Fran Lowry

December 14, 2012

AVENTURA, Florida — Providing patients in residential substance abuse rehabilitation programs access to free-of-charge nicotine replacement therapy enhances smoking reduction and cessation, new research shows.

Dr. Stephanie Peglow

"Smoking cessation is a positive predictor for success in substance use treatment, and it's also, if one continues to smoke, a risk factor for relapse, so it's important to address in any place we can," coauthor Stephanie Peglow, DO, from Eastern Virginia Medical School, in Norfolk, told Medscape Medical News.

"In our inpatient substance use treatment facility, we have great contact with our patients, and we thought, why not try nicotine replacement at the same time to help them reduce their smoking, or stop altogether," Dr. Peglow said. "So we offered all of our inpatient substance use disorder patients free nicotine replacement therapy during their rehab."

The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 23rd Annual Meeting & Symposium.

To determine the success of this smoking cessation initiative, Dr. Peglow and colleagues retrospectively reviewed 643 medical records from all patients who were admitted between 2009 and 2011 to a residential substance use treatment program.

High Rate of Nicotine Dependence

The vast majority (82%) were nicotine dependent. They were offered combination nicotine replacement therapy during treatment and were referred to smoking cessation classes.

A total of 305 patients refused nicotine replacement therapy.

Self-reports of smoking reduction or cessation were entered into the patients' medical records.

The researchers found that patients who used nicotine replacement reported a significantly higher rate of smoking reduction (71.5%) compared with those who did not (11.1%; P <.000).

Similarly, patients who used nicotine replacement reported a higher rate of smoking cessation — 11.3%, vs 2.2% for those who did not (P < .000).

The patients who completed the treatment program were more than 7 times more likely to reduce the amount they smoked (odds ratio [OR], 7.26; P < .000). The review also showed that back pain (OR, 1.76; P = .035) was associated with smoking reduction.

On the other hand, patients who did not reduce the amount they smoked were more likely to have dental problems (OR, 0.48; P = .021) or felony convictions (OR, 0.864; P = .056) or to be homeless prior to admission (OR, 0.58; P = .044).

The researchers also found that smoking cessation was associated with Axis II disorder (OR, 2.76; P = .063), older age (OR, 1.09; P = .007), treatment completion (OR, 5.96; P < .019), African American ethnicity (OR, 3.19; P = .058), and number of nonfelony convictions (OR, 1.132; P = .008).

Perfect Opportunity

Dr. Peglow acknowledged that some experts believe that getting substance abuse patients to stop smoking should be addressed after the substance abuse has been dealt with.

"They believe that nicotine is a longer-term addiction, it doesn't kill people right away, and that we should address a patient's most important substance use problems first, but as our research shows, smoking cessation can be addressed at the same time. Our patients were interested and motivated to try, and we think it is important to address the issue while they are being treated for substance abuse," she said.

"It's a perfect opportunity — they are a captive audience. We followed them for 90 to 120 days, and the average length of stay was about 73 days, so we had a lot of contact with them."

Commenting on the findings for Medscape Medical News, William Lawson, MD, PhD, professor and chair, Department of Medicine, Howard University, Washington, DC, agreed with the study investigators.

"Some rehabilitation specialists think that smoking cessation may be too difficult to deal with at the same time as the patient is going through detox, but the reality is that when you are in the hospital setting, you have the whole treatment team focused on you," he said.

"Normally, in a smoking cessation program, people have a lot of other stresses and other things going on, and they usually say 'the hell with it,' so in a way, being a captive audience is a good thing here," he added.

The study was supported in part by the Department of Veterans Affairs. Dr. Peglow and Dr. Lawson have disclosed no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 23rd Annual Meeting & Symposium. Abstract 32. Presented December 8, 2012.