Does smoking intervention influence adolescent substance use disorder treatment outcomes?

Cause for concern: Australian youth engaged with alcohol and other drug services are falling behind our community progress in reducing tobacco use

AIM

Tobacco use is decreasing in the general youth population yet little evidence is tracking changes in young people who are engaged with youth alcohol and other drug (AOD) services that are often disengaged from school and wok settings.

METHOD

This study reviews tobacco use amongst 1823 young people engaged with youth AOD services in Victoria in 2013 and 2017 from the Youth Needs Census. This study contrasted use patterns over the three-year period against Australian population data.

RESULTS

The results show tobacco use is not declining in the youth AOD engaged population as observed with other young Australians. Further, reductions in tobacco use observed in the community sample were not evident in the youth AOD group. Finally, high rates of tobacco dependence are shown in the 2016 cohort.

CONCLUSION

The results highlight a need for the adoption of evidence-based tobacco early intervention programs in youth AOD services to address this significant health risk.

Using Facebook to address smoking and heavy drinking in young adults: Protocol for a randomized, controlled trial

INTRODUCTION

Tobacco and alcohol often are used simultaneously by young adults, and their co-use is associated with greater health consequences than from single use. Social media platforms offer low cost and highly accessible channels to reach and engage young people in substance use interventions. The current trial seeks to compare the Facebook Tobacco Status Project (TSP) smoking cessation intervention to an intervention targeting both tobacco use and heavy episodic drinking (TSP + ALC) among young adults who use both substances.

METHODS

This randomized clinical trial will evaluate the feasibility and initial efficacy of TSP + ALC compared to TSP with 225 US young adult smokers reporting heavy drinking. Participants will be recruited online and randomized to one of two conditions (TSP or TSP + ALC), both with assignment to a Facebook group tailored to readiness to quit smoking. Groups will receive a 90-day intervention including daily Facebook postings and weekly live counseling sessions. The TSP + ALC group will include content related to alcohol use. All participants will be offered a 2-week introductory supply of nicotine patch. Participants will complete baseline, 3-, 6-, and 12-month online assessments of substance use and other health risk behaviors. The primary efficacy outcome is biochemically-verified 7-day point prevalence abstinence. Secondary outcomes include alcohol and tobacco use, combined use, and thoughts about each substance.

DISCUSSION

This trial examines an innovative and scalable approach to engaging young adults online in tobacco and alcohol use treatment. Study findings will inform digital health interventions and best practices for treating multiple substance use in young adults.

Tobacco cessation interventions for young people

BACKGROUND

Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.

OBJECTIVES

To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO.

SELECTION CRITERIA

We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up.

MAIN RESULTS

Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias.

AUTHORS' CONCLUSIONS

There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

Impact of quitting smoking and smoking cessation treatment on substance use outcomes: An updated and narrative review

BACKGROUND

Historically, smoking cessation was thought to negatively impact substance use outcomes among smokers who use other substances. We sought to synthesize recent reports on this association.

METHODS

Google Scholar, PubMed, and Cinahl were searched for studies published from 2006 to March 29, 2016 that reported impact of smoking cessation treatment or quitting smoking on substance use or substance use disorder treatment outcomes in the general population and among those in substance abuse treatment. Studies were grouped by reported impact as follows: "positive" (i.e. improved), "null" (i.e. no change), or "negative" (i.e. worsened).

RESULTS

Twenty-four studies were included. Eighteen reported the impact of quitting smoking and six reported the impact of smoking cessation treatment intervention, independent of quitting, on substance use outcomes. Eleven studies (46%) reported solely positive impact; four (17%) reported solely null impact; eight (33%) reported mixed positive and null impact by analysis (combined and subgroup, n=1); substance (n=4); length of follow-up (n=2); and comparison group (n=1). One study (4%) reported mixed negative and null impact by ethnic group. No studies reported increased substance use.

CONCLUSION

Smoking cessation does not appear to have a negative effect, and often has a positive effect on substance use outcomes. Smoking cessation advice should be offered, without hesitation, to smokers who report substance use and those in treatment for substance use disorder.

Tobacco cessation interventions for young people

BACKGROUND

Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the second update of a Cochrane review first published in 2006.

OBJECTIVES

To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialized Register in February 2013. This includes reports for trials identified in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsyclNFO.

SELECTION CRITERIA

We included randomized controlled trials, cluster-randomized controlled trials and other controlled trials recruiting young people, aged less than 20, who were regular tobacco smokers. We included any interventions; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months follow-up among those who smoked at baseline.

DATA COLLECTION AND ANALYSIS

Both authors independently assessed the eligibility of candidate trials and extracted data. Included studies were evaluated for risk of bias using standard Cochrane methodology. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at longest follow-up.

MAIN RESULTS

Twenty-eight trials involving approximately 6000 young people met our inclusion criteria (12 cluster-randomized controlled trials, 14 randomized controlled trials and 2 controlled trials). The majority of studies were judged to be at high or unclear risk of bias in at least one domain. Many studies combined components from various theoretical backgrounds to form complex interventions.The majority used some form of motivational enhancement combined with psychological support such as cognitive behavioural therapy (CBT) and some were tailored to stage of change using the transtheoretical model (TTM). Three trials based mainly on TTM interventions achieved moderate long-term success, with a pooled risk ratio (RR) of 1.56 at one year (95% confidence interval (CI) 1.21 to 2.01). The 12 trials that included some form of motivational enhancement gave an estimated RR of 1.60 (95% CI 1.28 to 2.01). None of the 13 individual trials of complex interventions that included cognitive behavioural therapy achieved statistically significant results, and results were not pooled due to clinical heterogeneity. There was a marginally significant effect of pooling six studies of the Not on Tobacco programme (RR of 1.31, 95% CI 1.01 to 1.71), although three of the trials used abstinence for as little as 24 hours at six months as the cessation outcome. A small trial testing nicotine replacement therapy did not detect a statistically significant effect. Two trials of bupropion, one testing two doses and one testing it as an adjunct to NRT, did not detect significant effects. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions.

AUTHORS' CONCLUSIONS

Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence or continuous abstinence at six months), especially those incorporating elements sensitive to stage of change and using motivational enhancement and CBT. Given the episodic nature of adolescent smoking, more data is needed on sustained quitting. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. There is not yet sufficient evidence to recommend widespread implementation of any one model. There continues to be a need for well-designed adequately powered randomized controlled trials of interventions for this population of smokers.

Marijuana and tobacco co-use in young adults: patterns and thoughts about use

OBJECTIVE

We examined the frequency and intensity of tobacco use and thoughts about abstinence among young adults in the United States as a function of their use of marijuana. We hypothesized that heavier marijuana use would be associated with heavier tobacco use and fewer attempts to quit smoking, and we explored relationships between marijuana use and ratings of intentions and thoughts related to quitting tobacco.

METHOD

This was a cross-sectional survey consisting of online recruitment and anonymous self-report. Participants were English literate, were between the ages of 18 and 25 years, and reported past-month tobacco use. More than half (53%) had smoked marijuana in the past 30 days. Tobacco use (quantity/frequency, Heavy Smoking Index, past-year quit attempt), thoughts about tobacco use (outcome expectancies, desire, self-efficacy, difficulty of quitting, abstinence goal, pros and cons, stage of change), alcohol use, and other drug use were assessed.

RESULTS

Compared with those who smoked only tobacco, cousers were younger and had smoked for fewer years; had higher household income; were more likely to be male, multiethnic, and nondaily smokers; and reported greater alcohol and other drug use. The variable of days using marijuana in the past 30 days was associated with multiple measures of tobacco use intensity/frequency. Only one association was significant between marijuana use and tobacco-related cognitions: Cousers had a lower likelihood of planning to quit tobacco for good (odds ratio = 0.75, 95% CI [0.58, 0.98]).

CONCLUSIONS

Findings support the association between tobacco and marijuana use among young people but speak to the importance of addressing tobacco cognitions in young adult smokers regardless of level of marijuana use.

Validity and reliability of the nicotine and marijuana interaction expectancy (NAMIE) questionnaire

BACKGROUND

The co-occurring use of tobacco and marijuana among young people is a concern, yet little research has examined processes of co-use. Understanding expectancies around use of the two substances will help identify intervention targets. This study examined psychometric properties of the Nicotine and Marijuana Interaction Expectancy (NAMIE) questionnaire based on three modified scales of the Nicotine and Other Substance Interaction Expectancy (NOSIE) questionnaire.

METHOD

An anonymous online survey recruited participants (N=1152) age 18-25 (mean age 20 years, 67% male, 72% Caucasian) who reported use of cigarettes and marijuana in the past 30 days. Analyses examined reliability and validity of the NAMIE.

RESULTS

A confirmatory factor analysis indicated good model fit for a 3-factor model. Scales were marijuana increases tobacco use and urges, tobacco increases marijuana use and urges, and smoking to cope with marijuana urges. Subscales correlated significantly with measures of cigarette smoking (r=.08 to .27, p<.01) and nicotine dependence (r=-.07 to -.20, p<.01), marijuana use (r=.08 to .29, p<.01) and dependence (r=.27 to .42, p<.01), percent of days using both cigarettes and marijuana in the past 30 days (r=.15 to .30, p<.01), thoughts about tobacco and marijuana abstinence (r=-.09 to .44, p<.01), and motivation to quit using marijuana (F=9.43, p<.001). When entered into a regression model, variables of use and thoughts about use remained significant.

CONCLUSIONS

The NAMIE was well-adapted for use with a marijuana-using community sample of young adult smokers.

Tobacco use among African-American youth receiving behavioral healthcare services

African-American youth with behavioral health problems may be particularly vulnerable to tobacco use and dependence; however, little is known about overall prevalence and factors associated with tobacco use in this population. The present study compared rates of tobacco use for African-Americans (aged 13-17) receiving behavioral healthcare services to state and national prevalence rates. In addition, we examined whether tobacco use prevalence was related to treatment characteristics and services rendered. Retrospective chart reviews were conducted at an urban, public behavioral healthcare agency for youth admitted in 2009. Tobacco use rates among African-Americans receiving behavioral healthcare services were similar to, and in some cases, higher than statewide and national prevalence rates. While tobacco users were more likely to be enrolled in a substance abuse program than in a mental health program, only 2 of 55 youth reporting tobacco use had received documented tobacco cessation treatment. Future work should focus on implementing tobacco cessation prevention and treatment for these youth.

Correlates of tobacco dependence and motivation to quit among young people receiving mental health treatment

BACKGROUND

Young people with mental health concerns are at high-risk for initiation and continuation of tobacco use. To inform treatment needs, the current study sought to describe tobacco dependence, motivations to quit and associated sociodemographic factors among young people seen in mental health settings.

METHODS

Sixty adolescent and young adult smokers (age mean=19.5 years, range 13-25) receiving outpatient mental health treatment completed measures of tobacco dependence, motivation to quit smoking, mental health, and social environmental factors.

RESULTS

Participants averaged 8.0 cigarettes per day (SD=6.6) and moderate nicotine dependence (mFTQ M=4.8, SD=1.6). Participants' mean rating (10-point scales) of perceived difficulty with avoiding relapse during a quit attempt was significantly higher (M=6.7, SD=2.6), than ratings of desire (M=5.1, SD=2.6) and perceived success (M=4.6, SD=2.6) with quitting. Over half (52%) did not intend to quit smoking in the next 6 months, and few (11%) were prepared to quit in the next 30 days. Mental health treatment and symptomatology measures were unrelated to level of dependence or motivation to quit. Among the social environmental factors, having close friends who smoke was associated with greater perceived difficulty with avoiding relapse during a quit attempt (r=0.25, p<0.01).

CONCLUSIONS

In this sample of adolescent and young adult smokers in mental health treatment, moderate levels of tobacco dependence and motivation to quit were observed and found to be unrelated to mental health measures. Over half of the sample was not intending to quit smoking in the near future, supporting the need for treatment strategies aimed at increasing motivation.

Tobacco and marijuana use among adolescents and young adults: a systematic review of their co-use

Tobacco (TOB) and marijuana (MJ) are the most widely used drugs among adolescents and young adults. The literature on their co-use, however, has not been systematically reviewed. We identified 163 English language articles published from 1999 to 2009 examining TOB and MJ co-use, correlates or consequences of co-use, or interventions for prevention or cessation of co-use with participants aging 13-25 years. Most studies (n=114, 70%) examined TOB and MJ co-use, and 85% of relationships studied indicated a significant association. Fifty-nine studies (36%) examined correlates or consequences of co-use. Factors consistently associated with increased likelihood of co-use, defined as significant associations in at least four studies, were African-American ethnicity, mental and physical health characteristics (e.g., high-intensity pleasure temperament), and school characteristics (e.g., good grades). The only consistent consequence of co-use was exacerbation of mental health symptoms. Few studies examined prevention (n=3) or cessation (n=2) interventions for TOB and MJ co-use, and the findings were stronger for prevention efforts. A sufficient literature base has documented that TOB and MJ use are strongly related in young people, yet few consistent correlates and consequences of co-use have been identified to inform intervention targets.

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment

Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040-0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105-0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.

Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders

BACKGROUND

Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n=303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD.

METHODS

Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo).

RESULTS

Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8±1.1 to 6.2±1.1 cigarettes per day).

CONCLUSIONS

Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel.

A Review of Multiple Health Behavior Change Interventions for Primary Prevention

Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. Treating 2 addictions, including smoking, resulted in greater long-term sobriety from alcohol and illicit drugs. MHBC intervention effects were stronger and more consistent for cancer prevention than CVD prevention. MHBC interventions offer a new paradigm for broader, more comprehensive health promotion; however, the potential value in maximizing intervention impact is largely unmet.

A Review of Multiple Health Behavior Change Interventions for Primary Prevention

Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. Treating 2 addictions, including smoking, resulted in greater long-term sobriety from alcohol and illicit drugs. MHBC intervention effects were stronger and more consistent for cancer prevention than CVD prevention. MHBC interventions offer a new paradigm for broader, more comprehensive health promotion; however, the potential value in maximizing intervention impact is largely unmet.

Cannabis consumption initiation among adolescents: a longitudinal study

This study aimed to investigate factors related to initiation of cannabis consumption among adolescents. A questionnaire was administered to 2043 14-15-year-olds from Barcelona who were followed-up and re-interviewed after 15 months. A bivariate analysis was performed to identify the factors associated with consumption, and multivariate logistic regression was carried out to model cannabis initiation. Among matched students, 23.7% of non-users at baseline had started to consume 15 months later (23.0% boys and 24.2% girls). Among those who had reported occasional cannabis use, 30.3% reported consumption during the previous month at the follow-up survey. Factors associated with cannabis initiation among boys and girls were smoking, risky alcohol use and intention to consume cannabis. Among boys, other associated factors were frequenting bars or discotheques and not having organized activities in leisure time. Among girls, another risk factor for initiation was having cannabis-using friends. Cannabis initiation was facilitated by legal drug use, favorable attitudes and context-related variables. These results highlight the role of behavioral and contextual variables and support the importance of reinforcing social skills in preventive programs.

Intentions to quit smoking among youth in substance abuse treatment

INTRODUCTION

Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths' intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment.

METHODS

Participants were 178 adolescents who were in inpatient (n=90) or outpatient (n=88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD=1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale).

RESULTS

SUD youth intention to quit smoking averaged 4.9 out of 10 (SD=3.2), comparable to intention to quit drinking (M=5.3, SD=3.6), but lower than their intention to quit using drugs (M=6.0, SD=3.4). Teens' intentions to quit smoking were associated with nicotine dependence (r=-.30, p<.01) and smoking cessation related self-efficacy (r=.36, p<.01), but not with pretreatment substance use severity (r=-.15). Controlling for nicotine dependence, teens' intentions to quit smoking were positively related to smoking cessation self-efficacy (pr=.26, p<.01) and intention to quit using illicit drugs (pr=.15, p<.05), but unrelated to intention to quit drinking.

DISCUSSION

Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.

Effects on substance use outcomes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization

The purpose of this study was to compare substance involvement among psychiatrically hospitalized adolescent smokers who had received motivational interviewing (MI) versus brief advice (BA) for smoking cessation. One hundred and ninety-one (191) adolescent smokers (62.3% female; 15.4 years of age) were randomly assigned to MI (n=116) or BA (n=75). All patients were assessed at baseline, immediately after hospitalization, and at 1-, 3-, 6-, 9-, and 12-month follow-ups. Rates of substance use in the MI condition during follow-up increased from a low of 8.2% (SD=18.5) to a high of 15.4% (SD=30.0) substance use days, whereas in BA, substance use days increased from a low of 8.4% (SD=20.8) to a high of 21.4% (SD=35.2). The results of this study suggest that MI, relative to BA, for smoking cessation was associated with better substance use outcomes during the first 6 months following psychiatric hospitalization among adolescents. This finding is consistent with previous studies that have shown that smoking cessation does not have a detrimental effect on substance abuse treatment outcomes among youth.

Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings

This article reviews the research on the treatment of cigarette smoking in individuals who have comorbid mental illnesses or non-nicotinic addictions. The prevalence of smoking in mentally ill and substance-abusing populations is presented, as well as reasons for this high prevalence. The historical role of cigarettes and tobacco in mental illness and addiction is reviewed to help the reader better understand the pervasiveness of smoking in these disorders and the relative absence of intervention efforts in mental heath and addiction treatment settings. The article then discusses the several reasons for integrating smoking treatment into mental health and addiction settings. The outcome research for adult and adolescent comorbid smokers is reviewed, and barriers to treatment are discussed. The review closes with a brief discussion of models of integration and thoughts about prevention.