Research That Matters (January 17 - 20, 2008)

Purpose: Cigarette smoking among clients in addiction treatment settings is a leading cause of morbidity and mortality and roughly four times more prevalent than its occurrence in the general population. Nicotine dependence is higher and quit rates are lower when compared to smokers in the general population. Questions about when to introduce smoking cessation treatments, as well as the strength of the relationship between cigarette smoking cessation and better substance abuse outcomes persist. Using concepts derived from Social Learning Theory, a test of the coping versus priming hypotheses was conducted to study dual tobacco and substance abuse outcomes among a treatment sample of clients with co-occurring nicotine and drug/alcohol abuse. Longitudinal data were used to test the hypothesis that concurrent tobacco treatment would be effective in smoking cessation and primary drug abstinence due to the reciprocal relationship between the two. Methods: Data were collected from newly admitted clients (N=936) in 20 randomly selected community based addiction treatment programs, over three time points: baseline (T1), three months post baseline (T2), and twelve months post baseline (T3). Predictor and outcome measures were obtained from The Addiction Severity Index and Treatment Services Review. Results: At baseline 82% of sample smoked cigarettes. Bivariate analyses indicated that those who smoked were more likely to be female (χ2 = 13.02, df = 1, p < 0.001), and more likely to have heroin as their primary drug problem compared to cocaine, alcohol, or marijuana (χ2 = 52.03, df = 3, p < 0.001). Fifteen percent of smokers were assigned to a concurrent smoking program. Of baseline smokers, 10% stopped smoking at T3. Seventy-eight percent of respondents were primary drug abstinent at T3. Tobacco program participation was not a significant predictor in separate multivariate tests of smoking cessation and primary drug abstinence, failing to support the hypothesis that a concurrent tobacco program would be associated with drug abstinence and smoking cessation. The hypothesized reciprocal relationship between T3 smoking cessation and T3 primary drug abstinence was supported, in confirmation of the priming hypothesis. Conclusions and Implications: Favorable drug and alcohol abuse outcomes appear to be positively associated with smoking cessation. The development of interventions that utilize the most efficacious smoking cessation protocols requires continued investigation. It is possible that support for smoking cessation within treatment environments plays a role in the effectiveness of tobacco interventions. Social work practitioners interface regularly with clients with substance abuse problems, regardless of the program setting. Many of these clients probably smoke cigarettes, putting them at risk for continued substance abuse and harmful health effects from both addictions. Clients should be assessed for nicotine dependence, and advised to examine their tobacco use in the context of their overall addiction and mental health treatment.