How Stimulant And Smoking Addictions Can Be Treated Together

In the United States, 48 percent to 98 percent of illicit drug users smoke cigarettes compared to 19.8 percent of the general population. For those involved in treatment programs for addiction, there is some concern that treating smoking addiction at the same time as illicit drug addiction could impact the effectiveness of the core addiction treatment.

This hypothesis has been put to the test in a recent study, and the findings suggest that treating smoking addiction at the same time as addiction to stimulants such as cocaine and methamphetamine doesn’t affect the individual’s chance of remaining abstinent. The finding could prompt a shift in how rehab centers deal with people addicted to both nicotine and illicit drugs, but there is an important limitation that could impact how well the finding translates to real-world scenarios.

Studying Treatment For Those Addicted To Drugs And Cigarettes

The researchers ran a randomized trial over the course of 10 weeks at 12 different substance abuse treatment programs between February 2010 and July 2012. The participants had to meet the diagnostic criteria for methamphetamine or cocaine addiction (or both), and also be interested in quitting smoking. The treatment for drug addiction went ahead as it ordinarily would for all participants during the study period, but they were split into two groups. In the first group, 271 participants simply received this “treatment as usual,” but in the second group, 267 participants were also given smoking-cessation treatment to see if it had an impact on their substance use outcomes.

The smoking-cessation treatment consisted of counseling over the first 10 weeks of treatment along with the quit-smoking medication bupropion. After the fourth week, the group assigned to smoking-cessation treatment also received a nicotine inhaler to help with cravings. The researchers were mainly interested in how many participants in each group were abstinent from stimulants during each of the treatment weeks (confirmed by urine testing), but also looked at nicotine (and other substance) use as a secondary outcome, confirming smoking abstinence through a carbon monoxide breath test. The researchers followed up with the participants three and six months after the treatment period to investigate longer-term outcomes.

What The Smoking-Cessation Treatment Study Found

The results show that there was no significant difference in the number of weeks abstinent from stimulants between the two groups after 10 weeks, although the group that received smoking-cessation treatment averaged 77.2 percent of weeks’ abstinent from stimulants compared to 78.1 percent of those who just received treatment as usual. This isn’t a “significant” result because the difference wasn’t large enough to rule out random statistical fluctuations; in other words, the outcomes were the same.

It was also found that those who received the smoking-cessation treatment were considerably more likely to have quit smoking at any point during the 10-week trial period and throughout the follow-up. Given that this had no impact on overall stimulant-use outcomes over the 10-week period, the researchers suggest that smoking addiction can be treated alongside drug addiction without having a negative effect.

However, the results for abstinence from stimulants after the six-month follow-up were different. There was a significant difference in the number of drug-free days between the groups, with those who also received smoking-cessation treatment having had more drug-free days than those who just received treatment as usual. If anything, this suggests that concurrent smoking cessation and stimulant addiction treatment could have a benefit for both outcomes.

Limitations Of The Smoking-Cessation Treatment Study

The results may be promising, but there is an important limitation that could have an impact on the relevance of the findings. In the research, the smoking-cessation treatment included weekly counseling, a pharmacological treatment and nicotine replacement therapy. This is a full battery of stop-smoking treatments, and is unlikely to represent the level of stop-smoking care a drug addiction treatment facility could realistically provide. Additionally, a large percentage of participants were able to remain abstinent from stimulants, which may indicate that some other factor is making this study unrepresentative of real-world outcomes.

Treating Substance Abuse And Smoking Addiction Together Still May Be Helpfu

However, these are relatively minor criticisms, and the authors point out that other research (looking at treating alcoholism and smoking addiction together) has also shown that smoking-cessation treatment appears to have a positive impact on substance abuse treatment.

The core finding of this research suggests that treatment providers shouldn’t be opposed to drug users attempting to tackle nicotine addiction at the same time as their illicit drug problem, but more studies will be needed to see if this effect continues in more realistic scenarios.

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