Smoking Cessation Programs Should Be Part of Drug Rehabilitation
WASHINGTON -- Breaking a drug habit is hard enough, but it may be harder if you're a smoker too. New research funded by the National Institute on Drug Abuse (NIDA) explores how craving tobacco also increases the urge to use illicit drugs if one already abuses drugs. Two studies in this month's American Psychological Association's (APA) Experimental and Clinical Psychopharmacology explore why smokers who use illegal drugs may have a harder time quitting their drug habit than nonsmokers. How tobacco and illicit drug use are related is also examined.
In a study that compared 32 opiate dependent smokers' and nonsmokers' drug usage, researchers Dominick L. Frosch, B.A., Steve Shoptaw, Ph.D., Deborah Nahom, M.S., and Murray E. Jarvik, M.D., Ph.D., found that smoking cigarettes is linked to illicit drug use among those who use illicit drugs. Among the findings: Opiate and cocaine use (determined by measuring the subject's urine toxicology) was substantially higher in heavy smokers than in chippers and nonsmokers (smokers who smoked five cigarettes or fewer a day were referred to as chippers, and those who smoked 20-40 cigarettes a day were referred to as heavy smokers).
"We learned that there is a connection between tobacco smoking and illicit drug use among drug-dependent persons such that the more cigarettes smoked, the more likely the person was to use illegal drugs," said Mr. Frosch. "This suggests that nicotine and other substances share similar brain pathways and reinforce cravings for each drug."
"These findings along with current research on tobacco and illicit drug use suggest that drug users who continue to use drugs while attempting to quit smoking are far less likely to actually quit using drugs. The implication of this," said the authors, "is that any smoking cessation program for this group should also target substance abuse during the intervention."
"Our findings strongly support others' work to show linkages between tobacco and opiate and cocaine use. Drug-dependent persons should be encouraged to give up tobacco smoking as this may give them a better shot at kicking their drug habit," said Frosch.
A second study found more evidence that tobacco cravings increased cravings for illicit drugs among drug users. In a study of 42 smokers who were classified as drug-dependent and not interested in quitting smoking, psychologist Stephen J. Heishman, Ph.D., and colleagues at the National Institute on Drug Abuse and Johns Hopkins School of Medicine found another link between tobacco and drug cravings among drug-abusing adults.
In the first of two experiments, participants were asked to listen to scripts containing positive, negative or neutral content with or without descriptions of people describing their urge to smoke. In the second experiment, the participants were asked to listen to scripts containing only positive content that had varying levels of intensity of people with tobacco cravings.
"The scripts describing urges to smoke produced significantly greater reports of tobacco cravings among the participants than the scripts having no urge descriptions," said Dr. Heishman. Furthermore, the scripts containing negative content without descriptions of urges to smoke still increased the drug users' urge to smoke compared with the content that contained positive or neutral content with no urge-to-smoke descriptions, according to the study.
Tobacco cravings also increased self-reported cravings for the drug of choice in both the urge and no urge conditions, said the authors. "Environmental stimuli that engender urges and cravings for tobacco also increased cravings for other drugs of abuse," said Dr. Heishman.
"We see from our two experiments that smoking urge cues did increase urges among our sample of drug abusers and that the varying intensity of urges portrayed in the scripts had an orderly intensity-related increase in tobacco cravings," said Dr. Heishman.
Previous studies using the same script manipulations, but, with smokers who wanted to quit, had a different result. The tobacco-craving scripts did not increase the smokers desire to smoke, possibly because the smokers had learned how to inhibit their cravings and thus increase their chances of quitting.
Article: "Associations Between Tobacco Smoking and Illicit Drug Use Among Methadone-Maintained Opiate-Dependent Individuals," Dominick L. Frosch, B.A., San Diego State University and University of California, San Diego, and Los Angeles Addiction Research Consortium; Steve Shoptaw, Ph.D., Los Angeles Addiction Research Consortium; Deborah Nahom, M.S., Los Angeles Addiction Research Consortium and University of Washington; and Murray E. Jarvik, M.D., Ph.D., Los Angeles Addiction Research Consortium and University of California, Los Angeles, Experimental and Clinical Psychopharmacology, Vol. 8, No.1.
Article: "Tobacco Craving: Intensity-Related Effects of Imagery Scripts in Drug Abusers," Richard C. Taylor, M.A., and Nichole A. Harris, B.A., National Institute of Drug Abuse; Edward G. Singleton, Ph.D., Johns Hopkins University School of Medicine; Eric T. Moolchan, M.D., and Stephen J. Heishman, Ph.D., National Institute on Drug Abuse, Experimental and Clinical Psychopharmacology, Vol. 8, No.1.
(Full text of the articles are available from the APA Public Affairs Office.)
Dominick L. Frosch, B.A., can be reached at (310) 479-9330 or drfrosch@ucsd.edu
Stephen J. Heishman, Ph.D., can be reached at (410) 550-1547 or sheish@intra.nida.nih.gov
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 159,000 researchers, educators, clinicians, consultants and students. Through its divisions in 52 subfields of psychology and affiliations with 59 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.
Journal
Experimental and Clinical Psychopharmacology