The prevalence of tobacco use is particularly high amongst people who use other drugs. This is made evident by data from the Australian drug and alcohol treatment sector, with reports of up to 90 per cent of clients being nicotine dependent. This is more than four times higher than rates for the general population.
Historically, there has been a reluctance amongst drug and alcohol treatment services to simultaneously address clients’ tobacco dependence, out of a concern that the extra challenge may hinder outcomes by, in part, denying clients a well-loved “coping tool” as well as placing additional demands on expertise and staff time. And of course for many staff in the sector, smoking continues to be an effective “engagement tool” that creates an opportunity to develop rapport and conversation with clients.
Generally, even with specific treatment the rates of smoking cessation are very low amongst people who are drug dependent. In addition, studies suggest that smoking cigarettes causes substantial morbidity and mortality in people who are drug dependent. It has even been suggested that smoking can be more lethal to drug dependent patients than their primary illicit drug of choice.
Harm reduction approaches that pertain to tobacco include nicotine patches, nicotine chewing gum, and snuss.