Journal of Substance Abuse Treatment 2015;53:39-46. [doi: 10.1016/j.jsat.2014.12.007]
Erin A. McClure, PhD (Medical University of South Carolina, SC Node), Aimee N. C. Campbell, PhD (Columbia University, GNY Node), Martina Pavlicova, PhD (Columbia University, GNY Node), Mei-Chen Hu, PhD (Columbia University, GNY Node), Theresa M. Winhusen, PhD (University of Cincinnati, OV Node), Ryan G. Vandrey, PhD (Johns Hopkins University, MA Node), Lesia M. Ruglass, PhD (The City College of New York), Lirio S. Covey, PhD (Columbia University, GNY Node), Maxine L. Stitzer, PhD (Johns Hopkins University, MA Node), Tiffany L. Kyle, PhD (Center for Drug-Free Living, Inc., FNA Node), Edward V. Nunes, MD (Columbia University, GNY Node).
The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during the treatment cycle.
In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network (protocol CTN-0044, WEB-TX, an evaluation of a web-delivered psychosocial treatment, the Therapeutic Education System (TES)). Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerstrom Test for Nicotine Dependence during the 12-week study among all smokers (Aim #1), specifically among those in the experimental treatment group (Aim #2), and the moderating effect of being a smoker on treatment outcomes (Aim #3). Results found that participants generally did not reduce or quit smoking throughout the course of the study. Among a subset of participants with higher baseline nicotine dependency scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial.
Conclusions: This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. Cigarette smoking was not targeted by the treatment intervention and may not have been addressed in the usual care received by participants in the treatment programs. Therefore, it is not surprising that participants generally did not quit smoking during the trial. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients and thus avoid the almost-inevitable smoking-related illnesses that this participants will likely encounter. (Article (Peer-Reviewed), PDF, English, 2015)
Keywords: Behavior therapy | Community health services | CTN platform/ancillary study | Fagerstrom Test for Nicotine Dependence (FTND) | Internet counseling | Smoking | Therapeutic Education System (TES) | Journal of Substance Abuse Treatment (journal)
Document No: 1114, PMID: 25595301, PMCID: PMC4414703.
Submitted by the CTN Dissemination Librarians, 1/7/2015.