Addressing tobacco use during cannabis treatment is feasible but tobacco quit rates remain poor | Research

The takeaway

Simultaneously treating tobacco use during cannabis treatment was acceptable and did not undermine cannabis outcomes, but tobacco cessation rates were low regardless of timing.

Addiction clinicians, patients using both cannabis and tobacco, and treatment program designers.

62% engaged with tobacco treatment

What the researchers found

No significant differences in cannabis outcomes between simultaneous and sequential tobacco treatment during weeks 1-12. Most simultaneous participants engaged with the tobacco intervention (62% initiated counseling, 50% made quit attempts). However, only 30% of sequential participants continued to the delayed tobacco phase, highlighting the risk of deferring treatment.

Why it matters

Tobacco use is common among people seeking cannabis treatment and predicts worse cannabis outcomes. Clinicians often hesitate to address both substances simultaneously, but this study suggests that concern may be unfounded.

The numbers in context

67 adults enrolled; SIM: 62% initiated tobacco counseling, 50% made quit attempts, 41% used NRT; SEQ: 39% made quit attempts spontaneously before tobacco phase began; only 30% of SEQ continued to weeks 13-24.

How the study worked

Proof-of-concept RCT with 67 adults receiving simultaneous (SIM) or sequential (SEQ) tobacco cessation during outpatient cannabis use disorder treatment. SIM received tobacco intervention weeks 1-12; SEQ received it weeks 13-24. Both included web-based counseling plus nicotine replacement therapy.

What this study cannot tell us

Small sample (67), proof-of-concept design. High attrition in the sequential arm compromised comparison. Tobacco cessation outcomes were poor in both groups. Single-site study.

How to read the evidence

Preliminary: small proof-of-concept trial with high attrition in one arm.

When this study was published

Published in 2019.

The bigger picture

The finding that 39% of sequential participants spontaneously attempted tobacco cessation before it was offered suggests patients are motivated to address tobacco when they are already working on cannabis. Delaying the intervention may miss this window.

Questions still open

Would more intensive tobacco interventions produce better quit rates in this population? Does quitting tobacco actually improve long-term cannabis outcomes?

Common questions

Should tobacco treatment wait until after cannabis treatment?

This study suggests not. Delaying tobacco treatment led to 70% dropout before it could be offered, while simultaneous treatment did not harm cannabis outcomes.

Did addressing tobacco hurt cannabis treatment?

No. There were no significant differences in cannabis outcomes between the groups during the first 12 weeks.

Read the original research

Sequential and simultaneous treatment approaches to cannabis use disorder and tobacco use.

Journal of substance abuse treatment, 98, 39-46

View on PubMed ↗Publisher’s paper ↗

Citation

Lee, Dustin C; Walker, Denise D; Hughes, John R; Brunette, Mary F; Scherer, Emily; Stanger, Catherine; Etter, Jean-Francois; Auty, Samantha; Budney, Alan J. (2019). Sequential and simultaneous treatment approaches to cannabis use disorder and tobacco use.. Journal of substance abuse treatment, 98, 39-46. https://doi.org/10.1016/j.jsat.2018.12.005