Cigarette smoking is common and is linked with the use of other drugs, including alcohol. [1] However, new research has shown that those who quit smoking are more likely to have a sustained remission of other substance use disorders, highlighting the importance of quitting smoking in people who misuse more than one substance. [2]
The connection between smoking cessation & addiction recovery
Individuals with substance use disorders or alcohol addiction have a greater likelihood of also being addicted to nicotine, the main psychoactive substance in cigarettes. [2] Smoking rates are almost twice as high in those with substance use disorders compared to the general population, which may be a result of the shared neurobiological pathways between addictive substances. [2][3]
Importantly, the NIH PATH study found that those who quit smoking had a 42% greater odds of being in recovery from other substance use disorders. [2] This finding suggests that smoking cessation should be seen as an integral part of the recovery journey, rather than another challenge to address after achieving sobriety from other substances.
Overview of the NIH PATH study
The study analyzed data from 2,652 adults who had a history of substance use disorder and who had a change in their recovery status in the past 4 years. [2] The participants were asked about their smoking status and other substance use annually. [2] Those whose smoking status changed from ‘current’ to ‘former’ had an increased likelihood of also being in recovery for their other substance use. [2]
Why quitting smoking improves recovery outcomes
There are several reasons why quitting smoking can improve recovery outcomes for other substance use disorders. The following are some of these factors.
Improved abstinence self-efficacy
Stopping smoking can build confidence in your ability to overcome addiction. This can help strengthen the commitment to sobriety from other substances, proving to yourself that change is possible.
Improved physical and mental health
Smoking takes a toll on physical and mental health, notably affecting the cardiovascular and respiratory systems, alongside increasing anxiety and stress. Quitting smoking improves the health of these systems almost immediately, in addition to helping alleviate the risk of myocardial infarction (heart attack), cerebrovascular accident (stroke), peripheral artery disease, coronary heart disease, asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. These changes boost mental health, helping the individual to feel better overall and potentially also stopping other substance use.
Breaking addiction patterns
Smoking is intertwined with other substance use, as many people smoke while drinking or using drugs. Nicotine also involves the same dopamine reward pathways in the brain as other substances. Continuing to smoke maintains these behavioral triggers and continues to stimulate the reward system, making withdrawal symptoms and relapse more likely. Quitting smoking helps break these patterns and helps the dopamine reward system to reset properly.
How smoking interacts with other substance use disorders
Smoking is connected with other substance use in many ways. As mentioned, people often smoke at the same time as using other substances. Over time, this can lead to a learned behaviour where the individual closely associates smoking cigarettes with the use of other substances. It then becomes challenging to use one substance without the other.
Polysubstance use generally occurs to either enhance the effect of one drug or to manage the unwanted effects of another. [4] As nicotine activates the same reward pathway as other drugs, it can often make other substances feel more rewarding, leading to polysubstance use. [4] Some people also use nicotine to help manage withdrawal symptoms of substances, which can often be seen as the ‘lesser of two evils’. Social and environmental factors, like seeing friends at a bar, can trigger cravings for multiple substances simultaneously.
Integrating smoking cessation into addiction treatment
It’s now known that smoking cessation has a positive impact on addiction treatment. [5] Integrating smoking cessation into addiction treatment is generally thought to provide better long-term outcomes than sequential treatment, i.e., addressing smoking cessation after undergoing recovery from other substance use disorders. Many substance use treatment programs now incorporate smoking cessation into their programs.
This integrated approach recognizes that addiction often involves multiple substances. By having a comprehensive treatment that addresses all substances together, it can be easier to get to the root of the addiction and change behaviours relating to this, rather than just treating each substance in isolation. This approach often leads to a stronger foundation for long-term sobriety and improved quality of life.
Although research supports integrated treatment, medical and mental health professionals recognize that each person's recovery journey is unique and will tailor treatment plans accordingly.
Addressing common concerns
Some people may get overwhelmed at the thought of becoming abstinent from multiple substances in one go, and it’s important to discuss any concerns with your medical professional. Although this can seem daunting, integrated treatment is often the most effective in order to break old habits. It can be challenging and will likely cause intense cravings, but with a structured treatment plan and both professional and social support, recovery can be achieved.
The risk of relapse significantly falls the longer the period of total abstinence, and quitting smoking does not increase this risk. In fact, many people find that after the initial adjustment period, their overall stress levels decrease, increasing their confidence from successfully overcoming multiple dependencies at once. This improves abstinence self-efficacy, motivating ongoing recovery.
Practical steps for quitting smoking during recovery
The following steps can help increase the chances of success when quitting smoking during substance use recovery:
- Nicotine replacement therapy (NRT). This comes in multiple forms, like gum or patches, and can help significantly reduce cravings for cigarettes. NRT options can be discussed with your medical provider.
- Avoid triggers. Triggers could include people, places, and activities associated with smoking. These are best avoided, especially early on, while cravings are likely to be stronger.
- Strong support network. Having a strong network of friends, family, and medical professionals can help support you during quitting.
- Healthy lifestyle. Regular exercise, enough sleep, and a balanced diet can all help to combat cravings.
- Medication. Several medications can help with smoking cessation. If you feel these could be beneficial to you, this can be discussed with your medical provider.
Conclusion
This new research clearly shows that quitting smoking significantly improves recovery outcomes from other substance use disorders. The interconnected nature of nicotine addiction with other substances means that addressing smoking cessation alongside other addiction treatment creates a stronger foundation for long-term sobriety.
While the prospect of quitting multiple substances simultaneously may seem overwhelming, integrated treatment approaches supported by healthcare professionals, strong support networks, and practical strategies offer the most effective path to sustained recovery. By breaking free from all substances together, individuals not only improve their physical and mental health but also build the confidence necessary for lasting change.
