Patients in treatment for drug use disorders have a high prevalence of smoking, but treating nicotine dependence in outpatient substance abuse treatment (OSAT) facilities is uncommon. To evaluate the availability of smoking cessation services in US OSAT programs and to identify factors associated with offering such services, researchers analyzed interviews with 550 pairs of OSAT administrative directors and clinical supervisors completed between 2004 and 2005 from a nationally representative sample of programs.

• 41% of all programs offered either counseling or pharmacotherapy to help patients quit smoking, and 16.5% of all programs offered pharmacotherapy.
• Among programs offering pharmacotherapy, approximately one-third offered bupropion or other antidepressants, one-third offered nicotine replacement therapy, and one-third offered both.
• Factors independently associated with the availability of smoking cessation counseling or pharmacotherapy included hospital affiliation, breadth of services (more medical staff was associated with greater availability of smoking cessation medications), smoking assessment, and physical health as an important treatment goal.
• The availability of addiction treatment medications other than methadone was associated with a twofold increase in the availability of both smoking cessation counseling and pharmacotherapy services.
• Overall, 98% of OSAT programs were smoke-free.

Comments by James Harrison, MHS, CADC
This study points out that, although limited treatment for smoking cessation exists in OSAT settings, patients could benefit from more integrated services. Many states mandate smoke-free facilities, which have been shown to increase smoking cessation. Increased medical staff coupled with pharmacotherapy should be more broadly implemented to ensure effective delivery of smoking cessation programs for OSAT patients.

Comments by Julia H. Arnsten, MD, MPH, Associate Editor, Alcohol, Other Drugs, and Health: Current Evidence
Smoking is highly prevalent among patients in substance abuse treatment, but smoking cessation treatment in OSAT settings remains limited. To better integrate treatment for tobacco dependence with substance abuse treatment, new policies are needed at state and federal levels. Such policies, already implemented in some states, should include staff training and support of smoke-free OSAT programs.