Addressing tobacco use disorder in smokers in early remission from alcohol dependence: The case for integrating smoking cessation services in substance use disorder treatment programs

Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, MA 01655, USA.
Clinical psychology review (Impact Factor: 7.18). 09/2009; 30(1):12-24. DOI: 10.1016/j.cpr.2009.08.009
Source: PubMed


Despite the declining overall rate of cigarette smoking in the general population in the United States, the prevalence of smoking is estimated to be as high as 80% among treatment-seeking alcoholics. The serious adverse health effects of tobacco and heavy alcohol use are synergistic and recent evidence suggests that smoking slows the process of cognitive recovery following alcohol abstinence. In addition, substantial evidence shows that treatment for tobacco dependence does not jeopardize alcohol abstinence. In this paper, we focus on the impact and treatment implications of tobacco dependence among treatment-seeking alcoholics through a review of five areas of research. We begin with brief reviews of two areas of research: studies investigating the genetic and neurobiological vulnerability of comorbid tobacco and alcohol dependence and studies investigating the consequences of comorbid dependence on neurobiological and cognitive functioning. We then review literature on the effects of smoking cessation on drinking urges and alcohol use and the effectiveness of smoking cessation interventions with alcoholic smokers. Finally, we offer recommendations for research with an emphasis on clinical research for enhancing smoking cessation outcomes in this population.

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    • "While smoking prevalence is higher among persons with substance use disorders (Grant, Hasin, Chou, Stinson, & Dawson, 2004;Lasser et al., 2000), it is highest among those inGuydish, Yu, Le, Pagano, & Delucchi, 2015). Quitting smoking does not jeopardize recovery from other drug use (Kalman, Kim, DiGirolamo, Smelson, & Ziedonis, 2010;Martin et al., 1997;Stuyt, 1997). Smoking cessation during the first year after admission to addiction treatment was associated with improved drug use outcomes in one study (Tsoh, Chi, Mertens, & Weisner, 2011), and a meta-analysis found that patients receiving tobacco intervention during addiction treatment had a 25% higher likelihood of abstinence from other drugs (J. "
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    ABSTRACT: This study implemented a smoking cessation Readiness Group (RG) in two women-focused residential substance abuse treatment programs, with the aim of engaging women in smoking cessation services. The primary outcome was defined as attending at least one cessation group after the RG ended. The RG combined features of the Expert Systems (ES) approach with a practice quit attempt. ES is an interactive system which tailors intervention to the smokers’ stage of change, while the practice quit attempt rehearses the process of quitting smoking. As a secondary aim we tested whether incentives, used to promote participation and engagement in the RG, would increase initiation of smoking cessation services. Participants (N = 75) were women smokers enrolled in two residential programs, and intention to quit smoking was not required for participation. Twelve participant cohorts were randomly assigned to receive the RG with or without incentives. Following the RG intervention, 38.7% of participants (n = 29) attended at least one smoking cessation session. Both the number of RG sessions attended and a successful practice quit attempt predicted the later use of cessation services, while incentives did not. From pre to post RG, participants reported decreased cigarettes per day (CPD: 11.8 v. 7.6, p < .0001) and decreased nicotine dependence as measured by the Heaviness Smoking Index (HSI: 2.3 v. 1.8, p < .001). The 3-session group-format RG intervention was associated with initiation of smoking cessation services and with changes in smoking behavior.
    No preview · Article · Dec 2015
    • "Conversely, adults who consume alcohol or meet criteria for an AUD are more likely to report current and former smoking and to meet criteria for tobacco use disorders (Lasser et al., 2000; McKee et al., 2007). Further, while each substance has potentially serious health effects on its own, comorbid smoking and alcohol use demonstrate multiplicative effects on disease (Kalman et al., 2010). Because of the strong and reciprocal relationship between alcohol use and smoking, it is important to understand how one behavior impacts changes in the other behavior , especially the ability to successfully abstain or avoid problematic use. "

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    • "Approximately 35% of individuals with an AUD also meet criteria for tobacco use disorder (Grant et al., 2004). That prevalence rises to approximately 80% among individuals seeking treatment for AUDs (Kalman et al., 2010). The combination of smoking and AUDs is particularly malignant, as morbidity and mortality associated with co-occurrence versus singular use of alcohol and tobacco use disorders is substantially higher (Marrero et al., 2005; Pelucchi et al., 2006). "
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    ABSTRACT: Background: Posttraumatic stress disorder (PTSD) and alcohol use disorders (AUDs) often co-occur with smoking and tobacco use disorders. Each of these disorders is known to have negative health consequences and impairment independently, but little is known about the impact of their co-occurrence. The aim of the present study is to examine the prevalence, correlates, order of onset, and impact of co-occurring daily smoking, PTSD, and AUDs. Method: The 2007 Australian National Survey of Mental Health and Wellbeing (2007 NSMHWB) was a nationally representative survey of 8841 Australians. The survey assessed for 12-month DSM-IV mental disorders; the age respondents first started smoking daily, experienced a traumatic event, or developed problems with alcohol; and self-reported mental and physical health and impairment. Results: There were systematic patterns of co-occurrence between daily smoking, PTSD, and AUDs. Daily smoking and problems with alcohol use tended to develop after first trauma exposure, which is broadly consistent with the self-medication hypothesis. Daily smoking, PTSD, and AUDs were also associated with additive negative effects on mental and physical health and functioning, after controlling for demographics. Conclusions: Smoking, PTSD, and AUDs commonly co-occur in this nationally representative sample of Australian men and women, and this comorbidity was associated with greater severity of mental and physical health problems and impairment in several areas of functioning. This study highlights the importance of identifying and eliminating these patterns of co-occurrence, potentially through integrated interventions.
    No preview · Article · Sep 2015 · Drug and alcohol dependence
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