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Around the world, those treated for addiction far more likely to smoke

20-country review finds substance abuse programs do not address tobacco use

University of California - San Francisco

People in addiction treatment programs around the world use tobacco at two to three times the rate of people who are not being treated for addiction, according to a review of research studies from 20 countries other than the United States.

The review, led by Joseph R. Guydish, PhD, a UC San Francisco professor of medicine and health policy, was published on Tuesday, Sept. 22, 2015 in the journal Addiction.

"When people come into treatment for drugs and alcohol, we are not treating another addiction that has a significant chance of eventually killing them, which is tobacco use," said Guydish. "At a public health level, this means that our addiction treatment efforts should address smoking and tobacco use better than they do now."

Guydish and his team reviewed 54 studies, involving a total of 37,364 participants in 20 countries on six continents, which were published in English from 1987 to 2013. They found that among people in treatment for drug and alcohol use, the overall rate of smoking was 84 percent, compared with a rate of 31 percent for members of the general population, matched for gender and year of study.

The results agree with an earlier review led by Guydish of smoking addiction treatment programs in the U.S. In that paper, the authors found that the median smoking rate among people in addiction treatment was 76.3 percent, in contrast with the smoking rate in the general U.S. population, which is now estimated at less than 18 percent.

"Every person who enters substance abuse treatment ought to have their tobacco use evaluated and treated," said Guydish. "If they don't want to be treated and quit right away, they should have some education to help them think more about quitting."

Guydish observed that "there are data from a number of studies which strongly suggest that you can improve substance treatment outcomes by addressing smoking among the patients in treatment. That's what we should be doing."

The World Health Organization (WHO) has created a policy package called MPOWER, noted Guydish, which is designed to assist countries in implementing anti-smoking initiatives. "We would recommend that WHO pay attention to this finding and use it to extend their MPOWER strategies," said Guydish. "Anyone who is interested in smoking reduction internationally could use this information at the policy level."

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Co-authors of the study are Emma Passalacqua, Anna Pagano, PhD, Thao Le, MPH, Barbara Tajima, MEd, Lindsay Docto, Daria Garina and Kevin Delucchi, PhD, of UCSF; Cristina Martínez of the Catalan Institute of Oncology-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain; and JongSerl Chun of Ewha Womans University, Seoul, South Korea.

The paper is titled, "An International Systematic Review of Smoking Prevalence in Addiction Treatment." The study was supported by funds from the National Institute on Drug Abuse and the UCSF Tobacco Related Disease Research Program.

UCSF is the nation's leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospitals.

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