Imagine a patient who has just conquered heroin dependence—only to succumb to a cigarette or vaping habit that shatters their lungs, steals decades from their life, and leaves them vulnerable to cancer and heart disease. This scenario is heartbreakingly common. If we ignore tobacco dependence in addiction treatment, we may help them save themselves from one peril only to condemn them to another.
The Harsh Truth: Incidence & Prevalence
• Tobacco use among SUD patients can be twice or more than the general population. Smoking rates for those in addiction recovery often fall between 49% and 98%—compared to ~14% in the general population.
• Over 80% of youth entering SUD treatment are current tobacco users— many heavy daily smokers destined for lifelong dependence.
• In France, nearly 73% of inpatient SUD patients were daily smokers— more than double the national average. • People with SUDs are more nicotine- dependent, more likely to relapse to tobacco, and more vulnerable—leading to thousands of extra deaths annually from smoking-related illnesses.
The Overlap Matters
• Tobacco remains the leading preventable killer in the U.S., claiming hundreds of thousands of lives yearly. • Continual nicotine use undermines recovery from other addictions— relapse rates are higher for those who keep smoking.
• Many treatment systems don’t routinely screen for tobacco, leaving it untreated even though patients are willing to quit—and an overwhelming majority want help.
Hope & Healing: Treatment Works Even Amid Other Addictions Pharmacotherapies
• Nicotine Replacement Therapy (NRT) (patches, gum, lozenges, sprays): Boost quit rates by 50–70%. Combining patch + lozenge offers even stronger results.
• Bupropion: Double the likelihood of quitting, on par with NRT.
• Varenicline and newer tools like cytisine and rTMS (brain stimulation) are promising, especially in resistant, dependent users.
Behavioral Interventions
• Cognitive Behavioral Therapy (CBT) and motivational interviewing help patients reframe coping strategies and resist cravings. In one study, CBT users had a 45% abstinence rate at 20 weeks versus 29% without.
• Brief interventions—even a respectful nudge—can tip the balance for those not yet ready to quit.
Integrated, Whole‐Person Care
• Treating tobacco and SUD simultaneously yields better outcomes for both: better substance recovery, stronger quit efforts, healthier gaps between relapse events.
• The American Society of Addiction Medicine (ASAM) and Truth Initiative strongly promote integrated treatment models.
Overcoming Barriers: Screening & Policies
• Only ~63% of hospital outpatients are screened for tobacco, and only 25% of smokers receive cessation advice or treatment.
• Staff attitudes matter: when treatment providers smoke, fewer patients get cessation support.
• Implementing routine screening, policies, and staff training can make screening and intervention second nature.
Why This Matters to Us—and to Every Patient
• Every cigarette extinguished is another chance at a full, thriving life. If our patients survive their initial addiction but die 10–20 years early from tobacco, have we truly healed them?
• Seeing a cigarette as “less harmful” in addiction treatment is a dangerous myth. In reality, it’s a co-addiction we can—and must—treat.
• It’s about dignity. Our patients deserve the full spectrum of care: physical, psychological, and emotional wellness.
How We Can Make a Change
• Mandate Universal TUD Screening— when they check in for alcohol, opioids, cocaine, ask about smoking.
• Offer Immediate Support: NRT on site, counseling referrals, quitline enrollment.
• Train Every Staff Member—from intake to therapist—in TUD treatment basics.
• Audit and Feedback monthly— how many were screened? How many offered treatment?
Tobacco use disorder isn’t a side note— it’s a co-conspirator in the suffering of our patients. When we screen for and treat TUD alongside other SUDs, we don’t just add years to life; we add life to years. Let’s refuse to leave cigarettes in the shadows. Because when we see tobacco as part of the addiction story, we ensure our patients hear its final chapter: Recovery, Peace, Renewal.
About PursueCare’s Medical Director
Dr. Kirby leverages his expertise in addiction medicine to deliver comprehensive, patient-centered care through a digital medical home model. He is the President of the Tennessee Society of Addiction Medicine and an expert in population health policy, healthcare economics, evidence-based outcomes-oriented addiction medicine, and human behavior. He is dual board-certified in addiction medicine from the American Board of Preventive Medicine and family medicine from the American Board of Family Medicine.