Importance of Combining Smoking Cessation with Substance Abuse Treatment
Why should tobacco cessation services be offered within substance abuse treatment?
The percentage of people receiving substance abuse treatment and who smoke is quite high, with reports ranging between 67% and 98%1, much higher than the U.S. general population rate of 17.8%2. People who smoke can expect to lose at least 10 years of their life due to smoking3. Clients receiving substance use treatment who smoke are much more likely to die from smoking- related diseases compared to complications from their current drug of choice4.
Given this significant relationship between substance use disorders and tobacco use, the US Department of Health and Human Services recommends combining treatments to address both addictions at the same time. However, the majority of substance abuse providers continue not to offer nicotine treatment among their substance abuse services5.
Would focusing on smoking cessation during the treatment of other substance use disorders possibly worsen the likelihood of people quitting their drug of choice?
Smoking cessation can actually improve substance abuse treatment outcomes. For example, as nicotine and alcohol can serve as a trigger for each other, addressing both at the same time can be increasingly effective. In one review of many clinical studies, smoking interventions provided during the time of addiction treatment led to a 25% increase in likelihood of abstinence from both alcohol and illicit drugs6. The benefits of reducing smoking during substance use 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 3 years later7.
But substance abuse 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., the majority of people who smoke and receive substance abuse treatment are knowledgeable about the harmful health effects, and are interested in quitting. Many studies support the willingness of smokers to receive treatment for cessation within their substance abuse treatment8,9. Other studies have found that the client discharge rate did not increase after smoking cessation efforts were implemented9.
What are some things substance abuse treatment sites should know if they are interested in starting smoking cessation services?
As part of the push to address nicotine dependence with 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 before smoking interventions are adopted. For example, substance abuse counselors who smoke themselves are less likely to address cigarette smoking with their patients or agree with its implementation. Successful programs in adopting smoking cessation services have often developed programs for treatment staff as well as clients.
Environmental barriers should also be examined. When designated smoking areas exist, they create a problem for both patients and counselors who might smoke together during treatment breaks. Overall, smoking cessation efforts are more easily implemented when treatment providers feel supported, and all staff buy-in to the importance of providing smoking cessation services to clients using tobacco.
I want to learn more. Where should I look?
• Treatment Provider Toolkit: Tobacco Treatment for Persons with Substance Use Disorders,
• SAMHSA Advisory Resource - Tobacco Use Cessation During Substance Abuse Treatment Counseling,
• Fact sheet for counselors and clients from NY OASAS, Know the Facts on Smoking and Substance Abuse, available at: https://www.oasas.ny.gov/publications/pdf/FactSheet.pdf
• For help with organizational implementation: Treating Tobacco Dependence Practice Manual: A Systems Change Approach, available at: http://www.aafp.org/dam/AAFP/documents/patient_care/tobacco/practice-manual.pdf
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.