Treating Cannabis and Tobacco Addiction at the Same Time | Research

The takeaway

A combined computer-assisted treatment for cannabis and tobacco use disorders was feasible and did not negatively affect cannabis outcomes, while showing promising reductions in tobacco use.

Read this if you use both cannabis and tobacco and are thinking about quitting one or both.

56% of participants attempted to quit tobacco during cannabis treatment

What the researchers found

Researchers enrolled 32 people who met criteria for cannabis use disorder and also smoked tobacco daily in a 12-week program that simultaneously treated both addictions. The cannabis component used computer-assisted behavioral treatment, while the tobacco component added tailored counseling and nicotine replacement therapy.

Participants achieved an average of 3.6 consecutive weeks of cannabis abstinence, comparable to a historical control group that received cannabis treatment only (3.1 weeks). Over half (56%) initiated tobacco quit attempts, and 28% achieved at least two consecutive weeks of tobacco abstinence.

Tobacco use (cigarettes per day) decreased more in the combined treatment group than in controls, though formal tobacco abstinence rates were not statistically different.

Why it matters

Cannabis and tobacco use frequently co-occur, and tobacco use predicts worse cannabis treatment outcomes. This study demonstrated that adding tobacco treatment does not undermine cannabis cessation efforts, addressing a common concern among clinicians.

The numbers in context

32 participants; 12-week treatment; 3.6 weeks mean cannabis abstinence (vs. 3.1 in controls); 78% completed at least one tobacco module; 44% started NRT; 56% attempted tobacco quit; 28% achieved 2+ weeks tobacco abstinence

How the study worked

Pilot study of 32 participants with cannabis use disorder and daily tobacco use. Received 12-week computer-assisted behavioral treatment for both substances, including nicotine replacement therapy for tobacco. Cannabis outcomes compared to a historical control group that received cannabis treatment alone.

What this study cannot tell us

Small sample without randomization. Comparison to historical controls introduces potential confounding. 12-week follow-up is short. No long-term outcome data. Selection bias in participants willing to address both substances.

How to read the evidence

Small pilot study without randomization, compared to historical controls. Demonstrates feasibility but cannot establish efficacy.

When this study was published

Published in 2015. Digital and app-based treatment tools have advanced considerably since this study.

The bigger picture

The tradition of treating one addiction at a time may be unnecessarily conservative. Integrated approaches that address multiple substance use disorders simultaneously could improve overall outcomes without compromising either target.

Questions still open

Would a larger randomized trial confirm these findings? Does quitting tobacco improve long-term cannabis cessation rates? What is the optimal timing and intensity for integrated substance use treatment?

Common questions

Should you quit cannabis and tobacco at the same time?

This study suggests it is feasible. Treating both simultaneously did not make cannabis outcomes worse, and many participants successfully reduced tobacco use. However, individual circumstances vary.

Why do cannabis and tobacco use often go together?

Many cannabis users also smoke tobacco, and tobacco use is associated with worse outcomes in cannabis treatment. The two substances share some neurobiological pathways and behavioral patterns, making co-use common.

Read the original research

Outcomes from a computer-assisted intervention simultaneously targeting cannabis and tobacco use.

Drug and alcohol dependence, 155, 134-40

View on PubMed ↗Publisher’s paper ↗

Citation

Lee, Dustin C; Budney, Alan J; Brunette, Mary F; Hughes, John R; Etter, Jean-Francois; Stanger, Catherine. (2015). Outcomes from a computer-assisted intervention simultaneously targeting cannabis and tobacco use.. Drug and alcohol dependence, 155, 134-40. https://doi.org/10.1016/j.drugalcdep.2015.08.001