Cochrane for Clinicians

Putting Evidence into Practice

Interventions for Tobacco Cessation in Patients Being Treated for or Recovering from Substance Use Disorders


Am Fam Physician. 2017 Nov 1;96(9):572-573.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are tobacco cessation interventions effective for patients being treated for or recovering from other substance use disorders?

Evidence-Based Answer

Pharmacotherapy alone and pharmacotherapy plus counseling are effective for tobacco cessation among patients being treated for or recovering from alcohol and substance use disorders (number needed to treat [NNT] = 21; 95% confidence interval [CI], 8 to 58 for patients receiving pharmacotherapy alone; NNT = 15; 95% CI, 9 to 28 for patients receiving pharmacotherapy plus counseling). Counseling interventions without pharmacotherapy are not effective for tobacco cessation among patients in treatment for or recovery from substance use disorders. There is no evidence that tobacco cessation interventions affect abstinence rates from alcohol or other drugs.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Smoking remains the leading cause of preventable death in the United States, and approximately 19% of adults report tobacco use.2 Among adults in early recovery from alcohol and substance use disorders, smoking rates are greater than 75%, with smoking-related mortality exceeding alcohol-related mortality in this population.3 Despite strong evidence supporting smoking cessation efforts in persons recovering from alcohol and substance use disorders, physicians remain apprehensive that smoking cessation may increase the risk of alcohol or substance use relapse.1 The authors examined the effectiveness of various smoking cessation interventions among patients in treatment for or recovery from alcohol and other non-tobacco substance use disorders, and whether smoking cessation increased the risk of relapse.

In this review, 34 randomized controlled trials involving 5,796 patients examined tobacco cessation counseling alone (11 studies); pharmacotherapy alone (i.e., nicotine replacement therapy [NRT], non-NRT, or the two combined; 11 studies); and counseling in c

Author disclosure: No relevant financial affiliations.


show all references

1. Apollonio D, Philipps R, Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database Syst Rev. 2016;(11):CD010274....

2. Centers for Disease Control and Prevention. Current cigarette smoking among adults—United States, 2011. MMWR Morb Mortal Weekly Rep. 2012;61(44):889–894.

3. Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict. 2005;14(2):106–123.

4. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;(5):CD009329.

5. Management of Substance Use Disorders Work Group. VA/DoD clinical practice guideline for the management of substance use disorders. Version 3.0. Washington, DC: Department of Veterans Affairs, Department of Defense; 2015.

6. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service; 2008.

7. Zyban (bupropion hydrochloride) sustained-release tablets [prescribing information]. Greenville, N.C.: GlaxoSmithKline; August 2011. Accessed September 24, 2017.

8. Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016;387(10037):2507–2520.

9. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA revises description of mental health side effects of the stop-smoking medicines Chantix (varenicline) and Zyban (bupropion) to reflect clinical trial findings. December 16, 2016. Accessed September 24, 2017.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at



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