While cigarette smoking has declined in the U.S. for the past several decades, since 2002 the prevalence of smoking has increased significantly among people with an illicit substance use disorder, according to a new study by researchers at Columbia University's Mailman School of Public Health and the City University of New York. Until now, little was known about whether the decline in smoking was also occurring among individuals with illicit substance use disorders. The findings are published online in the journal Addiction.
The data show that smoking rates increased among those with substance use disorders, including hallucinogens, inhalants, tranquilizers, cocaine, heroin, pain relievers, simulants, and sedatives, while cigarette smoking decreased among individuals with cannabis use disorders, as well as among those without any substance use disorders.
The researchers analyzed data from 725,010 Americans ages 12 and older in the National Survey on Drug Use and Health for 2002 to 2014. They found more than half of individuals with a substance use disorder (56 percent) reported cigarette use in the past month, compared with 18 percent of those without a substance use disorder. When cannabis use disorders were excluded, smoking rates for those with a substance use disorder climbed to 64 percent; among those with cannabis use disorder, 51 percent reported past month cigarette use.
"We found that cigarette use was not only disproportionately common among those with a substance use disorder, but that the odds of smoking were five times greater than that of the general population," said Renee Goodwin, PhD, in the Department of Epidemiology at the Mailman School of Public Health, and senior author. "And individuals with a substance use disorder other than cannabis were 7.5 times more likely to be smokers."
"Given the extremely elevated rates of smoking among persons with substance use disorders, it seems that neither population-based tobacco control efforts nor clinical smoking cessation strategies have reached or been as effective among persons with substance use disorders," noted Goodwin. "New and innovative public health strategies are needed if we are to reach those with substance use disorders and bring down the smoking rates among this vulnerable group of individuals."
"An increasing number of substance-use treatment programs are offering smoking cessation services, presenting an important opportunity for smoking cessation," observed Goodwin. "How substance disorder treatment programs can integrate smoking treatments into their service delivery most effectively, however, still remains an open question."
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