CEASe: CEssation for substance Abusers from Smoking - A qualitative systematic review

First published: 10 May 2019 | Last updated: 20 May 2019

Background/Aims: The majority of patients in treatment/recovery for substance misuse also smoke tobacco. Many express a desire to quit and there is evidence for effective interventions that also improve substance misuse outcomes, yet support for smoking cessation is rarely offered. This study reviews qualitative literature on barriers and facilitators to smoking cessation and perceptions of patients and treatment providers about when interventions should be offered and their consequential impact on recovery from other substances.

Methods: Eight databases were systematically searched for studies on smoking cessation for people in substance misuse treatment/recovery. Thematic content analysis of reported qualitative data is in progress.

Results: 10,939 citations were screened, of which 508 appeared relevant. Full text screening has so far identified 11 studies for inclusion.

Emergent key themes include: participant motivation, and use of cigarettes for managing negative affect. Limited support and sometimes active discouragement of cessation from staff, due to lack of time, training, and managerial support in providing smoking cessation advice, or perceiving smoking cessation as not a priority, potentially affecting recovery from other substance misuse, potentially compromising the therapeutic relationship, and not part of their role. Influence of peer and staff smoking was also a barrier. Both patients and staff report concerns that tackling multiple addictions may be too challenging, although some patients perceived complete lifestyle change, tackling all their problems together, as beneficial.

Conclusions: Emergent findings of this ongoing review suggest openness to smoking cessation interventions among people in substance misuse treatment, but timing of delivery, and barriers and facilitators to success must be considered when designing interventions.


Dr Jean Craig, Norwich Medical School, University of East Anglia, Norwich, UK Professor Richard Holland, Norwich Medical School, University of East Anglia, Norwich, UK Dr Caitlin Notley, Norwich Medical School, University of East Anglia, Norwich, UK

Conflicts of interest:

Unfunded work.

Dr Sarah Gentry