Worldwide, Smoking Rates In Substance Abuse Treatment Double General Population

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Worldwide, Smoking Rates In Substance Abuse Treatment Double General Population

According to a study published in the Society for Study of Addiction, globally, tobacco smoking is much higher among patients in substance abuse treatment that those in the general population. Researchers believe that this is due to a combination of both biology and culture that contribute to high rates of cigarette smoking in rehabilitation facilities.

Joseph Guydish, lead researcher of the study and professor of medicine at the University of California, San Francisco:

“In the U.S., we talk a lot about the environmental and cultural factors that drive smoking in addiction treatment. For example, a lot of people work in our addiction treatment system are people who themselves were addicted and are now in recovery,”

“So sometimes, not always, staff members in these programs who smoke at higher rates than the general population smoke together and use it as a way to bond with their clients and build rapport.”

substance-abuse treatmentAfter observing this phenomenon in the U.S., researchers sought to determine if this effect could be seen globally. Thus, they analyzed databases for studies reporting on smoking prevalence in substance abuse treatment samples.

Researchers discovered a massive amount of studies – more than 4,500 – which included over 37,000 participants and 54 papers published in English. They ranged from 1987-2013 and included 20 counties.


“We wanted to know if this phenomenon within the U.S. would also be seen in different countries it highlights the importance of the biological relationship that we’re dealing with.

You can say that there are certain features of the drug treatment system in the U.S. that might support smoking, but why would there be features in drug abuse treatment in 20 different countries that support smoking?”

substance abuse treatment | Just Believe Recoverycollected represented multiple studies from each of the following countries: Australia, Brazil, France, Germany, Italy, Switzerland, and the U.K. Thirteen other studies came from various other countries.

The common drugs treated included alcohol (48%), following by heroin/opioids (35%), and alcohol as a polysubstance in combination with other drugs (17%.) Smoking prevalence throughout the studies ranged from 41% to….100%. What?

As it turned out, persons in substance abuse treatment were more than twice as likely to smoke than the general population who exhibited similar demographic characteristics (84% compared to 31%.) Interestingly, those treated for opioid use disorder were more likely to smoke than those in treatment for alcohol abuse.

“Based on what I’ve been able to read in literature, the relationship between nicotine and other drugs and this biological relationship is somehow stronger when you’re talking about opiates. There’s some research that says it helps with withdrawal symptoms.”

Guydish believes another reason is that smoking, like other substance use, releases dopamine into brain regions that activate reward mechanisms:

“It does it usually through some intermediate routes that are different from how alcohol or opiates activate the reward mechanisms, but it does the same thing. People who are seeking chemical rewards through drugs often include nicotine because it does some of the same things.”

“Not always but often smoking is not addressed. People in drug abuse treatment end up dying of tobacco-related causes downstream a lot more often than people in the general population because they smoke a lot more.”

The Trouble With Smoking

According to the study, every year the use of tobacco use accounts for around 18% of deaths in high-income countries, 11% in middle-income countries, and 4% in low-income countries.

substance abuse treatment | Just Believe RecoveryGlobally, the economic cost of tobacco use is estimated at more than $500 billion per year. And according to the Centers for Disease Control and Prevention, worldwide, tobacco use causes nearly 6 million deaths per year.

And trends show that tobacco use may cause more than 8 million deaths yearly by 2030.

Also, in the U.S. alone, more than 16 million Americans are currently living with a smoking-related disease. For each person who dies from smoking, at least another 30 are living a serious illness related to tobacco use.

It is the leading cause of preventable death in the U.S, and is responsible for more than 480,000 deaths per year (including 41,000 due to second-hand smoke.) That’s about 1,300 deaths every day, and 1 in 5 deaths annually.


I agree with Guydish’s conclusions, but I would also like to add that in these situations, smoking is often treated as the lesser of two evils (indeed, it probably is.) While people certainly suffer and die of smoking-related causes, it doesn’t affect the lives of others, such as family, in the same manner as drug addiction or alcoholism.

Moreover, it doesn’t interfere with jobs, driving, and other daily activities in the way other substance abuse may, because it doesn’t necessarily affect decision-making, coordination, or other basic mental and motor skills needed to function normally.

It makes me wonder if more substance abuse treatment programs should address smoking as a polysubstance use disorder.

~ G. Nathalee Serrels, M.A., Psychology

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