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Tobacco smoking is common in people with other drug use such as alcohol, cannabis and opiate dependence. Cannabis and tobacco are often used together as a way of smoking cannabis. As rates of cigarette smoking decline, it is now more common for cannabis dependence to lead to tobacco dependence than was previously the case.201 Smoking cessation has not been a major part of clinical interventions with these people as the attention is usually focused on the alcohol or illicit drug use. There is good evidence that smoking cessation can enhance short-term abstinence, rather than compromise the outcome of drug and alcohol treatments.202
People with alcohol dependence typically have lower success rates in smoking cessation compared to the general population.203 There is also evidence that continued smoking adversely affects treatment for cannabis dependence. Success in smoking cessation for people with opiate dependence is lower than the general population. Monitoring and support are needed for smoking cessation in people with substance use problems who may benefit from the involvement of other health professionals, such as a drug and alcohol counsellor or intensive counselling from Quitline.
Recommended smoking cessation treatment
- Health professionals should offer encouragement, motivation, advice and counselling to these people.
- NRT is effective for quit attempts.
- Bupropion should be monitored carefully when used concurrently with alcohol use.
- Varenicline can be used. Prescribers should ask patients to report any mood or behaviour changes.11