The prevalence of smoking among clients in community drug abuse treatment programs is three to four times that of the general population1
and smoking-related diseases are a leading cause of death among individuals with substance abuse problems.2
Drug abuse treatment programs, however, typically do not target smoking due to the beliefs that cigarette smoking is a lower treatment priority, and that smoking cessation efforts could jeopardize drug and alcohol treatment, and that clients are not interested in quitting.3
Many individuals in treatment are interested in quitting smoking as a part of recovery.4
Learning to quit smoking may positively influence drug and alcohol problems by providing effective skills and techniques for cessation as well as a sense of mastery.5
Longer-term treatment clients, such as methadone maintenance patients who develop improved lifestyles due to less illicit opiate use, may be well suited for smoking cessation treatment.6
Patients in residential drug treatment may be motivated to quit smoking, and a stay in residential treatment may be a good time to quit.7
Kohn, Tsoh, & Weisner8
examined the impact of change in smoking behavior on 12-month drug treatment outcomes among HMO participants seeking drug treatment. They found that 13 % of the sample quit smoking and those who quit smoking or who were non-smokers had more days abstinent from alcohol and drugs compared to those who started, resumed, or continued smoking. This is consistent with Friend & Pagano9
who reported that Project Match participants who reduced tobacco use had better alcohol treatment outcomes. While a few studies have explored smoking in residential drug treatment settings,10
we found only one study that examined smoking specifically in a therapeutic community (TC) setting.11
McDonald et al.11
implemented a tobacco education and cessation program in an adolescent TC setting. They studied impacts of the program partly by examining smoking behavior and interest in quitting in a group of adolescents (n=55) at the time of admission and again at discharge from the program. At admission, 93% were current smokers, and 61% were interested in quitting smoking. At discharge, after exposure to the tobacco education program, 16% of smokers had quit smoking and 87% were interested in quitting.
While elevated smoking prevalence is reported for individuals enrolled in all types of drug treatment, the highest smoking prevalences (85−98%) have been reported in methadone maintenance.5, 12
Richter and Ahluwalia 13
speculated that, in this population, the stimulant properties of nicotine may be used to offset the sedating effects of methadone. Previous studies demonstrate that opioid use increases smoking behavior. 14
Haas et al. 15
examined smoking behaviors among 126 opioid using patients who presented for non-psychiatric medical services at San Francisco General Hospital but not enrolled in substance abuse treatment. They found that smoking prevalence was 92% at baseline and 2 patients reported quitting smoking at a one-year follow-up. Out of treatment opioid users are a high risk group for continued smoking. In a study of U.S. outpatient methadone clinics, only one in ten of the responding facilities offered patients a full set of recommended smoking cessation services.8
In a study of methadone maintenance in Baltimore, 92% were current smokers.5
Study participants reported an average of 2.6 (SD
=5.0) prior attempts at quitting, 21% reported prior use of either nicotine patches or nicotine gum, and only 5% had participated in a formal smoking cessation program. About 57% were interested in quitting, and 73% said that they planned to quit within 6 months.
This study examined smoking behavior, over 12 months, in 231 opioid-dependent clients entering TC treatment. We anticipated that opioid users entering a TC setting would have smoking prevalence similar to that reported for opioid users enrolled in methadone maintenance. We analyzed relationships between smoking measures and drug treatment outcome measures to investigate how smoking may relate to drug abuse treatment outcomes.