Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment

Mannelli, Paolo; Wu, Li‐Tzy; Peindl, Kathleen; Gorelick, David A.

doi:10.1093/ntr/ntt046

Cited by 35 publications

(36 citation statements)

References 66 publications

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“…This difference was not present among baseline smokers. This result is consistent with the literature suggesting better drug abstinence outcomes (or proxies of outcomes) in non-smokers or former smokers (Haney et al, 2013; Mannelli et al, 2013; Peters et al, 2012; Winhusen et al, 2014), but demonstrates this relationship in a large, geographically diverse outpatient SUD (non-opioid) adult population. This relationship appears to be robust, and it may be possible that reducing smoking early in the SUD treatment may serve to improve treatment response.…”

Section: Discussionsupporting

confidence: 91%

“…Among users of both tobacco and cannabis, a recent review showed poorer cannabis cessation outcomes compared to cannabis only users (Peters, Budney, & Carroll, 2012), and a human laboratory-based study showed that co-users of tobacco and cannabis were more likely to relapse (to cannabis) compared to non-smoking cannabis users (Haney et al, 2013). Smoking during opioid detoxification was shown to increase opioid craving (Mannelli, Wu, Peindl, & Gorelick, 2013). It has also been found that cocaine-dependent patients who stopped smoking in response to smoking cessation treatment provided concurrently with SUD treatment had improved cocaine-use outcomes relative to those who continued to smoke (Winhusen, Kropp, Theobald, & Lewis, 2014).…”

Section: Introductionmentioning

confidence: 99%

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

McClure

Campbell

Pavlicová

et al. 2015

Journal of Substance Abuse Treatment

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

McClure

Campbell

Pavlicová

et al. 2015

Journal of Substance Abuse Treatment

View full text Add to dashboard Cite

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“…Our finding that the majority of people who ceased opioids (60% in AAs and 66% in EAs) also ceased cocaine is consistent with evidence of high rates of co-occurrence of OUD and cocaine use disorder (CUD) (39,40), which supports the development of treatment strategies to target both disorders (39,41), and suggests that ceasing one substance might influence, or reflect, the ability to cease the other. Our findings are also consistent with observations that failure to address tobacco use lowers the efficacy of opioid cessation treatment (42) and that a behavioral intervention in patients with antisocial personality disorder reduces substance use (43). Unlike problems that are associated with other drug use, which predicts lower odds of opioid cessation, we found having cannabis use related problems predicts higher odds of opioid cessation (i.e had two marijuana symptoms lasting a month; marijuana interferes with work).…”

Section: Discussionsupporting

confidence: 89%

Factors associated with opioid cessation: a machine learning approach

Cox

Sherva

Lunetta

et al. 2019

Preprint

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Background and Aims People with opioid use disorder (OUD) can stop using opioids on their own, with help from groups and with treatment, but there is limited research on the factors that influence opioid cessation. Methods We employed multiple machine learning prediction algorithms (LASSO, random forest, deep neural network, and support vector machine) to assess factors associated with ceasing opioid use in a sample comprised of African Americans (AAs) and European Americans (EAs) who met DSM-5 criteria for mild to severe OUD. Values for several thousand demographic, alcohol and other drug use, general health, and behavioral variables, as well as diagnoses for other psychiatric disorders, were obtained for each participant from a detailed semi-structured interview. Results Support vector machine models performed marginally better on average than those derived using other machine learning methods with maximum prediction accuracies of 75.4% in AAs and 79.4% in EAs. Subsequent stepwise regression analyses that considered the 83 most highly ranked variables across all methods and models identified less recent cocaine use (p<5×10 -8 ), a shorter duration of opioid use (p<5×10 -6 ), and older age (p<5×10 -9 ) as the strongest independent predictors of opioid cessation. Factors related to drug use comprised about half of the significant independent predictors, with other predictors related to non-drug use behaviors, psychiatric disorders, overall health, and demographics. Conclusions These proof-ofconcept findings provide information that can help develop strategies for improving OUD management and the methods we applied provide a framework for personalizing OUD treatment.

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“…Smoking is associated with more severe SUD symptoms (Mannelli, Wu, Peindl, & Gorelick, 2013), worse SUD treatment outcomes (Frosch, Shoptaw, Nahom, & Jarvik, 2000; Peters, Budney, & Carroll, 2012), and increased mortality among those with SUDs. Of particular concern, smoking may be a stronger contributor to mortality in this population than other substance use (Hurt et al, 1996; Lanier, Johnson, Rolfs, Friedrichs, & Grey, 2012).…”

Section: Introductionmentioning

confidence: 99%

Perceived barriers to smoking cessation among adults with substance use disorders

McHugh

Votaw

Fulciniti

et al. 2017

Journal of Substance Abuse Treatment

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The majority of adults seeking substance use disorder treatment also smoke. Smoking is associated with greater substance use disorder severity, poorer treatment outcome, and increased mortality among those with substance use disorders. Yet, engaging this population in smoking cessation treatment is a significant challenge. The aim of this study was to examine perceived barriers to smoking cessation among treatment-seeking adults with alcohol or opioid use disorder. Additionally, we examined whether anxiety sensitivity--a known risk factor for barriers to smoking cessation in the general population--was associated with more barriers to smoking cessation in this sample. A sample of 208 adults was recruited for a one-time study and completed self-report measures of anxiety sensitivity and perceived barriers to smoking cessation. Results indicated that the most common barriers were anxiety (82% of the sample), tension/irritability (76%), and concerns about the ability to maintain sobriety from their primary substance of abuse (64%). Those who reported more barriers also reported lower confidence in the ability to change their smoking behavior. Higher anxiety sensitivity was associated with more perceived barriers to smoking cessation, even when controlling for nicotine dependence severity. These results suggest that there are several perceived barriers to smoking cessation among treatment-seeking adults with substance use disorders. In addition to psychoeducational interventions aimed to modify negative beliefs about smoking cessation, anxiety sensitivity may be a promising therapeutic target in this population.

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Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment

Abstract: The relevance of tobacco use in opioid addiction (OA) has generated a demand for available and more effective interventions. Thus, further analysis of less explored nicotine-opioid clinical interactions is warranted.

Cited by 35 publications

References 66 publications

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

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

Factors associated with opioid cessation: a machine learning approach

Perceived barriers to smoking cessation among adults with substance use disorders

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