Tobacco use is causally related to 17 different types of cancers, heart disease, stroke, and
chronic obstructive lung diseases. About 65%-87% of substance use disorder (SUD) patients smoke as compared to 14% of the general adult population; they also smoke more heavily. Moreover, SUD patients have more deaths attributed to tobacco use than the non-nicotine SUD for which they sought care.
Despite patient interest in quitting tobacco, the use of evidence-based tobacco control interventions is low in substance use treatment centers (SUTCs). Only 64% of SUTCs screen patients for tobacco use, 47% offer tobacco cessation counseling, and 26% provide nicotine replacement therapy (NRT). Moreover, only 35% have tobacco-free workplace (TFW) policies. This lack of system-wide, evidence-based tobacco control initiatives within SUTCs is rooted in clinical misconceptions, lack of training, and high smoking rates among clinicians. Clinicians are often concerned that treating tobacco during SUD treatment will overwhelm patients and jeopardize non-nicotine substance use recovery. However, smoking cessation mitigates smoking-related health risks while minimizing the risk of SUD relapse. Despite the importance of training in addressing attitudes, skills, and knowledge, employees in addiction treatment settings receive little training in treating tobacco dependence. Additionally, among clinicians treating SUD patients, 14% to 40% smoke, which perpetuates a smoking culture and interferes with tobacco treatment provision for SUD patients.
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