Nicotine treatment at the drug dependency program of the Minneapolis VA Medical Center. A researcher's perspective

Substance use disorder treatment professionals historically have been reluctant to address tobacco dependence in their patients, despite a high prevalence of smoking, unique health effects, and evidence of physical addiction to nicotine. We performed two prospective studies to examine (1) the feasibility of a smoke-free policy and nicotine treatment program in an inpatient drug and alcohol treatment program, and (2) the impact of this intervention on long-term treatment outcomes. In both studies we used self-reported data from two groups of patients; one hospitalized after the implementation of the intervention and a historical control. The first set of data indicated that patients were more interested in quitting smoking and were more likely to abstain from smoking after the policy was implemented than before. They did not feel quitting smoking would threaten abstinence, and the policy did not increase early discharges. The second study failed to show that the change in policy was associated with an adverse effect on drug and alcohol treatment outcomes. A small but significant positive effect was demonstrated for smoking cessation. These studies also showed that many patients regard smoking as different from the primary drug that brought them to treatment. Randomized clinical trials testing a variety of smoking intervention techniques are desperately needed in this population to scientifically determine effective methods to decrease smoking.