Addictions and Tobacco Use
The co-occurrence of a substance addiction and tobacco use is well documented. Individuals with an addiction are 3-4 times more likely to use tobacco than someone without an addiction. Among Veterans with an addiction in VA care, nearly 54% identify themselves as smokers.
Health effects of addictions and tobacco use
For individuals with a substance abuse disorder (SUD) who smoke, they experience health effects that include:
- A death rate four times higher for individuals with a long-term SUD who smoke compared to non-smoking individuals with a long-term SUD
- Approximately 50% of deaths among people with alcohol dependence are due to tobacco-related disease
- The use of alcohol and smoking together puts an individual at higher risk of mouth or oral cancer, esophageal cancer, and heart disease
Treating addictions and tobacco use
Providing smoking cessation interventions in addiction treatment settings improves the health of Veterans because:
- It allows VA providers to reach a group of Veterans experiencing the synergistic negative health effects of multiple addictions
- Most individuals with an addiction are interested in quitting tobacco
- Attempting to quit smoking does not destabilize an individual's addiction treatment
- Individuals who quit tobacco have a 25% increased likelihood of long-term abstinence from all substances
Sequence of treatment does not matter
When offering cessation treatment to an individual with an addiction, the sequence of smoking cessation treatment and addiction treatment does not matter. Cessation treatment provided concurrent with or sequential to addiction treatment results in the same positive outcome—increased abstinence from tobacco and other substances.
What is important is to ask all tobacco users in addiction treatment if they would like to quit and whether they want to make that attempt while in treatment or in recovery. It is important that patients know providers are ready to assist them in their quit attempt whenever the patients are ready.
Tobacco cessation can aid recovery
In some addiction treatment settings, providers may be reluctant to introduce smoking cessation interventions. Providers may think it is too much to ask someone to forego tobacco while they are trying to abstain from another substance as this may undermine their addiction treatment. Yet research has shown that in general, smoking cessation does not adversely affect individuals in addiction treatment and can actually aid an individual in their overall recovery.
What is helpful to providers in addiction treatment settings is organizational support for integrated care and training on how to provide tobacco cessation services.
Substance abuse providers can help
Addiction care providers are well suited to address tobacco cessation because they:
- Have an existing therapeutic relationship with the Veteran making it appropriate for them to address tobacco use as a chronic disorder
- Are skilled to offer cessation counseling because of their expertise in behavioral counseling treatment
- Are trained in addiction treatment
Learn more about substance use and related VA services.
Tools and publications
- Smoking Cessation and Mental Health Populations (1.6 MB, PDF)
- Smoking and Tobacco Use Mini-Clinic: Community Provider Toolkit
- Patient tools
- 1-855-QUIT-VET, telephone counseling for Veterans with or without psychiatric disorders
- SmokefreeVET text messaging program, augments and extends treatment and support for Veterans attempting to quit
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