Smoking prevalence in addiction treatment: a review

Abstract

Introduction: This review explores whether smoking prevalence in addiction treatment samples exceeds that shown in epidemiological data for persons with alcohol or other drug use disorders and whether smoking may have decreased over time in the addiction treatment population as it has done in the general population.

Methods: English language papers published between 1987 and 2009 were searched electronically. Forty papers reporting smoking prevalence for addiction treatment samples in the United States were identified, and key predictor variables were abstracted. Random logistic models were used to assess relationships between each individual predictor (year, treatment modality, primary drug treated, government status, and public/private funding status) and smoking prevalence.

Results: The lowest smoking prevalence aggregated for studies reported in any single year was 65%, well above epidemiological estimates reported among those with alcohol use and drug use disorders. The odds of smoking were higher in methadone maintenance programs (odds ratio [OR] = 2.25, CI = 1.08, 4.68) as compared with outpatient programs. No other variables in the model were significant. Reanalysis omitting recent studies that may represent outliers or confounding with type of treatment showed a small but significant decrease in smoking over time (OR = 0.9891, CI = 0.9888, 0.9893).

Conclusions: The very high smoking rates reported in addiction treatment samples warrant significant, organized, and systemic response from addiction treatment systems, from agencies that fund and regulate those systems, and from agencies concerned with tobacco control.

Figures

Figure 1.

Smoking prevalence in 42 U.S. addiction treatment studies, in epidemiological reports, and in the U.S. population. The literature review uncovered no studies from U.S. drug treatment facilities in 2004, giving a break in the topmost line at 2004. National Survey on Drug Use and Health (NSDUH) data (dotted line) are available in 2000–2009. Prior to 2000, NSDUH used a different variable to reflect any drug or alcohol treatment. The individual points reflect epidemiological data, showing rate of smoking among persons with a substance use disorder. National Comorbidity Study (NCS) data were collected in 1991–92, and National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data were collected in 2001–2002. The bottom line reflects smoking prevalence in the U.S. general population.