SAMHSA Toolkit to Help Providers Promote Tobacco Cessation

Smoking tobacco is prevalent among people with substance use disorder (SUD). Individuals seeking SUD treatment are much more likely to use tobacco than the general population.

The Centers for Disease Control and Prevention (CDC) report that “current smoking has declined from nearly 21 of every 100 adults (20.9 percent) in 2005 to about 15 of every 100 adults (15.5 percent) in 2016.”

The numbers are quite different for people suffering from alcohol or drug addiction. An estimated 70–80 percent of individuals with substance use disorders are smokers. The consequences are deadly. Drug users who smoke cigarettes are four times more likely to die prematurely than those who do not smoke, according to the CDC.

Many addiction treatment providers have traditionally tolerated continued tobacco use by their patients on the premise that quitting drugs or alcohol and tobacco use at the same time may seem too daunting to their clients. Research shows, however, that smoking can have a negative impact on recovery outcomes and many people in treatment are actually interested in quitting tobacco use.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) recommends the adoption of tobacco-free facility/grounds policies and the integration of tobacco-dependence treatment into substance abuse treatment. To help providers make the switch to a tobacco-free campus, SAMHSA has issued a new implementation guide. “Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings” offers many good reasons why tobacco cessation is important and effective strategies to achieve it.

The most important reason for addiction treatment providers to combine smoking cessation and SUD treatment: quitting smoking increases the odds of long-term recovery, whereas continued smoking following treatment increases the likelihood of relapse to substance misuse.

Tobacco cessation can have mental health benefits and quitting smoking at any age has physical health benefits that emerge almost immediately and continue for years.

SAMHSA suggests that treatment providers could begin a quit-smoking intervention with five easy steps—5 As:

  • ASK – Document each client’s tobacco use status at every visit.
  • ADVISE – Respectfully urge every tobacco user to quit.
  • ASSESS – Determine whether the tobacco user is willing to try quitting.
  • ASSIST – Use counseling and pharmacotherapy to help willing clients quit.
  • ARRANGE – Schedule follow-up phone calls or meetings, preferably the first week after the quit date.

Fewer than half of all addiction treatment facilities in the United States offered tobacco cessation services in 2016. The Farley Center at Williamsburg Place reacted to the mounting evidence for the benefits of smoking cessation a few years ago and became tobacco free in January 2015. Fortunately, Farley’s addiction treatment model works well for managing cravings, positive self-soothing, trigger identification and management, and an aftercare support structure. Treatment strategies at Farley include 12-Step work, nicotine sobriety group, nicotine replacement therapy (e.g., patches, lozenges), and pharmacotherapy.



Download the free SAMHSA tobacco cessation guide 

For more information about tobacco-free addiction treatment call The Farley Center.