Government and Regulations

Quitting Smoking During Substance Abuse Treatment


“Smoking tobacco causes more deaths among clients in substance abuse treatment than the alcohol or drug use that brings them to treatment,” according to the Substance Abuse and Mental Health Services Administration (SAMHSA). An 11-year study found that 51% of deaths in people in addictions treatment were tobacco related—a rate twice that found in the general population and nearly 1.5 times the rate of death by other addiction-related causes.

Substance abuse treatment programs often hesitate to incorporate smoking cessation therapies, fearing that patients will drop out entirely, says National Institute on Drug Abuse Director Dr. Nora D. Volkow. According to SAMHSA in a 2008 study, 63% of people who reported a substance use disorder also reported current tobacco use, compared with 28% of the general population.

So recent study findings from the National Institutes of Health bring good news: Helping smokers who are addicted to cocaine or methamphetamine to quit smoking won’t interfere with the substance abuse treatment.

Findings from the 10-week trial were published in the December 2013 issue of Journal of Clinical Psychiatry. In the study, 538 adults being treated for cocaine or methamphetamine dependence who were also interested in quitting smoking were assigned to treatment as usual or treatment as usual with smoking cessation treatment. If assigned to the concurrent treatment, participants received weekly individual smoking cessation counseling and extended release bupropion (300 mg/d) during weeks 1 to 10. During postquit treatment (weeks 4-10), participants in the concurrent arm also received a nicotine inhaler and contingency management for smoking abstinence.

The researchers found no significant treatment effects on stimulant-use outcomes or on attendance. Participants assigned to the concurrent treatments had significantly better outcomes for drug-free days at the 6-month follow-up (P < .05) and significantly better outcomes in remaining smoke free (P < .001).

“These findings,” said Theresa Winhusen, PhD, lead author on the study, “coupled with past research, should reassure clinicians that providing smoking-cessation treatment in conjunction with treatment for other substance use disorders will be beneficial to their patients.”

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