Mandatory Smoking Abstinence Improves Substance Treatment Outcomes

Cigarette use is quite common among people who have diagnosable problems with alcohol, drug or medication intake. Unfortunately, many people continue to smoke after entering substance treatment and continue to experience the potentially fatal health complications associated with cigarette intake. In a study published in December 2014 in The American Journal on Addictions, researchers from two U.S. institutions looked at the outcomes of smokers who are forced to quit as part of the terms of their substance treatment. These researchers concluded that mandatory smoking abstinence during treatment increases the likelihood that program graduates will maintain substance abstinence and avoid experiencing a relapse.

Smoking, Substance Problems and Substance Treatment

Roughly 18 percent of American adults are smokers, according to figures compiled by the federal Centers for Disease Control and Prevention. However, people affected by diagnosable substance problems are far more likely to use cigarettes. For example, estimates from another federal agency called the Substance Abuse and Mental Health Services Administration (SAMHSA) indicate that over 50 percent of Americans affected by alcohol abuse and/or alcoholism (known collectively as alcohol use disorder) smoke. Among people affected by drug abuse and/or drug addiction, the smoking rate rises even higher to almost 70 percent. In people dealing with diagnosable drug and alcohol issues, the smoking rate tops 70 percent. The highest smoking rate in substance users typically appears among people affected by dual diagnosis, a condition characterized the simultaneous presence of serious substance problems and separately defined mental illness. Figures compiled by SAMHSA indicate that roughly three-quarters of all people who undergo substance treatment in specialized programs are smokers. Cigarette use is so prevalent that, in the particular case of alcoholism, more people in treatment ultimately die from smoking-related complications than from alcohol-related complications. For a number of reasons, substance programs often don’t address cigarette use, despite the wide availability of proven options for addressing nicotine addiction.

Smoking Cessation

Most people who smoke want to quit, and current evidence indicates that this fact holds true for individuals enrolled in substance treatment. Widely verified methods of successful smoking cessation include the use of nicotine patches and other nicotine replacement products, the use of non-nicotine-based prescription medications that reduce the desire to smoke, the use of brief educational interventions that provide information and cessation advice to smokers, enrollment in smoking-oriented group or individual therapy and the use of behavior-oriented psychotherapy. Unfortunately, within or outside the context of substance treatment, most cigarette users do not take advantage of these proven options and instead try to quit smoking on their own.

Does Mandatory Abstinence Help?

In the study published The American Journal on Addictions, researchers from the University of Colorado and the Colorado Mental Health Institute at Pueblo used information obtained from 140 adults affected by dual diagnosis to help determine if mandatory smoking abstinence during substance treatment increases the likelihood of successful drug and/or alcohol abstinence after treatment. All of the adults were enrolled in a three-month inpatient substance program that required smoking abstinence and addressed smoking addiction at the same time as drug/alcohol addiction. After leaving treatment, each participant maintained monthly contact with the researchers for a year and self-reported his or her success in abstaining from drug or alcohol intake. When the study participants first entered treatment, 86 percent of them were habitual cigarette users. The researchers concluded that one year after undergoing a mandatory three-month period of smoking abstinence, the rate of habitual cigarette intake among the participants had fallen to 73 percent. Compared to those individuals who continued to avoid smoking, the individuals who returned to smoking had substantially higher rates of relapse back into active alcohol and/or drug consumption. Conversely, the participants who committed themselves to maintaining smoking abstinence had substantially higher chances of successfully avoiding a relapse and staying sober over the entire course of the yearlong follow-up. The study’s authors believe their findings demonstrate the willingness and ability of people with serious substance problems to avoid smoking during substance treatment. They also believe their findings demonstrate the impact that continued cigarette use has on the odds that any given person participating in substance treatment will ultimately relapse back into substance use. Finally, the study’s authors believe that their findings demonstrate that substance programs can successfully address smoking-related issues along with drug- and alcohol-related issues in their clients/patients.

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