Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
4.1.2 Tobacco use in combination with other substance-use disorders
Tobacco use amongst people with alcohol and other substance-use disorders may be as high as three times that of the general community(102, 103). As comorbid tobacco consumption amongst individuals with other substance-use disorders (and mental disorders) is common, it is accepted as 'normal' by clinicians. As a result, individuals with other substance-use issues or mental disorders do not receive support to address tobacco consumption(70). These people are often not asked about their tobacco use and little information is provided to them on the risks of smoking and benefits of quitting. They are also rarely offered the opportunity to quit.
Traditionally, the drug treatment culture has explicitly excluded smoking cessation treatments and dissuaded individuals from attempting cessation out of concern that concurrent treatment of multiple drugs of abuse is too difficult and may compromise sobriety. Tobacco use has few immediate consequences (including lack of direct psychoactive effects), and thus has not been a priority for treatment.
Yet, the use of tobacco accounts for greater morbidity than alcohol and all other drugs combined(104). Among individuals treated for alcohol dependence, tobacco-related diseases were responsible for half of all deaths – greater than alcohol-related causes.
In a 24-year study of long-term users, the death rate among cigarette smokers was four times that of non-smokers. Although the magnitude of the problem of tobacco use in this patient population is clear, questions of when and how to best intervene remain(105).
However, evidence suggests that smoking cessation strategies can be implemented and are effective at the same time as treatment for alcohol and other drug use if patients are established and stable in treatment***(106).
Studies have shown that people with substance-use disorders are able to quit smoking especially if their other substance use is abating. Quitting smoking may also help control their use of other substances****(102, 107, 108).