Cigarette Smoking Is Associated With Increased Risk of Substance Use Disorder Relapse

Abstract

Objective Little is known about the relationship between cigarette smoking and long-term substance use disorder (SUD) outcomes. The current study examined the association between smoking and SUD relapse among adults with remitted SUDs. Method Analyses were conducted on respondents who completed Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions and met DSM-IV criteria for substance abuse and/or prior to but not during the year before the Wave 1 interview (n=5,515). Relationships between smoking status (Wave 2 smoking versus non-smoking among Wave 1 smokers; Wave 2 smoking versus non-smoking among Wave 1 non-smokers) and Wave 2 substance use and SUD relapse were examined using logistic regression analyses. Analyses were adjusted for demographics; psychiatric and alcohol use disorders; nicotine dependence; and SUD severity. Results In the fully adjusted models, among Wave 1 smokers, continued smoking at Wave 2 was associated with significantly greater odds of substance use (OR=1.56, 95% CI=1.10-2.20) and SUD relapse (OR=2.02, 95% CI=1.65-2.47) compared to Wave 2 non-smoking. In the fully adjusted model, among Wave 1 non-smokers, smoking at Wave 2 was associated with significantly greater odds of SUD relapse compared to Wave 2 non-smoking (OR=4.86, 95% CI=3.11-7.58). Conclusion Continued smoking for smokers and smoking initiation for non-smokers was associated with greater odds of SUD relapse. More research is needed to examine the timing of SUD relapse in relation to smoking behaviors. Incorporating smoking cessation and prevention efforts into substance abuse treatment may improve long-term substance use outcomes for adult smokers with SUDs.

A review of epidemiologic research on smoking behavior among persons with alcohol and illicit substance use disorders

“…Studies conducted in clinical treatment settings have found that smoking treatment or successful abstinence does not lead to worse treatment outcomes and may even improve abstinence from alcohol and other drugs 61–66 . Further, smoking by adults with past AUDs and SUDs has been associated with a greater likelihood of AUD or SUD relapse 67,68 .…”

Use of Smoking Cessation Methods Among Patients Receiving Office-based Buprenorphine Maintenance Treatment

“…These rates far exceed the population-wide prevalence of 15% (Jamal et al, 2016). In addition, research shows increased risk of relapse to substance use disorder and high tobacco-related mortality among smokers with substance use disorder (Hser et al, 1994; Hurt et al, 1996; Weinberger et al, 2017). …”

Missed opportunities to test the neuropsychiatric safety--and efficacy--of varenicline among smokers with substance use disorders

“…Two tobacco cessation intervention trials show an association between periods of tobacco abstinence and abstinence from alcohol (Cooney et al, 2015) or opioids and cocaine (Shoptaw et al, 2002). These findings are also seen in epidemiologic data: compared to non-smokers, smokers with SUD who are in recovery have an increased risk of relapse (Weinberger et al, 2017). …”

“…Over 75% of individuals in treatment for SUD smoke cigarettes (Guydish et al, 2011) and smokers with SUD face a disproportionate burden of tobacco-related disease and death (Aldridge et al, 2017; Apollonio, 2016; Hurt et al, 1996). Additionally, smokers with SUD who are in recovery have an increased risk of relapse, compared to non-smokers (Weinberger et al, 2017). Without identification and implementation of efficacious tobacco treatment interventions, smokers with SUD may enter treatment, achieve recovery, and remain at risk for relapse or death from tobacco-related causes.…”