IMPLEMENTING TOBACCO CESSATION PROGRAMS IN SUBSTANCE USE DISORDER TREATMENT SETTINGS
A QUICK GUIDE FOR PROGRAM DIRECTORS AND CLINICIANS
Why Combine Smoking Cessation and Substance Use Disorder Treatment?
● Quitting smoking increases the odds of long-term recovery, whereas continued smoking following treatment increases the likelihood of relapse to substance use.
● Tobacco cessation can have mental health benefits.
● Quitting smoking at any age has physical health benefits that begin almost immediately and continue for years.
● Quitting smoking can increase clients’ sense of mastery, helping them focus on a positive lifestyle.
Do you work in a substance use disorder treatment setting, such as an opioid treatment program, a residential treatment program, or an outpatient treatment program?
Do you want to take action to reduce the use of tobacco products and resulting tobacco related diseases among your clients with substance use disorders (SUDs)?
If you answered yes to these two questions, this guide can help you implement a tobacco cessation program for clients. This objective will require staff time and resources, and it may require a culture shift within your agency.
However, it’s worth the investment because of the clear benefits that will accrue to your clients, their families, and your staff.
Overview of the Problem
● Cigarette smoking is very common among people with substance use problems. Past-month smoking was reported by 74 percent of people ages 12 and older who received SUD treatment in the past year—a rate approximately three times higher than that for people who did not receive treatment in the same period (Substance Abuse and Mental Health Services Administration [SAMHSA], 2011).
● The rate of tobacco-related deaths is substantially higher for people who have received SUD treatment services compared with the general population. An Oregon study based on data from publicly funded treatment services and state vital statistics records found that the tobacco-related death rate was 53.6 percent for people who received SUD treatment compared to 30.7 percent of the general population (Bandiera, Anteneh, Le, Delucchi, & Guydish, 2015).
● Less than half of all U.S. substance use disorder treatment facilities offer tobacco cessation services. In 2016, only about 47 percent of substance abuse treatment facilities in the United States provided cessation counseling. About 25 percent offered nicotine replacement therapy and/or other cessation medications for tobacco use. About one third of SUD treatment facilities had smoke-free policies inside and outside their facilities (SAMHSA, 2017).
Benefits of Tobacco Cessation
● Tobacco cessation interventions offered to clients in treatment or recovery for alcohol and other drug or substance use disorders can increase tobacco abstinence. A meta-analysis of 34 randomized controlled trials found that two forms of tobacco cessation interventions increased tobacco abstinence: pharmacotherapy alone and pharmacotherapy in combination with counseling (Apollonio, Philipps, & Bero, 2016).
● Tobacco cessation is associated with improved SUD treatment outcomes. A meta-analysis of 19 randomized controlled trials found that, for clients in current addiction treatment or recovery, smoking cessation interventions were associated with a 25 percent increased likelihood of abstinence from alcohol and illicit drugs at 6 to 12 months after treatment (Prochaska, Delucchi, & Hall, 2004).
A growing body of research suggests that quitting smoking increases the odds of long-term recovery, whereas continued smoking following treatment increases the likelihood of substance use relapse (Knudsen, Studts, & Studts, 2012; Weinberger, Platt, Esan, Galea, Ehrlich, & Goodwin, 2017). In a prospective study of 1,185 adults in SUD treatment, quitting smoking in the first year after intake predicted long-term recovery from substance use and remission status 9 years later. The correlation was independent of substance use status at 1 year or length of stay in treatment (Tsoh, Chi, Mertens, & Weisner, 2011).
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Behavioral Health Rehabilitative Specialist & Addiction Counselor