15
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: not found
      • Article: not found

      Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders

      , , 1
      Cochrane Database of Systematic Reviews
      Wiley-Blackwell

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Smoking rates in people with alcohol and other drug dependencies are two to four times those of the general population. Concurrent treatment of tobacco dependence has been limited due to concern that these interventions are not successful in this population or that recovery from other addictions could be compromised if tobacco cessation was combined with other drug dependency treatment. To evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. We searched the Cochrane Tobacco Addiction Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and clinicaltrials.gov databases, with the most recent search completed in August 2016. A grey literature search of conference abstracts from the Society on Nicotine Research and Treatment and the ProQuest database of digital dissertations yielded one additional study, which was excluded. We included randomised controlled trials assessing tobacco cessation interventions among people in concurrent treatment for alcohol or other drug dependence or in outpatient recovery programmes. Two review authors independently assessed study risk of bias and extracted data. We resolved disagreements by consensus. The primary outcome was abstinence from tobacco use at the longest period of follow‐up, and the secondary outcome was abstinence from alcohol or other drugs, or both. We reported the strictest definition of abstinence. We summarised effects as risk ratios and 95% confidence intervals (CI). Two clustered studies did not provide intraclass correlation coefficients, and were excluded from the sensitivity analysis. We used the I 2 statistic to assess heterogeneity. Thirty‐five randomised controlled trials, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of nicotine replacement therapy (NRT) or non‐NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear. Analyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta‐analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.88, 95% CI 1.35 to 2.57, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow‐up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I 2 = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95). Interventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40). Offering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I 2 = 66%)). Data on adverse effect of the interventions were limited. The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence. There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs. The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency. The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment. Certain results were sensitive to the length of follow‐up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non‐NRT or combined pharmacotherapy. Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence. Background Tobacco use is a leading preventable cause of death worldwide, and smoking rates are especially high among people who are dependent on alcohol or other drugs. People who are being treated for alcohol or other drug addictions have not usually been offered treatment to help them stop smoking at the same time. There has been concern that trying to stop smoking might make people in treatment less likely to recover from other addictions. Study characteristics We looked for studies that enrolled adult smokers who were either in treatment or had completed treatment for substance abuse, in hospital, outpatient or community settings and randomised them to either a treatment to help them stop smoking or a control. We last searched for evidence in August 2016. We found 34 published studies. The types of smoking cessation treatment tested included: counselling (which might be a brief advice session or multiple sessions of behavioural support, either individually or in a group); medicine (called pharmacotherapy; including any type of nicotine replacement therapy, with or without other medicines that help smokers to stop smoking); or a combination of counselling and pharmacotherapy. We combined the results of trials separately for each of these types of treatment, although different trials used different treatments. People who were in the control groups received usual care, brief advice about quitting smoking, or were put on a waiting list to receive treatment later. Most trials assessed the number of people who had quit smoking at least six months after beginning treatment although we also included some studies with a shorter time. Key results Eleven studies with 1808 people tested the effects of various types of pharmacotherapy. There was evidence that people given pharmacotherapy were more successful at quitting smoking. Twelve studies with 2229 participants tested treatments that combined pharmacotherapy and counselling. There was evidence that people given combined treatments were more successful at quitting smoking. Eleven studies with 1759 people tested the effect of counselling compared to usual care. Combining these results did not show evidence of a benefit of counselling alone. Eleven studies with 2231 people reported whether people remained abstinent from alcohol and other drugs. Providing tobacco cessation interventions did not make people more likely to return to using alcohol or other drugs. We found no evidence that it made a difference whether people were given treatment to quit smoking when they were just starting treatment for other drug use or after they were in recovery. Results were also similar for people who were treated for alcohol use and for people who were treated for other drugs such as heroin. Quality of the evidence We judged the quality of the evidence to be low. Many studies did not give enough details about the methods that they used. The studies also considered very different types of treatment, making comparisons challenging.

          Related collections

          Most cited references83

          • Record: found
          • Abstract: found
          • Article: not found

          Outcome reporting bias in randomized trials funded by the Canadian Institutes of Health Research.

          The reporting of outcomes within published randomized trials has previously been shown to be incomplete, biased and inconsistent with study protocols. We sought to determine whether outcome reporting bias would be present in a cohort of government-funded trials subjected to rigorous peer review. We compared protocols for randomized trials approved for funding by the Canadian Institutes of Health Research (formerly the Medical Research Council of Canada) from 1990 to 1998 with subsequent reports of the trials identified in journal publications. Characteristics of reported and unreported outcomes were recorded from the protocols and publications. Incompletely reported outcomes were defined as those with insufficient data provided in publications for inclusion in meta-analyses. An overall odds ratio measuring the association between completeness of reporting and statistical significance was calculated stratified by trial. Finally, primary outcomes specified in trial protocols were compared with those reported in publications. We identified 48 trials with 68 publications and 1402 outcomes. The median number of participants per trial was 299, and 44% of the trials were published in general medical journals. A median of 31% (10th-90th percentile range 5%-67%) of outcomes measured to assess the efficacy of an intervention (efficacy outcomes) and 59% (0%-100%) of those measured to assess the harm of an intervention (harm outcomes) per trial were incompletely reported. Statistically significant efficacy outcomes had a higher odds than nonsignificant efficacy outcomes of being fully reported (odds ratio 2.7; 95% confidence interval 1.5-5.0). Primary outcomes differed between protocols and publications for 40% of the trials. Selective reporting of outcomes frequently occurs in publications of high-quality government-funded trials.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery.

            This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (> or = 6 months) were summarized with random effects models. Intervention effects for smoking cessation were significant at posttreatment and comparable for participants in addictions treatment and recovery; however, intervention effects for smoking cessation were nonsignificant at long-term follow-up. Smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. Short-term smoking cessation effects look promising, but innovative strategies are needed for long-term cessation. Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety. Copyright 2004 APA.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Addressing tobacco among individuals with a mental illness or an addiction.

              Tobacco dependence among individuals with a mental illness or an addiction is a tremendous problem that goes largely ignored. Studies of genetics, neuroimaging, and nicotinic receptors support a neurobiological link between tobacco use and alcohol dependence, drug dependence, schizophrenia, depression, attention-deficit hyperactivity disorder (ADHD), and anxiety disorders. This paper summarizes the recent literature on this topic and discusses how treatment for tobacco can no longer be ignored in mental-health and addiction-treatment settings. More research is needed as well as a national organized effort to address tobacco in this large segment of smokers.
                Bookmark

                Author and article information

                Journal
                Cochrane Database of Systematic Reviews
                Wiley-Blackwell
                14651858
                November 23 2016
                :
                :
                Affiliations
                [1 ]Cochrane Tobacco Addiction Group
                Article
                10.1002/14651858.CD010274.pub2
                6464324
                27878808
                db82bb10-ee54-4807-b46f-c126a2368de7
                © 2016
                History

                Comments

                Comment on this article