Teens Who Kept Smoking Cigarettes Were More Likely to Relapse on Marijuana and Alcohol | Research

The takeaway

Adolescents who continued smoking cigarettes or started smoking during substance abuse treatment had significantly higher odds of relapsing on marijuana and alcohol at 12-month follow-up.

Read this if you work with teens in substance abuse treatment or are a parent of a teen in recovery.

1,779 teens followed: persistent smokers had higher odds of marijuana and alcohol relapse

What the researchers found

Researchers followed 1,779 adolescents in substance abuse treatment, categorizing them by cigarette smoking status: persistent smokers, nonsmokers, quitters, and those who started smoking during the study period.

Persistent smokers and those who started smoking had significantly greater odds of relapsing on both alcohol and marijuana compared with those who quit smoking. These two groups also had shorter periods before marijuana relapse.

The results held after controlling for intake substance use levels and demographic and treatment characteristics.

Why it matters

This finding suggests that tobacco cessation should be integrated into adolescent substance abuse treatment programs, as continued cigarette use appears to be associated with worse outcomes for other substances.

The numbers in context

1,779 adolescents were followed. Four smoking status groups were compared. Persistent smokers and smoking initiators had significantly greater odds of alcohol and marijuana relapse, plus shorter time to marijuana relapse.

How the study worked

Data came from the Drug Abuse Treatment Outcomes Study for Adolescents (DATOS-A). Participants were classified into four groups based on change in cigarette smoking status from intake to 12-month follow-up. Logistic regression predicted likelihood of relapse to alcohol, marijuana, and other drugs, controlling for baseline substance use and demographics.

What this study cannot tell us

This is observational data, so the relationship between smoking and relapse could reflect a shared underlying vulnerability rather than a causal connection. Self-reported substance use may be unreliable in adolescents.

How to read the evidence

Large sample from an established treatment outcomes study with 12-month follow-up, though observational design limits causal claims.

When this study was published

Published in 2009. The relationship between tobacco and other substance use outcomes has continued to be studied, with findings generally supporting integrated treatment approaches.

The bigger picture

Substance use patterns tend to cluster together, especially in adolescents. This study suggests that addressing tobacco alongside other substances in treatment settings could improve overall outcomes rather than treating each substance in isolation.

Questions still open

Would adding tobacco cessation to adolescent substance abuse treatment reduce relapse rates for other substances? Is the connection between smoking and relapse driven by shared neurobiology, shared environments, or both?

Common questions

Does this mean cigarettes cause marijuana relapse?

The study found an association, not a causal relationship. Teens who smoke may have higher overall risk-taking tendencies, more substance-using peers, or other factors that also increase relapse risk.

Should treatment programs address tobacco use?

The findings suggest tobacco cessation should be considered as part of adolescent substance abuse treatment, as continued smoking was associated with worse outcomes for other substances.

Read the original research

Adolescent tobacco use and substance abuse treatment outcomes.

Journal of substance abuse treatment, 37(1), 17-24

View on PubMed ↗Publisher’s paper ↗

Citation

de Dios, Marcel A; Vaughan, Ellen L; Stanton, Cassandra A; Niaura, Raymond. (2009). Adolescent tobacco use and substance abuse treatment outcomes.. Journal of substance abuse treatment, 37(1), 17-24. https://doi.org/10.1016/j.jsat.2008.09.006