Abstract
The prevalence of nicotine dependence among alcohol or other substance abusers is extremely high, and surveys have revealed that many patients in drug or alcohol treatment programs are interested in smoking cessation. However, smoking cessation has not been a traditional focus in clinical interventions for this population. Recent evidence from clinical trials among individuals abusing alcohol, marijuana, cocaine, or opioids have shown the following: 1) smokers with a past but not current history of alcohol dependence have a similar rate of success compared with non-alcoholic smokers; 2) tobacco abstinence does not increase alcohol relapse; 3) continued smoking adversely affects treatment for marijuana dependence; 4) patterns of cocaine and nicotine use are interrelated; 5) smoking cessation rates among opioid-dependent individuals are several times lower than in the general US population. Smoking cessation is indicated for substance dependent persons already in recovery and may protect against relapse to the illicit drug of abuse.
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References and Recommended Reading
Sees KL, Clark HW: When to begin smoking cessation in substance abusers. J Subst Abuse Treat 1993, 10:189–195.
Bobo JK, McIlvain HE, Lando HA, et al.: Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial. Addiction 1998, 93:877–887.
Shoptaw S, Jarvik ME, Ling W, Rawson RA: Contingency management for tobacco smoking in methadone-maintained opiate addicts. Addict Behav 1996, 21:409–412.
Frosch DL, Shoptaw S, Nahom D, Jarvik ME: Associations between tobacco smoking and illicit drug use among methadone-maintained opiate-dependent individuals. Exp Clin Psychopharmacol 2000, 8:97–103. authors examined methadone maintained individuals according to smoking status: tobacco chippers (less than five cigarettes per day), heavy smokers (20 or more cigarettes per day), and non-smokers. They found that 1) average daily dose of cigarette chippers and non-smokers combined was less than that of heavy smokers, and 2) for illicit opiates, as well as for cocaine, a stepwise reduction in percentage of new users is seen for heavy smokers to chippers to nonusers. These findings recommend that smoking cessation be offered to all methadone-maintained individuals.
Joseph AM: Effect of treatment for nicotine dependence on alcohol and drug treatment outcomes. Addict Behav 1993, 18:635–644.
Cigarette smoking among adults. MMWR Morb Mortal Wkly Rep 2002, 51:642–645.
Budney AJ, Higgins ST, Hughes JR, Bickel WK: Nicotine and caffeine use in cocaine-dependent individuals. J Subst Abuse 1993, 5:117–130.
Darke S, Hall W: Levels and correlates of polydrug use among heroin users and regular amphetamine users. Drug Alcohol Depend 1995, 39:231–235.
Degenhardt L, Hall W: The relationship between tobacco use, substance-use disorders and mental health: results from the National Survey of Mental Health and Well-being. Nicotine Tobacco Res 2001, 3:225–234.
Burling TA, Ramsey TG, Seidner AL, Kondo CS: Issues related to smoking treatment for substance abusers. J Subst Abuse 1997, 9:27–40.
Hurt RD, Offord KP, Croghan IT, et al.: Mortality following inpatient addictions treatment: role of tobacco use in a community-based cohort. JAMA 1996, 275:1097–1103.
Burling TA, Burling AS, Latini D: A Controlled smoking cessation trial for substance-dependent inpatients. J Consult Clin Psychol 2001, 69:295–304.
Breslau N, Kilbey M, Andreski P: Nicotine dependence, major depression, and anxiety in young adults. Arch Gen Psychiatry 1991, 48:1069–1074.
Covey LS, Glassman AH, Stetner F, Becker J: Effect of history of alcoholism of major depression on smoking cessation. Am J Psychiatry 1993, 150:1546–1547.
Daeppen J-B, Smith TL, Danko GP, et al.: Clinical correlates of cigarette smoking and nicotine dependence in alcoholdependent men and women. Alcohol Alcohol 2000, 35:171–175.
Dawson DA: Drinking as a risk factor for sustained smoking. Drug Alcohol Depend 2000, 59:235–249.
Glassman AH, Helzer JE, Covey LS, et al.: Smoking, smoking cessation, and major depression. JAMA 1990, 264:1546–1549.
Bobo JK, Lando HA, Walker RD, McIlvain HE: Predictors of tobacco quit attempts among recovering alcoholics. J Subst Abuse 1996, 8:431–443.
Ellingstad TP, Sobell LC, Sobell MB, et al.: Alcohol abusers who want to quit smoking: implications for clinical treatment. Drug Alcohol Depend 1999, 54:259–265.
Irving LM, Seidner AL, Burling TA, et al.: Drug and alcohol abuse inpatients’ attitudes about smoking cessation. J Subst Abuse 1994, 6:267–278.
Martin JE, Calfas KJ, Patten C, et al.: Prospective evaluation of three smoking interventions in 205 recovering alcoholics: one-year results of Project SCRAP-Tobacco. J Cons Clin Psychol 1997, 65:190–194.
Hurt RD, Dale LC, Offord KP, et al.: Nicotine patch therapy for smoking cessation in recovering alcoholics. Addiction 1995, 90:1541–1546.
Marks JL, Hill EM, Pomerleau CS, et al.: Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers. J Subst Abuse Treat 1997, 14:521–527.
Breslau N: Are smokers with alcohol disorders less likely to quit? Am J Public Health 1996, 86:985–990.
Hayford KE, Patten CA, Rummans TA, et al.: Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 1999, 174:173–178.
Humfleet G, Munoz R, Sees K, et al.: History of alcohol or drug problems, current use of alcohol of marijuana, and success in quitting smoking. Addict Behav 1999, 24:149–154. researchers found that among cigarette smokers participating in a clinical trial for smoking cessation, any alcohol use during treatment predicted failure to quit smoking. Because even low to moderate levels of alcohol use during smoking cessation interventions increase the likelihood of treatment failure, treatment providers may wish to recommend no alcohol use during treatment.
Hays JT, Schroeder DR, Offord KP, et al.: Response to nicotine dependence treatment in smokers with current and past alcohol problems. Ann Behav Med 1999, 21:244–250.
Novy P, Hughes JR, Callas P: A comparison of recovering alcoholic and non-alcoholic smokers. Drug Alcohol Depend 2001, 65:17–23.
Patten CA, Martin JE, Calfas KJ, Lento J: Behavioral treatment for smokers with a history of alcoholism: predictors of successful outcome. J Consult Cin Psychol 2001, 69:796–801. this study, cigarette smokers with a past history of alcoholism were randomized to one of three 12-step programs: standard treatment (ST), behavioral counseling plus exercise (BEX), or behavioral counseling plus nicotine gum (BNIC). Among those with a 12-step sponsor, the standard treatment was more effective than behavioral counseling augmented with either exercise or nicotine gum. However, both BEX and BNC were more effective than ST for those without a 12-step sponsor. Thus, for cigarette smokers with a history of alcoholism, having a 12-step sponsor may modify treatment outcome for those participating in behavioral counseling for smoking cessation.
Patten CA, Martin JE, Myers MG, et al.: Effectiveness of cognitive-behavioral therapy for smokers with histories of alcohol dependence and depression. J Stud Alcohol 1998, 59:327–335.
Kalman D, Hayes K, Colby SM, et al.: Concurrent versus delayed smoking cessation treatment for persons in early alcohol recovery: a pilot study. J Subst Abuse Treat 2001, 20:233–238.
Willis N, West R: Cannabis use as a predictor of smoking cessation. Poster presented at the Third Annual Meeting of the Society for Research on Nicotine and Tobacco; Nashville, TN. June 14, 1997;
Farrelly MC, Bray JW, Zarkin GA, Wendling BW: The joint demand for cigarettes and marijuana: evidence from the National Household Surveys on Drug Abuse. J Health Economics 2001, 20:51–68.
Newcomb MD, Maddahian E, Bentler PM: Risk factors for drug use among adolescents: concurrent and longitudinal analyses. Am J Public Health 1986, 76:525–531.
Lynskey MT, Fergusson DM, Horwood LJ: The origins of the correlations between tobacco, alcohol, and cannabis use during adolescence. J Child Psychol Psychiatry 1998, 39:995–1005.
Kendler KS, Prescott CA: Cannabis use, abuse, and dependence in a population-based sample of female twins. Am J Psychiatry 1998, 155:1016–1022.
Kendler K, Neale M, Sullivan P, et al.: A population-based twin study in women of smoking initiation and nicotine dependence. Psychiatr Med 1999, 29:299–308.
Moore BA, Budney AJ: Tobacco smoking in marijuanadependent outpatients. J Subst Abuse 2001, 13:583–596.
Gourlay SG, Forbes A, Marriner T, et al.: Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation. BMJ 1994, 309:842–846.
Willis NJM, West RJ: Cannabis use as a predictor of smoking cessation. Paper presented at the Third Annual Meeting of the Society for Research on Nicotine and Tobacco; Nashville, TN, Nashville, TN. June 14, 1997;
Henningfield JE, Clayton R, Pollin W: Cigarette smoking and subjective response: effects of D-amphetamine. Clin Pharmacol Ther 1981, 30:497–505.
Low RB, Jones M, Carte B, Cadoret RJ: The effects of D-amphetamine and ephedrine on smoking attitude and behavior. Addict Behav 1984, 9:335–345.
Nemeth-Coslett R, Henningfield J, Katz J, Goldberg S: Effect of cocaine on rate of cigarette smoking. Pharmacol Biochem Behav 1986, 25:300.
Roll JM, Higgins ST, Budney AJ, et al.: A comparison of cocaine-dependent cigarette smokers and non-smokers on demographic, drug use, and other characteristics. Drug Alcohol Depend 1996, 40:195–201.
Wiseman EJ, McMillan DE: Relationship of cessation of cocaine use to cigarette smoking in cocaine-dependent outpatients. Am J Drug Alcohol Abuse 1998, 24:617–625.
Burling TA, Salvio MA, Seidner AL, Ramsey TG: Cigarette smoking in alcohol and cocaine abusers. J Subst Abuse 1996, 8:445–452.
Moliterno DJ, Willard JE, Lange RA, et al.: Coronary-artery vasoconstriction induced by cocaine, cigarette smoking, or both. N Engl J Med 1994, 330:454–459.
Minor RL, Scott BD, Brown DD, Winniford MD: Cocaineinduced myocardial infarction in patients with normal coronary arteries. Ann Intern Med 1991, 115:797–806.
Clarke JG, Stein MD, McGarry KA, Gogineni A: Interest in smoking cessation among injection drug users. Am J Addict 2001, 10:159–166.
Kreek MJ: Methadone-related opioid agonist pharmacotherapy for heroin addiction: history, recent molecular and neurochemical research and future in mainstream medicine. Ann N Y Acad Sci 2000, 909:186–216.
Berger H, Schweigler M: Smoking characteristics of methadone patients. JAMA 1972, 222:705.
Best D, Lehmann P, Gossop M, et al.: Eating too little, smoking and drinking too much: wider lifestyle problems among methadone maintenance patients. Addict Res 1998, 6:489–498.
Clemmy P, Nrooner R, Chutuape MA, et al.: Smoking habits and attitudes in a methadone maintenance treatment population. Drug Alcohol Depend 1997, 44:123–132.
Stark MJ, Campbell BK: Cigarette smoking and methadone dose levels. Am J Drug Alcohol Abuse 1993, 19:209–217.
Richter KP, Gibson AC, Ahluwalia JS, Schmelzle KH: Tobacco use and quit attempts among methadone maintenance clients. Am J Public Health 2001, 91:296–299.
Frosch DL, Shoptaw S, Jarvik ME, et al.: Interest in smoking cessation among methadone maintained outpatients. J Addict Dis 1998, 17:9–19.
Almeida LEF, Pereira EFR, Alkondon M, et al.: The opioid antagonist naltrexone inhibits activity and alters expression of a7 and a4b2 nicotinic receptors in hippocampal neurons: implications for smoking cessation programs. Neuropharmacology 2000, 39:2740–2755.
Covey LS, Glassman AH, Stetner F: Naltrexone effects on short-term and long-term smoking cessation. J Addict Dis 1999, 18:31–40.
Hutchinson KE, Monti PM, Rohsenow DJ, et al.: Effects of naltrexone with nicotine replacement on smoking cue reactivity: preliminary results. Psychopharmacol (Berlin) 1999, 142:139–143.
Lerner AG, Oyffe I, Sigal M: Naltrexone-induced reduction of tobacco intake. J Clin Psychiatry 1998, 59:30–31.
Wewers ME, Dhatt R, Tejwani GA: Naltrexone administration affects ad libitum smoking behavior. Psychopharmacol (Berlin) 1998, 140:185–190.
Robinson TE, Berridge KC: The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Rev 1993, 18:247–291.
Balfour DJ, Wright AE, Benwell ME, Birrell CE: The putative role of extra-synaptic mesolimbic dopamine in the neurobiology of nicotine dependence. Behav Brain Res 2000, 113:73–83.
Robinson TE, Berridge KC: Incentive-sensitization and addiction. Addiction 2001, 96:103–114.
Frosch DL, Shoptaw S, Jarvik ME, et al.: Preliminary experiences with opiate abusers seeking smoking cessation treatment. NIDA Res Monogr 1997, 178:67.
Spiga R, Schmitz J, Day J II: Effects of nicotine on methadone self-administration in humans. Drug Alcohol Depend 1998, 50:157–165.
King AC, Meyer PJ: Naltrexone alteration of acute smoking response in nicotine-dependent subjects. Pharmacol Biochem Behav 2000, 66:563–572.
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Sullivan, M.A., Covey, L.S. Current perspectives on smoking cessation among substance abusers. Curr Psychiatry Rep 4, 388–396 (2002). https://doi.org/10.1007/s11920-002-0087-5
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DOI: https://doi.org/10.1007/s11920-002-0087-5