566 Tobacco cessation interventions helpful for people with substance use disorders

December 13, 2017

written by Brian McAvoy

Clinical question
How effective are tobacco cessation interventions for people in treatment for, or recovery from, alcohol or other drug dependencies?

Bottom line
Tobacco cessation interventions (counselling and/ or pharmacotherapy) for people in treatment for, or recovery from, alcohol and other drug dependencies increased the odds of quitting smoking. Absolute quit rates were 109/1000 participants for pharmacotherapy, relative to 58/1000 for placebo or usual care, and 160/1000 participants for combined counselling and pharmacotherapy, relative to 92/1000. Counselling alone did not significantly increase tobacco abstinence. Providing tobacco cessation interventions did not appear to affect the rates of abstinence from alcohol or other drugs. Most trials assessed the number of people who had quit smoking at least 6 months after beginning treatment.

Caveat
These findings are based on studies of overall low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment. Data on adverse effects of the interventions were limited.

Context
Smoking rates in people with alcohol and other drug dependencies are 2 to 4 times those of the general population. Concurrent treatment of tobacco dependence has been limited due to concern that these interventions are not successful in this population or that recovery from other addictions could be compromised if tobacco cessation was combined with other drug dependency treatment.

Cochrane Systematic Review
Apollonia D et al. Interventions for tobacco cessation in people in treatment for or recovery from substance use disorders. Cochrane Reviews, 2017, Issue 1. Art. No.: CD010274.DOI: 10.1002/14651858. CD010274. pub2. This review contains 35 studies involving 5796 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.