Patients in treatment for substance use disorders have a high prevalence of smoking. Treating nicotine dependence in substance abuse treatment (SAT) settings, however, is uncommon. Researchers conducted a randomized trial to evaluate the effectiveness of a smoking cessation intervention in SAT programs. The intervention consisted of nicotine replacement therapy plus 9 weekly cognitive-behavioral group counseling sessions and was compared with treatment-as-usual (TAU). Participants included 225 smokers (≥10 cigarettes per day) from 5 methadone maintenance programs and 2 drug- and alcohol-dependence treatment programs. Counseling attendance was highest in the first 3 weeks (40-60%).

• In addition to significantly better smoking abstinence rates during treatment (see table, below), participants in the intervention arm had significantly greater reductions in cigarettes smoked per day, exhaled carbon monoxide levels, cigarette craving, and nicotine withdrawal.

Smoking Abstinence Rates (%)
	Intervention arm	TAU arm
Weeks 2-7 (treatment period)	10-11	<1
Week 13 follow-up*	5.5	0
Week 26 follow-up*	5.7	5.2

• There was no difference between groups on rates of SAT retention, abstinence from primary substance of abuse, or craving for primary substance of abuse.

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*Follow-up abstinence rates were not significant.

Comments by Michael Levy, PhD
Combining nicotine replacement therapy and group counseling in SAT programs is modestly effective in reducing smoking, with impact on number of cigarettes smoked and craving for cigarettes. Treating nicotine dependence did not interfere with the treatment of patients' primary drug or alcohol dependence problem in this study. Given the high rates of smoking among patients with substance use disorders, SAT programs should consider offering nicotine dependence treatment to the clients they serve.