EFFECT OF TREATMENT FOR NICOTINE DEPENDENCE ON ALCOHOL AND DRUG-TREATMENT OUTCOMES

This study was designed to examine the effect of a policy banning smok ing and a smoking-cessation intervention on alcohol and drug treatment outcomes. We compared long-term alcohol and drug treatment outcomes i n two cohorts hospitalized for substance use treatment, subjected to d ifferent smoking policies and cessation interventions in two periods. The study included 314 male patients, aged 18-65. The intervention coh ort was subjected to a total hospital smoking ban and concurrent drug and nicotine dependency treatment, with a requirement for nicotine abs tinence during hospitalization. The control cohort was hospitalized un der a policy permitting smoking in designated areas, with no specific smoking-cessation intervention. Current alcohol, drug, and tobacco use were ascertained by follow-up interview with patients 8-21 months aft er completion of treatment. There was a 60% response rate in the inter vention group (n = 92) and a 66% response rate in the control group (n = 105). Among respondents, there were no significant differences betw een intervention and control groups in rates of ''improvement'' for al cohol, cocaine, or marijuana use, or for these drugs combined, althoug h there was a nonsignificant trend toward less ''improvement'' in the intervention group. When nonrespondents were analyzed as treatment fai lures, the rate of ''improvement'' was significantly worse for cocaine users in the intervention group, but not for other drug users or for all patients combined. Ten percent of patients reported quitting smoki ng in the intervention group compared to 4% in the control group (diff erence not significant). Although patients resisted the mandatory natu re of the smoking intervention, many continuing smokers requested info rmation and referral for smoking cessation at the time of follow-up. T hese data suggest that concurrent intervention for nicotine dependence did not significantly harm treatment outcomes of patients using alcoh ol or marijuana as their drug of first choice. Due to a trend in this direction, this possibility should be investigated in randomized, cont rolled trials. The intervention was associated with a small increase i n self-reported smoking cessation. There is considerable interest in t his patient population in smoking cessation after completion of treatm ent.