Targeting both tobacco and cannabis together in treatment did not hurt cannabis outcomes | Research

The takeaway

In a pilot program addressing tobacco use during cannabis treatment, all six participants completed treatment, five achieved cannabis abstinence, and simultaneously targeting tobacco did not negatively impact cannabis outcomes.

Read this if you use both tobacco and cannabis and are considering treatment for either or both.

Adding tobacco treatment did not compromise cannabis outcomes (5 of 6 abstinent)

What the researchers found

Approximately 50% of individuals seeking cannabis treatment also smoke tobacco, and tobacco use predicts worse cannabis treatment outcomes. This pilot study tested whether simultaneously addressing tobacco use would undermine cannabis treatment.

Six participants received a 12-week program combining motivational enhancement, cognitive behavioral therapy, and contingency management for cannabis, plus an optional tobacco intervention with nicotine replacement therapy. All six completed the cannabis treatment, and five achieved cannabis abstinence.

All participants engaged with the tobacco intervention (completing at least one module), and half initiated nicotine replacement therapy. However, actual tobacco quit attempts were fewer than expected, and cessation outcomes were poor. The key finding was that adding tobacco treatment did not negatively impact cannabis outcomes.

Why it matters

Clinicians have long worried that addressing multiple substances simultaneously would overwhelm patients and worsen outcomes for both. This pilot provided initial evidence that dual targeting is safe and does not compromise cannabis treatment success.

The numbers in context

Six participants. All completed cannabis treatment. Five achieved cannabis abstinence. All completed at least one tobacco module (mean 2.5). Three initiated nicotine replacement therapy. Tobacco quit attempts lower than expected.

How the study worked

Case series of the first six participants in a pilot dual-substance treatment program. The 12-week program combined computer-assisted motivational and cognitive behavioral therapies with contingency management for cannabis, plus optional tobacco intervention.

What this study cannot tell us

Only six participants with no control group. Pilot/feasibility design. Tobacco cessation outcomes were poor. Self-selected participants interested in both treatments may not represent typical cannabis treatment seekers.

How to read the evidence

Pilot case series of six participants. Provides feasibility evidence but cannot establish efficacy.

When this study was published

Published in 2014.

The bigger picture

The finding that simultaneously addressing tobacco did not harm cannabis outcomes opens the door for integrated treatment approaches. Given that tobacco smoking predicts worse cannabis outcomes, treating both may actually improve long-term results even if tobacco cessation rates are initially modest.

Questions still open

Would a larger randomized trial confirm that dual treatment is safe? Why were tobacco quit attempts lower than expected? Would different tobacco interventions (e.g., medication-first approaches) be more effective alongside cannabis treatment?

Common questions

Can you treat tobacco and cannabis addiction at the same time?

This pilot study suggested yes. All six participants completed the dual-treatment program, and five achieved cannabis abstinence. Adding tobacco treatment did not negatively impact cannabis outcomes.

Does tobacco use affect cannabis treatment?

About 50% of cannabis treatment seekers also smoke tobacco, and tobacco smoking predicts worse cannabis outcomes. Addressing both simultaneously may be important for long-term success.

Read the original research

Treatment models for targeting tobacco use during treatment for cannabis use disorder: case series.

Addictive behaviors, 39(8), 1224-30

View on PubMed ↗Publisher’s paper ↗

Citation

Lee, Dustin C; Budney, Alan J; Brunette, Mary F; Hughes, John R; Etter, Jean-Francois; Stanger, Catherine. (2014). Treatment models for targeting tobacco use during treatment for cannabis use disorder: case series.. Addictive behaviors, 39(8), 1224-30. https://doi.org/10.1016/j.addbeh.2014.04.010