A new study from the Northern Medical Program (NMP) has found that tobacco-related illnesses accounted for a surprisingly large number of deaths among individuals diagnosed with alcohol- and drug-use disorders. People hospitalized with alcohol- or drug-use disorders were at a dramatically increased risk of death from 19 smoking-related conditions, such as smoking-related cancers, cardiovascular diseases, and respiratory diseases.

In the study, recently published in the international journal Drug and Alcohol Review, Dr. Russ Callaghan, NMP associate professor, and his research team looked at statewide linked hospital and death records in California over a fifteen year period (1990 to 2005) of individuals diagnosed with an alcohol- or drug-use disorder (alcohol, cocaine, methamphetamine, opioids, or marijuana). They found that during the 16-year study span, approximately 40-50 per cent of deaths in the alcohol and drug groups were smoking-related. Those with a substance-use disorder diagnosis were at approximately 2-4 times greater risk of death from a smoking-related cause than individuals of the same age, race, and sex in the general population.

“The prevalence of smoking is extremely high among people with substance-use disorders, approximately two to four times higher than in the general population. However, tobacco use in this population has usually been overlooked as an important clinical concern, and there is only limited research examining the impacts of smoking-related deaths in these groups,” says Dr. Callaghan, lead investigator.

“Our study is one of the first to show extremely elevated levels of smoking-related mortality among individuals with primary substance-use disorders related to alcohol, cocaine, opioids, methamphetamine, or marijuana use. The results highlight the importance of addressing nicotine dependence as a key clinical concern and integrating smoking-cessation options into treatment protocols for these individuals.”

While best-practice guidelines in many countries support the integration of concurrent treatment for nicotine dependence and alcohol/drug disorders, most clinical facilities do not offer integrated treatment, primarily because of constraints on resources, lack of capacity to train staff or the unsupported belief that smoking cessation may hinder recovery from alcohol- or drug-use disorders.

Dr. Callaghan plans to continue his research on the topic of smoking-related harms in special populations, including a current focus on youth tobacco-control policies.