The Untreated Addiction: Going Tobacco-Free in a VA Substance Abuse Residential Rehabilitation Treatment Program (SARRTP)

  • Megan ConradEmail author
  • Teri Bolte
  • Leigh Gaines
  • Zackery Avery
  • Linda Bodie


Despite negative effects of tobacco on the human body and the high prevalence of smoking among those who enter treatment for substance use, few residential programs endorse a tobacco-free policy. Conventional wisdom suggests that it is overwhelming to quit more than one substance at a time, and as a result, many clinicians believe that a shift to a tobacco-free treatment environment is unfeasible. However, the most recent scientific literature suggests the opposite: targeting tobacco use during substance use treatment can increase abstinence rates from both smoking and substances of choice. Therefore, the purpose of the current project is to outline the process by which a residential substance use treatment program within a Veterans Affairs (VA) medical center implemented a tobacco-free policy. In addition, preliminary program evaluation data dispels the myth that eliminating tobacco use in a residential treatment program leads to a decline in patient interest and program utilization.


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Baca CT, Yahne CE. Smoking Cessation during Substance Use Treatment: What You Need to Know. Journal of Substance Use Treatment. 2009;36(2):205–219.CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention (CDC). Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report. 2008;57(45):1226–1228.Google Scholar
  3. 3.
    Sarna L, Bialous SA, Rice VH, et al. Promoting Tobacco Dependence Treatment in Nursing Education. Drug Alcohol Review. 2009;28(5):507–516.CrossRefGoogle Scholar
  4. 4.
    U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington, DC: U.S. Government Printing Office, 2000.Google Scholar
  5. 5.
    Hser YI, McCarthy WJ, Anglin MD. Tobacco Use as a Distal Predictor of Mortality among Long-Term Narcotics Addicts. Preventive Medicine. 1994;23(1):61–69.CrossRefGoogle Scholar
  6. 6.
    Hurt RD, Offord KP, Croghan IT, et al. Mortality Following Inpatient Addictions Treatment: Role of Tobacco Use in a Community-Based Cohort. The Journal of the American Medical Association. 1996;275(14):1097–1103.CrossRefGoogle Scholar
  7. 7.
    Guydish J, Passalacqua E, Tajima B, et al. Smoking Prevalence in Addiction Treatment: A Review. Nicotine & Tobacco Research. 2011;13(6):401–411.CrossRefGoogle Scholar
  8. 8.
    Olsen Y, Alford DP, Horton NJ, et al. Addressing Smoking Cessation in Methadone Programs. Journal of Addictive Diseases. 2005;24(2):33–48.CrossRefGoogle Scholar
  9. 9.
    Richter KP, Choi WS, McCool RM, et al. Smoking Cessation Services in U.S. Methadone Maintenance Facilities. Psychiatric Services. 2004;55(11):1258–1264.CrossRefGoogle Scholar
  10. 10.
    Friedmann P, Jiang L, Richter KP. Cigarette Smoking Cessation Services in Outpatient Substance Abuse Treatment Programs in the United States. Journal of Substance Abuse Treatment. 2008;34(2):165–172.CrossRefGoogle Scholar
  11. 11.
    Fuller BE, Guydish J, Tsoh J, et al. Attitudes Toward the Integration of Smoking Cessation Treatment into Drug Abuse Clinics. Journal of Substance Abuse Treatment. 2007;32(1):53–60.CrossRefGoogle Scholar
  12. 12.
    Goldsmith RJ, Knapp J. Towards a Broader View of Recovery. Journal of Substance Abuse Treatment. 1993;10(2):107–111.CrossRefGoogle Scholar
  13. 13.
    Gulliver SB, Kamholz BW, Helstrom AW. Smoking Cessation and Alcohol Abstinence: What Do the Data Tell Us? Alcohol Research & Health. 2006;29(3):208–212.Google Scholar
  14. 14.
    Bobo JK, Slade J, Hoffman AL. Nicotine Addiction Counseling for Chemically Dependent Patients. Psychiatric Services. 1995;46(9):945–947.CrossRefGoogle Scholar
  15. 15.
    Richter KP. Good and Bad Times for Treating Cigarette Smoking in Drug Treatment. Journal of Psychoactive Drugs. 2006;38(3):311–315.CrossRefGoogle Scholar
  16. 16.
    Prochaska JJ. Failure to Treat Tobacco Use in Mental Health and Addiction Treatment Settings: A Form of Harm Reduction? Drug and Alcohol Dependence. 2010;110(3):177–182.CrossRefGoogle Scholar
  17. 17.
    Prochaska JJ, Fromont SC, Louie AK, et al. Training in Tobacco Treatments in Psychiatry: A National Survey of Psychiatry Residency Training Directors. Academic Psychiatry. 2006;30(5):372–378.CrossRefGoogle Scholar
  18. 18.
    Richter KP, McCool RM, Okuyemi KS, et al. Patients’ Views on Smoking Cessation and Tobacco Harm Reduction During Drug Treatment. Nicotine & Tobacco Research. 2002;4(S2):S175–182.CrossRefGoogle Scholar
  19. 19.
    Guydish J, Passalacqua E, Tajima B, et al. Staff Smoking and Other Barriers to Nicotine Dependence Intervention in Addiction Treatment Settings: A Review. Journal of Psychoactive Drugs. 2007;39(4):423–433.CrossRefGoogle Scholar
  20. 20.
    Walsh RA, Bowman JA, Tzelepis F, et al. Smoking Cessation Interventions in Australian Drug Treatment Agencies: A National Survey of Attitudes and Practices. Drug and Alcohol Review. 2005;24(3):235–244.CrossRefGoogle Scholar
  21. 21.
    McCool RM, Richter KP, Choi WS. Benefits of and Barriers to Providing Smoking Treatment in Methadone Clinics: Findings from a National Study. American Journal on Addictions. 2005;14(4):358–366.CrossRefGoogle Scholar
  22. 22.
    Hurt RD, Croghan IT, Offord KP, et al. Attitudes Toward Nicotine Dependence among Chemical Dependence Unit Staff—Before and After a Smoking Cessation Trial. Journal of Substance Abuse Treatment. 1995;12(4):247–252.CrossRefGoogle Scholar
  23. 23.
    U.S. Department of Health and Human Services. Alcohol and Tobacco. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2007.Google Scholar
  24. 24.
    Burling TA, Burling AS, Latini D. A Controlled Smoking Cessation Trial for Substance-Dependent Inpatients. Journal of Consulting and Clinical Psychology. 2001;69(2):295–304.CrossRefGoogle Scholar
  25. 25.
    Cooney NL, Litt MD, Cooney JL, et al. Concurrent Brief versus Intensive Smoking Intervention During Alcohol Dependence Treatment. Psychology of Addictive Behaviors. 2007;21(4):570–575.CrossRefGoogle Scholar
  26. 26.
    Cooney NL, Litt MD, Sevarino KA, et al. Concurrent Alcohol and Tobacco Treatment: Effect on Daily Process Measures and Alcohol Relapse Risk. Journal of Consulting and Clinical Psychology. 2015;83(2):346–358.CrossRefGoogle Scholar
  27. 27.
    Joseph A, Lexau B, Willenbring M, et al. Factors associated with Readiness to Stop Smoking among Patients in Treatment for Alcohol Use Disorder. American Journal on Addictions. 2004;13(4):405–417.CrossRefGoogle Scholar
  28. 28.
    Richter KP, McCool RM, Catley D, et al. Dual Pharmacotherapy and Motivational Interviewing for Tobacco Dependence among Drug Treatment Patients. Journal of Addictive Diseases. 2005;24(4):79–90.CrossRefGoogle Scholar
  29. 29.
    Stack KM, Goalder JS, Calhoun PS, et al. Antismoking Interventions in Residential Substance Abuse Treatment. Journal of Addiction Medicine. 2008;3(2):103–108.CrossRefGoogle Scholar
  30. 30.
    Stein MD, Anderson BJ, Niaura R. Nicotine Replacement Therapy: Patterns of Use After a Quit Attempt among Methadone-Maintained Smokers. Journal of General Internal Medicine. 2006;21(7):753–757.CrossRefGoogle Scholar
  31. 31.
    Bobo JK, McIlvain HE, Lando HA, et al. Effect of Smoking Cessation Counseling on Recovery from Alcoholism. Addiction. 1998;93(6):877–887.CrossRefGoogle Scholar
  32. 32.
    Friend KB, Pagano ME. Changes in Cigarette Consumption and Drinking Outcomes: Findings from Project MATCH. Journal of Substance Abuse Treatment. 2005;29(3):221–229.CrossRefGoogle Scholar
  33. 33.
    Kalman D, Kahler CW, Garvey AJ, et al. High-Dose Nicotine Patch Therapy for Smokers with a History of Alcohol Dependence: 36-Week Outcomes. Journal of Substance Abuse Treatment. 2006;30(3):213–217.CrossRefGoogle Scholar
  34. 34.
    Frosch DL, Shoptaw S, Nahom D, et al. Associations between Tobacco Smoking and Illicit Drug Use among Methadone-Maintained Opiate-Dependent Individuals. Experimental and Clinical Psychopharmacology. 2000;8(1):97–103.CrossRefGoogle Scholar
  35. 35.
    Shoptaw S, Jarvik ME, Ling W, et al. Contingency Management for Tobacco Smoking in Methadone-Maintained Opiate Addicts. Addictive Behaviors. 1996;21(3):409–412.CrossRefGoogle Scholar
  36. 36.
    Wiseman EJ, McMillan DE. Relationship of Cessation of Cocaine Use to Cigarette Smoking in Cocaine-Dependent Outpatients. American Journal of Drug and Alcohol Abuse. 1998;24(4):617–625.CrossRefGoogle Scholar
  37. 37.
    Prochaska JJ, Delucchi K, Hall SM. A Meta-Analysis of Smoking Cessation Interventions with Individuals in Substance Use Treatment or Recovery. Journal of Consulting and Clinical Psychology. 2004;72(6):1144–1156.CrossRefGoogle Scholar
  38. 38.
    Guydish J, Tajima B, Kulaga A, et al. The New York Policy on Smoking in Addiction Treatment: Findings After 1 Year. American Journal Public Health. 2012;102(5):e17–25.CrossRefGoogle Scholar
  39. 39.
    Hughes JR. Motivating and Helping Smokers to Stop Smoking. Journal of General Internal Medicine. 2003;18(12):1053–1057.CrossRefGoogle Scholar
  40. 40.
    Williams JM, Foulds J, Dwyer M, et al. The Integration of Tobacco Dependence Treatment and Tobacco-Free Standards into Residential Addictions Treatment in New Jersey. Journal of Substance Abuse Treatment. 2005;28(4):331–40.CrossRefGoogle Scholar
  41. 41.
    Harris AHS, Kivlahan D, Barnett PG, et al. Longer Length of Stay is Not Associated with Better Outcomes in VHA’s Substance Abuse Residential Rehabilitation Treatment Programs. The Journal of Behavioral Health Services and Research. 2012;39(1):68–79.CrossRefGoogle Scholar
  42. 42.
    Heffner JL, Blom TJ, Camerota E, et al. Interrelated Effects of Substance Use Diagnosis, Race, and Smoking Severity on Abstinence Initiation in Dually Dependent Male Smokers: Results of a Retrospective Chart Review. Journal of Addiction Medicine. 2007;1(4):191–197.CrossRefGoogle Scholar
  43. 43.
    Heffner JL, Anthenelli RM. Smoking Cessation During Substance Abuse Treatment: Is It Mission Possible? Psychiatric Times. 2009;26(9):1–3.Google Scholar
  44. 44.
    Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, 2008.Google Scholar
  45. 45.
    Gifford EV, Tavakoli S, Wang R, et al. Tobacco Dependence Diagnosis and Treatment in Veterans Health Administration Residential Substance Use Disorder Treatment Programs. Addiction. 2013;108(6):1127–1135.CrossRefGoogle Scholar

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  • Megan Conrad
    • 1
    Email author
  • Teri Bolte
    • 2
    • 3
  • Leigh Gaines
    • 2
    • 3
  • Zackery Avery
    • 2
  • Linda Bodie
    • 2
    • 3
  1. 1.Summa Health Traumatic Stress CenterAkronUSA
  2. 2.Cincinnati VA Medical CenterCincinnatiUSA
  3. 3.Department of Psychiatry and Behavioral Neurosciences, College of MedicineUniversity of CincinnatiCincinnatiUSA

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