Medication Treatment for Smoking Cessation in Patients with Comorbid Medical or Psychiatric Problems during Substance Use Rehabilitation

Introduction: Patients with substance use disorders smoke a higher rate than the general population, and have more difficulties with smoking cessation. The purpose of this study was to determine whether the use of smoking cessation medications improved the rate of smoking reduction or cessation during substance use rehabilitation treatment. Methods: A retrospective review of 643 medical records was conducted of patients admitted between 2009 and 2011 to a Veterans Administration residential substance use treatment program. All patients with nicotine use disorder patients (82%) were offered smoking cessation medications for nicotine use disorder and were referred to smoking cessation classes. Self-report of smoking reduction or cessation during treatment was charted. Bivariate statistics and binary logistic regression analysis were conducted using either smoking cessation or smoking reduction as the dependent variable and was performed in SPSS. Results: Significantly more patients who used smoking cessation medications reported smoking reduction (72% vs. 11%), χ2 (1, N=526)=201.3, p<0.000 and smoking cessation (11% vs. 2%), χ2 (1, N=526)=18.3, p<0.000 during treatment. Factors associated with smoking reduction using binary logistic regression analysis with smoking cessation as the dependent variable included: Use of smoking cessation medications (OR=28.6, p<0.00), treatment completion (OR=7.6, p<0.00), presence of dental problems (OR=2.1, p=0.03), and presence of back pain (OR=1.74, p=0.04). Smoking cessation was associated with use of smoking cessation medications (OR=5.1, p<0.00), older age (OR=1.1, p=0.01), treatment completion (OR=6.3, p=0.02), and the number of non-felony convictions (OR=1.1, p=0.01) using smoking cessation as the dependent variable in binary logistic regression analysis. Conclusion: Free access to smoking cessation medications appears to enhance smoking reduction and cessation during residential substance use treatment. Limitations of the study include the fact that reduction or cessation was based on self-report and that this was a retrospective record review, not a randomized, controlled trial.