Journal Articles

Essential Reading

“Smoking Cessation during Substance Abuse Treatment: What You Need to Know”, Journal of Substance Abuse Treatment, 36 (2009), 205-219, Baca, Catherine Theresa and Carolina E. Yahne.

Patients in substance abuse treatment frequently smoke cigarettes and often die of tobacco-related causes.  Substance abuse treatment programs too often ignore tobacco use.  Many patients have expressed interest in stopping smoking, although they may be ambivalent about smoking cessation during substance abuse treatment.  This article provides a review of tobacco cessation literature and successful methods of intervention.  Research supports two key findings: (a) smoking cessation during substance abuse treatment does not impair outcome of the presenting substance abuse problem and (b) smoking cessation may actually enhance outcome success.  We will discuss how to incorporate smoking cessation. 

“Failure to Treat Tobacco Use in Mental Health and Addiction Treatment Settings: A Form of Harm Reduction?,” Drug and Alcohol Dependence, 110 (2010), 177-182, Prochaska, Judith J.

In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction.  That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-have behaviors.  This paper examines the impact of providers’ failure to treat tobacco use on patients’ alcohol and illicit drug use and associated high-risk behaviors.  The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress; and (6) treatment of tobacco use does not harm mental health recovery.  Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. 

“ Barriers and Solutions to Addressing Tobacco Dependence in Addiction Treatment Programs”, Alcohol Research & Health, 29 (3) (2006), 228-35, Ziedonis, Douglas M., Guydish, J., Williams, J., Steinberg, M., Foulds, J.

Despite the high prevalence of tobacco use among people with substance use disorders, tobacco dependence is often overlooked in addiction treatment programs.  However, studies suggest patients who receive tobacco dependence treatment during addiction treatment have better overall substance abuse treatment outcomes compared with those who do not.  Barriers that contribute to this lack of attention include staff attitudes about and use of tobacco, lack of adequate staff training to address tobacco use, unfounded fears among treatment staff and administration regarding tobacco policies, and limited tobacco dependence treatment resources.  Specific clinical-, program-, and system-level changes are recommended to fully address the problem of tobacco use among alcohol and other drug abuse patients.

Useful Reading

“Addressing tobacco use disorder in smokers in early remission from alcohol dependence: The case for integrating smoking cessation services in substance use disorder treatment,” Clinical Psychology Review, 30(1) (February 2010), 12-24, Kalman, David, Kim, Sun, DiGirolamo, Gregory, Smelson, David, Ziedonis, Douglas.

The impact and treatment implications of tobacco dependence is considered among treatment-seeking alcoholics through a review of five areas of research:  Genetic and neurobiological vulnerability of comorbid tobacco and alcohol dependence, consequences of comorbid dependence on neurobiological and cognitive functioning, effects of smoking cessation on drinking urges and alcohol use, and the effectiveness of smoking cessation interventions with alcoholic smokers. 

“Smoking reduction for persons with mental illnesses: 6-month results from community-based interventions,” Community Mental Health Journal, 47(6) (December 2011), 694-702, Morris, Chad D., Waxmonsky, James A., May, Mandy G., Tinkelman, David G.

Persons with mental illnesses use tobacco at significantly higher and heavier rates than the general population, and suffer greater tobacco- related morbidity and mortality. However, there are few existing tobacco cessation interventions for these individuals. This study examined two interventions, a telephonic quitline intervention (counseling and nicotine replacement therapy) and a community-based group counseling intervention with adults receiving community mental health services. At 6-month follow-up, both groups demonstrated significantly reduced tobacco use, but participants who received both quitline services and the group counseling intervention were significantly more likely to have a 50% tobacco use reduction.  Findings suggest that common community tobacco cessation services are effective for this population.