A Systematic Review of Smoking Cessation Interventions for Adults in Substance Abuse Treatment or Recovery

Abstract

Introduction:The aim was to evaluate the effectiveness of smoking cessation interventions for patients with substance use disorders. The secondary aim was to evaluate impact on substance use treatment outcomes.Methods:Randomized controlled trials involving adult smokers, recently or currently receiving inpatient or outpatient treatment for substance use disorders were reviewed. Databases, grey literature, reference lists, and journals were searched for relevant studies between 1990 and August 2014. Two authors extracted data and assessed quality. The primary outcome was biochemically verified continuous abstinence from smoking at 6 or 12 months, secondary outcomes were biochemically verified 7-day point prevalence smoking abstinence (PPA) at 6 or 12 months and substance use outcomes. Heterogeneity between studies precluded pooled analyses of the data.Results:Seventeen of 847 publications were included. Five studies reported significant effects on smoking cessation: (1) nicotine patches improved continuous abstinence at 6 months; (2) nicotine gum improved continuous abstinence at 12 months; (3) counseling, contingency management and relapse prevention improved continuous abstinence at 6 and 12 months; (4) cognitive behavioral therapy, plus nicotine replacement therapy (NRT), improved PPA at 6 months; and (5) a combination of bupropion, NRT, counseling and contingency management improved PPA at 6 months. Two studies showed some evidence of improved substance use outcomes with the remaining eight studies measuring substance use outcomes showing no difference.Conclusions:NRT, behavioral support, and combination approaches appear to increase smoking abstinence in those treated for substance use disorders. Higher quality studies are required to strengthen the evidence base.

Treating smokers in substance treatment with contingent vouchers, nicotine replacement and brief advice adapted for sobriety settings

“…While CV resulted in significantly fewer cigarettes per day and percent days smoking across the follow-up period, the effects were small, averaging 9 versus 11 cigarettes per day and 84% versus 90% of days smoking for CV versus NV, respectively, effects not likely to be clinically meaningful. This is consistent with other studies of smokers with SUD where improved smoking abstinence within treatment did not result in significant differences in smoking abstinence at 6 or 12 months (reviewed by Thurgood, McNeill, Clark-Carter, & Brose, 2015). The small long-term effects of CV versus NV when combined with BA are consistent with our previous study where CV combined with BA resulted in significantly less pointprevalence abstinence over 12 months than CV combined with MI , suggesting that long-term abstinence rates in the current study may have been higher if MI had been used for counseling.…”

A review of interventions for smoking cessation

“…Clear evidence exists to support the effectiveness of NRT in smokers who do or do not use other psychoactive substances (16)(17)(18). The latest Cochrane review (2012) concludes that NRT in all available forms, skin patch, gum, nasal spray, inhaler, lozenge and sublingual tablet, increase the success rate of highly dependent (ten to 15 cigarettes or more per day) smokers who are motivated (16).…”

“…Two systematic reviews, one of them a Cochrane review (2016), found that NRT is effective in those who have undergone or are undergoing management of alcohol or other drug use disorder as either in-or outpatients, without having any negative effect on recovery from other drug or alcohol use disorders (17,18).…”

“…The meta-analysis showed that individual counselling was effective in helping people to quit (30). It has been shown, at least among people with smoking and other substance use, intensive CBT per se may not be more effective than other interventions, especially combinations (18). Another Cochrane review found that hypnotherapy is not effective as a smoking cessation intervention (31).…”

Smoking behavior among third year dental students in Latin American countries: prevalence, perceptions, and risk factors

“…20,21 For instance, the US Department of Public Health has developed two intervention models: the 5 As (Ask about tobacco use, Advise to quit, Assess willingness to make a quit attempt, Assist in the quitting attempt, and Arrange follow-ups) and the AAR (Ask, Advise, and Refer). 22 Both have been proven to provide positive results when used by dental practitioners to help their patients quit tobacco use.…”