What Happens When Substance Abusers Try to Quit Smoking Too? | Research

The takeaway

A review found that nicotine dependence was extremely common among substance abusers, quitting smoking did not increase relapse to other substances, and continued smoking actually worsened marijuana treatment outcomes.

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

Continued smoking worsened marijuana dependence treatment outcomes

What the researchers found

Nicotine dependence was extremely prevalent among people with alcohol or other substance use disorders, and many patients in treatment programs expressed interest in quitting smoking. The review identified several key findings from clinical trials: people with past but not current alcohol dependence had similar smoking cessation success rates as non-alcoholics; quitting tobacco did not increase alcohol relapse; continued smoking adversely affected treatment for marijuana dependence; cocaine and nicotine use patterns were interrelated; and smoking cessation rates among opioid-dependent individuals were several times lower than in the general population.

The authors concluded that smoking cessation was indicated for people already in recovery from substance dependence and might actually protect against relapse to the primary drug of abuse.

Why it matters

This review challenged the prevailing clinical wisdom that people in substance abuse treatment should not attempt smoking cessation simultaneously because it might trigger relapse. The finding that quitting smoking actually supported rather than undermined recovery from other substances was clinically significant and helped shift treatment approaches toward addressing nicotine dependence as part of comprehensive substance abuse care.

The numbers in context

Smoking cessation rates among opioid-dependent individuals were described as "several times lower" than in the general US population.

How the study worked

This was a narrative review of clinical trials and survey data examining smoking cessation among people with various substance use disorders, including alcohol, marijuana, cocaine, and opioid dependence.

What this study cannot tell us

The review covered a heterogeneous set of substance use disorders with varying evidence quality. The interaction between tobacco and cannabis treatment was noted but not extensively analyzed. The review did not provide a systematic assessment of all available evidence.

How to read the evidence

This is a narrative review of multiple clinical trials and surveys, providing moderate-level evidence through synthesis.

When this study was published

Published in 2002. The interaction between tobacco and cannabis use continues to be studied.

The bigger picture

The finding that continued smoking worsened marijuana dependence treatment outcomes is particularly relevant to the cannabis conversation. It suggests that tobacco and cannabis dependence interact in ways that affect treatment, a finding that has been replicated in subsequent research and has implications for how cannabis dependence treatment programs are designed.

Questions still open

What mechanisms explain why continued smoking worsened marijuana treatment outcomes? Would vaping or nicotine replacement therapy show the same interaction with cannabis dependence treatment?

Common questions

Should I quit smoking while also trying to quit cannabis?

This review found that continued smoking actually made marijuana treatment less effective, and quitting smoking did not trigger relapse to other substances. The evidence supported addressing both simultaneously rather than waiting.

Why is smoking so common among people with substance use disorders?

Nicotine dependence rates are extremely high among people with other substance use disorders, likely due to shared genetic vulnerability, common environmental risk factors, and the interactions between nicotine and other drugs' effects on the brain's reward system.

Read the original research

Current perspectives on smoking cessation among substance abusers.

Current psychiatry reports, 4(5), 388-96

View on PubMed ↗

Citation

Sullivan, Maria A; Covey, Lirio S. (2002). Current perspectives on smoking cessation among substance abusers.. Current psychiatry reports, 4(5), 388-96.