Among patients in treatment programs for drug abuse and addiction (also known as substance use disorder, or SUD), as many as 97% also use tobacco 1. Although the health dangers of cigarette smoking are well known, most smokers who enter drug treatment are not offered resources to help them stop their tobacco use 1.
Because there are relatively few treatment programs that address smoking, the . Evidence also suggests that treatment can encourage non-smokers to start. One study of smoking and alcohol treatment found that in the first year after completing treatment, 15% of non-smokers had started using tobacco 3.
There are 3 main beliefs used to justify not combining anti-smoking efforts with drug and alcohol treatment. These are 2,4:
- Smokers in drug treatment are not able to successfully quit, so anti-smoking therapies are a waste of resources and effort.
- Smoking poses less of a danger to people in recovery than other drugs.
- Trying to quit smoking and other drugs at the same time will be too difficult and will hurt patients’ chances of successfully getting sober.
More recently, studies into the links between smoking and drug treatment have challenged these traditional views and suggest that there are many benefits to treating tobacco addiction along with SUD. As a result, anti-smoking services are being made increasingly available in more drug rehab centers 1.
Can Patients in Drug Treatment Quit Smoking Successfully?
Oftentimes, drug treatment facilities do not devote resources to services like anti-smoking therapy because there is a perception that 2. However, surveys have shown that:
- Up to 80% of smokers who enter treatment for addiction do want to quit using tobacco as well 4.
- The majority of patients in treatment believe it is better to quit within 6 months of stopping drugs rather than waiting until later 5.
Clearly, patients in drug abuse recovery are willing to quit smoking, but the science is more mixed when it comes to the success rates of those attempting to quit. A personal history of alcoholism seems to reduce the chances of successfully quitting tobacco 4, and other studies have shown anti-smoking therapies in drug rehabilitation facilities have success rates as low as 4.7% after 6 months 6.
In light of this evidence it appears that quitting smoking is at least possible for patients in drug treatment, and more importantly, there is a lot of interest among these individuals to try. This is important because even small numbers of successful quitters will produce large benefits in major health benefits to those who successfully quit 6.
Why Is Quitting Smoking Important?
In the past, the traditional view among rehabilitation professionals has been that smoking is less dangerous than drug addiction and, therefore, not a priority during drug treatment. However, the results from several studies paint a clear picture of the danger smoking presents to drug abusers:
- In a study in Minnesota, over 50% of deaths among patients in treatment for SUD were related to tobacco use, while only 33% were due to drugs or alcohol 6.
- A 24-year study of more than 400 people in treatment for opiate addiction found that the death rate among those who smoked was greater than 4 times higher than those who did not 6.
- Patients who struggle with alcoholism and who smoke score lower in measures of mental and physical health than alcoholics who do not smoke 7.
Given what we know today about the dangers of tobacco use, it is not surprising that smoking is responsible for many health problems found among drug abusers. What is surprising, perhaps, is the extent of harm that it causes in this drug abusing population. While it is often seen as low on the priority list, offering anti-smoking therapies to patients in recovery could save many lives.
Does Tobacco Cessation Help or Hurt Recovery?
Despite the evidence that quitting smoking would be beneficial to the health of patients with substance abuse issues, those benefits might not be worth it if trying to quit smoking somehow decreased their chances to recover from their drug addictions. Many addiction professionals believe that quitting smoking while simultaneously recovering from drug addiction would be exceedingly difficult for patients and might impede their overall recovery 8.
There is some evidence to support the idea that quitting smoking and drugs at the same time is too hard for some patients. A study in a women’s treatment center in Ohio reported that when the center switched to a tobacco-free program in 2003, significantly more patients left early without completing the 90-day program than before the change 9.
Indeed, there is a lot of evidence that there are biological connections between smoking and using other drugs, so the effort to include tobacco cessation in recovery may well be worth it.
However, despite this discouraging result, one of the study’s authors, Gretchen Hammond from the Ohio State University in Columbus, Ohio, maintained her support for anti-smoking policies at treatment facilities 8. “You behave very similarly with a cigarette as you would with any other drug,” she stated in an interview. “So, for example, if I’m having a bad day I’ll try to smoke it away versus talking to someone or going to therapy and working on the problem.”
The view that smoking can be as much of a problem for patients as their addictions to other substances has also been supported by research into tobacco use and success rates for recovery. Many of these studies have found that quitting smoking improves the chances of sustained sobriety for patients treated for addictions to alcohol and other drugs 2.
Researchers have proposed several reasons for this association such as the possibility that anti-smoking counseling reinforces therapies for other drugs 2. Another hypothesis is that eliminating dependence on nicotine can help patients by reducing addictive urges and cravings in general 10. Indeed, there is a lot of evidence that there are biological connections between smoking and using other drugs, so the effort to include tobacco cessation in recovery may well be worth it.
The Link Between Smoking and Drug Use
Many researchers have explored the connection between smoking and drug use, and the statistics show that there is a very strong correlation between these behaviors. The exact numbers vary among different surveys, but between 75% and 98% of people with SUD also use tobacco 9, compared to only 16.8% of US adults, in general 11.
Scientists point to several possible reasons for the strong association between smoking and drug use, including:
- Nicotine, alcohol, and drugs of abuse all stimulate overlapping pathways in the brain that are involved in addictive behaviors 12.
- Opioids like heroin and methadone are associated with increased rates of tobacco use 13.
- Nicotine use during adolescents causes changes in the brain that may make individuals more susceptible to drug addiction later in life 14.
All of the above point to the possibility that quitting tobacco and other drugs at the same time may be beneficial since these behaviors seem to be so intertwined with each other. Indeed, studies that specifically consider whether smoking affects the success or failure of drug treatment show that quitting tobacco can improve the chances of prolonged drug abstinence.
- Patients in drug treatment who are non-smokers or who voluntarily quit have more total days abstinent from drugs and alcohol one year later than those who never stopped smoking.
- 74% of smokers who quit during treatment remained abstinent from alcohol and drugs after 5 years, compared to 50% who did not quit smoking.
- Patients who quit smoking in their first year of recovery are more likely to be abstinent from alcohol than smokers (53% vs. 40%) and drugs (82% vs. 72%) after 9 years.
These statistics clearly demonstrate that stopping tobacco use is beneficial to the maintenance of long-term abstinence even though attempting to quit smoking during drug treatment may increase the difficulty of succeeding for some patients.
Substance Abuse Treatment
Tobacco dependence is often the only addiction not addressed by drug treatment programs; however, more facilities are currently adding anti-smoking therapies to the services they offer.
Quitting smoking offers several benefits to patients in drug treatment, but the most important ones are improved health and increased chances of a successful recovery.
If you are considering enrolling in a treatment program for drug or alcohol addiction and also smoke, you may want to consider smoking policies when choosing a facility. Call us today 1-888-744-0069 , and find a drug rehabilitation program that is right for you.
- 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. J Subst Abuse Treat, 53, 39-46. doi:10.1016/j.jsat.2014.12.007
- Knudsen, H. K. (2016). Implementation of smoking cessation treatment in substance use disorder treatment settings: a review. Am J Drug Alcohol Abuse, 1-11. doi:10.1080/00952990.2016.1183019
- Friend, K. B., & Pagano, M. E. (2004). Smoking initiation among nonsmokers during and following treatment for alcohol use disorders. J Subst Abuse Treat, 26(3), 219-224. doi:10.1016/S0740-5472(04)00003-0
- Gulliver, S. B., Kamholz, B. W., & Helstrom, A. W. (2006). Smoking cessation and alcohol abstinence: what do the data tell us? Alcohol Res Health, 29(3), 208-212.
- McClure, E. A., Acquavita, S. P., Dunn, K. E., Stoller, K. B., & Stitzer, M. L. (2014). Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities. J Subst Abuse Treat, 46(2), 194-201. doi:10.1016/j.jsat.2013.07.009
- Baca, C. T., & Yahne, C. E. (2009). Smoking cessation during substance abuse treatment: what you need to know. J Subst Abuse Treat, 36(2), 205-219. doi:10.1016/j.jsat.2008.06.003
- Patten, C. A., Schneekloth, T. D., Morse, R. M., Herrick, L. M., Offord, K. P., Wolter, T. D., . . . Hurt, R. D. (2001). Effect of current tobacco use and history of an alcohol problem on health status in hospitalized patients. Addict Behav, 26(1), 129-136.
- Jessica Orwig. (2011). No Smoking Policies May Present Challenges to Treatment Center[Press release].
- Hammond, G. C., & Gregoire, T. K. (2011). Breaking Ground in Treating Tobacco Dependence at a Women’s Treatment Center. Journal of Social Work Practice in the Addictions, 11, 1-16. doi:10.1080/1533256X.2011.544606
- Pletcher, V. C. (1993). Nicotine treatment at the Drug Dependency Program of the Minneapolis VA Medical Center. A program director’s perspective. J Subst Abuse Treat, 10(2), 139-145.
- Centers for Disease Control and Prevention. (2016). FastStats – Smoking.
- Kalivas, P. W., Lalumiere, R. T., Knackstedt, L., & Shen, H. (2009). Glutamate transmission in addiction. Neuropharmacology, 56 Suppl 1, 169-173. doi:10.1016/j.neuropharm.2008.07.011
- Mutschler, N. H., Stephen, B. J., Teoh, S. K., Mendelson, J. H., & Mello, N. K. (2002). An inpatient study of the effects of buprenorphine on cigarette smoking in men concurrently dependent on cocaine and opioids. Nicotine Tob Res, 4(2), 223-228. doi:10.1080/14622200210124012
- Lydon, D. M., Wilson, S. J., Child, A., & Geier, C. F. (2014). Adolescent brain maturation and smoking: what we know and where we’re headed. Neurosci Biobehav Rev, 45, 323-342. doi:10.1016/j.neubiorev.2014.07.003