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.