12967