Drug-involved smokers feared quitting cigarettes would worsen their drug use | Research

The takeaway

Smokers who also used marijuana, cocaine, opiates, or other drugs expected that quitting smoking would cause adverse outcomes like increased drug use, which reduced their motivation to quit.

Read this if you smoke cigarettes and use other substances and wonder whether quitting smoking might affect your other drug use.

Fear of adverse outcomes from quitting smoking reduced quit motivation across all drug categories

What the researchers found

Among 507 non-treatment-seeking adult smokers, those who used marijuana and other drugs reported greater expectancies that quitting smoking would lead to adverse outcomes, such as worsening their drug use or causing other negative consequences. These adverse outcome expectancies statistically mediated the relationship between drug involvement and reduced motivation to quit smoking.

The pattern held across multiple substances: binge drinking, marijuana, cocaine, stimulants, opiates, and sedatives were all associated with greater adverse outcome expectancies, which in turn predicted lower desire to quit and lower likelihood of endorsing a goal of complete smoking abstinence.

Why it matters

Tobacco kills more people than any other substance. If drug-involved smokers avoid quit attempts because they believe quitting will destabilize their drug use, addressing these beliefs directly in clinical settings could improve smoking cessation rates in this high-risk population.

The numbers in context

507 smokers studied. Adverse outcome expectancies mediated the relationship between drug involvement and quit motivation across all six substance categories tested.

How the study worked

Cross-sectional survey of 507 non-treatment-seeking adult smokers from the community. Participants reported drug involvement, smoking abstinence expectancies (via the Smoking Abstinence Questionnaire), and motivation to quit. Mediation analyses tested whether adverse outcome expectancies explained the link between drug use and lower quit motivation.

What this study cannot tell us

Cross-sectional design cannot establish causation. Self-selected community sample. Expectancies about quitting may not accurately predict actual outcomes. The study did not test whether correcting these beliefs changed behavior.

How to read the evidence

Adequately powered cross-sectional study with mediation analysis, though unable to establish causal direction.

When this study was published

Published in 2014.

The bigger picture

The belief that quitting smoking will jeopardize sobriety from other substances is common but largely unsupported by evidence. Research generally shows that quitting smoking is associated with better, not worse, long-term substance use outcomes. Correcting this misconception could be an effective intervention target.

Questions still open

Would directly addressing adverse outcome expectancies improve quit rates in drug-involved smokers? Does quitting smoking actually worsen drug use outcomes, or is this belief unfounded? Are these expectancies different for medical marijuana users vs. recreational users?

Common questions

Does quitting smoking make drug use worse?

This study found that drug-involved smokers believe it will, and this belief reduces their motivation to quit. However, research generally suggests that quitting smoking is associated with better, not worse, long-term substance use outcomes.

Why do drug users avoid quitting smoking?

They reported expecting adverse outcomes from quitting, such as increased drug use or other negative consequences. These expectations were statistically linked to lower desire to quit and lower abstinence goals.

Read the original research

Expectancies for smoking cessation among drug-involved smokers: implications for clinical practice.

Journal of substance abuse treatment, 46(3), 320-4

View on PubMed ↗Publisher’s paper ↗

Citation

Hendricks, Peter S; Peters, Erica N; Thorne, Christopher B; Delucchi, Kevin L; Hall, Sharon M. (2014). Expectancies for smoking cessation among drug-involved smokers: implications for clinical practice.. Journal of substance abuse treatment, 46(3), 320-4. https://doi.org/10.1016/j.jsat.2013.10.011