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Clinical guidelines

Supporting smoking cessationA guide for health professionals

People with other substance use problems

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

References

  1. Fiore MC, Jaén CR, Baker TB, Bailey WC, et al. for the Guideline Panel. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, May 2008. Available at http://www.ncbi.nlm.nih.gov/books/NBK63952/ [accessed 20 March 2011].
  2. Patton G, Coffey C, Carlin J, Sawyer S, Lynskey M. Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 2005;100:1518–25.
  3. Prochaska JJ, Delucchi K, Hall SM. A meta- analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. J Consult Clin Psychol 2004;72:1144–56.
  4. Friend KB, Pagano ME. Smoking cessation and alcohol consumption in individuals in treatment for alcohol use disorders. J Addict Dis. 2005;24(2):61-75.
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