Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study

Abstract

Introduction The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. Methods In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (Aim #1), specifically among those in the experimental treatment group (Aim #2), and the moderating effect of being a smoker on treatment outcomes (Aim #3). Results Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. Conclusions This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients.

A qualitative study of patients' knowledge and views of about oral health and acceptability of related intervention in an Australian inpatient alcohol and drug treatment facility

“…Moreover, tobacco smoking which is substantially higher among people dependent on drugs and alcohol than peers (McClure et al . ), increases the risks of periodontal disease (Dentino et al . ) and oral and oro‐pharyngeal cancer (Lubin et al .…”

“…Parafunctional habits (grinding and clenching of teeth) associated with substance use may accelerate tooth wear and lead to joint and muscle pain (McGrath & Chan 2005). Moreover, tobacco smoking which is substantially higher among people dependent on drugs and alcohol than peers (McClure et al 2014), increases the risks of periodontal disease (Dentino et al 2013) and oral and oro-pharyngeal cancer (Lubin et al 2011). Drug seeking and using behaviours may compromise nutrition and oral hygiene (Robinson et al 2005) adversely affecting oral and general health.…”

Examining the effects of illicit drug use on tobacco cessation outcomes in the Helping HAND 2 randomized controlled trial

“…Providing smoking cessation interventions during substance abuse treatment and recovery can increase smoking abstinence (Thurgood et al, 2016), but substance users generally have lower absolute tobacco quit rates than non-users (Breslau et al, 1996; Hays et al, 1999; Hughes, 1993; Humfleet et al, 1999; McClure et al, 2015; Richter et al, 2002; Lasser et al, 2000). …”

Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study

“…Australia 12%, UK 16%, US 14%, and Canada 13%), 1–4 smoking rates are often much higher among vulnerable segments of the population. Examples include people affected by alcohol and other drug dependence (77%–88%), 5–7 experiencing homelessness (75%–81%) 8–11 or living with a mental illness (29%–70%) 12–15 …”

“…Australia 12%, UK 16%, US 14%, and Canada 13%), [1][2][3][4] smoking rates are often much higher among vulnerable segments of the population. Examples include people affected by alcohol and other drug dependence (77%-88%), [5][6][7] experiencing homelessness (75%-81%) [8][9][10][11] or living with a mental illness (29%-70%). [12][13][14][15] In Australia, community service organisations (CSOs) are not-for-profit organisations that support vulnerable groups by providing services such as short-term accommodation, counselling, outpatient drug and alcohol withdrawal services, food provision and rehabilitation.…”