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Cigarette Smoking Increases the Likelihood of Drug Use Relapse

May 31, 2018
By Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer

This research:

  • Found that cigarette smoking increased the likelihood of relapse among people in recovery from substance use disorder (SUD).
  • Suggests that helping patients quit and remain abstinent from smoking may improve their chances for sustained recovery from use of other drugs.
Figure 1. Data Collection for a Study of How Smoking Influences the Likelihood of Sustained Abstinence from Substance Use All participants had histories of substance use disorder (SUD) and had abstained from drugs for a year at the start of the study. Participants reported their smoking status in 2001–2002, and again in 2004–2005. In the second interview, they also reported any drug use and any SUD diagnosis since the first interview.
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Dr. Andrea H. Weinberger of the Ferkauf Graduate School of Psychology, Yeshiva University; Dr. Renee D. Goodwin of the Graduate School of Public Health and Health Policy, City University of New York; and colleagues analyzed data provided by 5,515 people who responded to the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in 2001–2002 and again in 2004–2005. All of these people had a history of SUD but who were in remission from SUD and abstinent from drug use at the initial interview (Figure 1).

The researchers found that people who smoked cigarettes at the initial interview and who were still smoking 3 years later were about 1.5 times more likely to use drugs and twice as likely to have SUD at follow-up than those who quit smoking. Among nonsmokers at the initial interview, those who had started to smoke between interviews were almost 5 times more likely to report substance use at the follow-up compared with those who did not smoke (Figure 2).

Heavier smokers were even more likely to relapse to SUD. Among smokers at the initial interview, the odds of relapse increased by 0.7 percent for each cigarette smoked per day 3 years later. Among nonsmokers at the initial interview, the odds of relapse increased by 2.4 percent for each cigarette smoked per day 3 years later.

The researchers cite possible explanations why cigarette smoking might increase the likelihood of SUD relapse:

  • Cigarette smoking often accompanies illicit drug use, and cigarettes may serve as a drug cue and relapse trigger.
  • Some studies have linked nicotine exposure to cravings for stimulants and opiates.
Figure 2. Cigarette Smoking Reduces the Likelihood of Remaining Abstinent Study participants who continued to smoke or who began smoking during the 3 years between the two interviews reverted to substance use and relapsed to SUD at higher rates than those who did not smoke.
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Smoking and SUD Treatment

Smoking is pervasive among people with SUD, and some clinical lore and public opinion posit that concurrent smoking cessation is too difficult for patients struggling to abstain from substance use. It has even been suggested that smoking may help patients with SUD achieve early abstinence. However, this study and others indicate that patients may do better if treatment programs address smoking cessation and treatment for other substance use simultaneously.

“The perception that cigarette use helps with remaining abstinent from alcohol and other drugs has fostered a culture of smoking among this patient population,” Dr. Goodwin says. “So far, the bulk of evidence suggests that concurrent smoking cessation and substance use treatment is the most beneficial approach,” Dr. Goodwin notes.

Dr. Heather L. Kimmel, Health Scientist Administrator of NIDA’s Epidemiology Research Branch, agrees, adding, “Even though various substances have different pharmacological mechanisms, all drugs of abuse ultimately affect the same reward pathway. Abstinence from all of them will help the patient move to a new physiological state and, hopefully, a new mental state as well.”

This study was supported by NIH grant DA20892.


Weinberger, A.H., Platt, J., Esan, H., et al. Cigarette smoking is associated with increased risk of substance use disorder relapse: A nationally representative, prospective longitudinal investigation. Journal of Clinical Psychiatry 78(2):e152-e160, 2017.

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This page was last updated May 2018

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    NIDA. (2018, May 31). Cigarette Smoking Increases the Likelihood of Drug Use Relapse. Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2018/05/cigarette-smoking-increases-likelihood-drug-use-relapse

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