Summary: A large U.S. cohort analysis shows that adults recovering from alcohol or other drug addictions are significantly more likely to maintain long-term remission when they also stop smoking cigarettes. Using data from 2,652 participants in the ongoing PATH Study, researchers found that a change from current to former smoking was associated with substantially higher odds of sustained recovery from non-tobacco substance use disorders.
The association remained after accounting for multiple confounding factors, and it appeared across different analytic approaches. Experts involved with the study emphasize that these findings support treating tobacco use as an integral part of addiction care rather than a separate or lower-priority issue.
Key Facts
- Higher odds of recovery: Within-person change from current to former cigarette smoking was associated with increased odds of sustained recovery from other substance use disorders. Primary within-person analyses indicated about a 30% increase in odds, and lagged or sensitivity analyses reported increases near 42%.
- Nationally representative data: Results derive from the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative U.S. cohort, making the findings widely applicable to adults with substance use disorders.
- Clinical implications: The evidence supports integrating smoking cessation services into standard treatment and recovery programs for alcohol and other drug addictions.
Source: NIH
Researchers from the National Institutes of Health (NIH) analyzed longitudinal PATH Study data to determine whether quitting cigarette smoking predicts improved recovery from other substance use disorders (SUDs). The study focused on adults with a prior history of SUD who experienced changes in recovery status over a four-year period.
“We now have strong evidence from a national sample that quitting cigarette smoking predicts improved recovery from other substance use disorders,” said Nora Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA), which supported the research. The results reinforce the idea that multiple addictions should be addressed together rather than separately.
The analysis included 2,652 adults aged 18 and older who were assessed annually in the PATH Study. Investigators tracked smoking status—classified as never, former, or current—and measured SUD recovery using a validated screening instrument that distinguishes sustained remission from ongoing symptoms.
In within-person fixed-effects models that control for time-invariant individual differences, the change from current to former smoking predicted greater likelihood of SUD recovery. The main year-to-year analysis showed approximately a 30% increase in the odds of being in sustained recovery when a person transitioned from current to former cigarette use; additional lagged and sensitivity analyses found similar or stronger associations, with some models indicating roughly a 42% increase in odds.
People with alcohol or drug use disorders commonly also use nicotine, and prior research has suggested that smoking cessation may improve outcomes for other substance use disorders. However, earlier studies often relied on treatment samples for a single substance or on smoking cessation trials rather than nationally representative cohorts. This PATH Study analysis addresses that gap by using a large, diverse sample and analytic methods designed to reduce confounding.
Investigators emphasize that the findings are consistent with using smoking cessation as part of comprehensive recovery planning. “Although the health benefits of quitting smoking are well-known, smoking cessation has not always been prioritized in addiction treatment settings,” said Wilson Compton, M.D., deputy director of NIDA and senior author of the study. “These results bolster the case for offering evidence-based tobacco treatment alongside care for other substance use disorders.”
The authors note that, while the longitudinal design and within-person methods strongly suggest that quitting smoking contributes to better recovery outcomes, further research is needed to establish a definitive causal relationship and to identify the best practices for integrating tobacco cessation into SUD treatment and recovery supports.
The PATH Study is an ongoing, nationally representative longitudinal cohort of youth and adults that evaluates tobacco use and related health outcomes. The study is funded by NIH and the U.S. Food and Drug Administration.
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About this addiction research news
Author: NIH Office of Communications
Source: NIH
Contact: NIH Office of Communications – NIH
Image: Image credited to Neuroscience News
Original Research: Closed access. “Cigarette Smoking During Recovery from Substance Use Disorders” by Wilson Compton et al., published in JAMA Psychiatry (DOI recorded in the original report).
Abstract
Cigarette Smoking During Recovery from Substance Use Disorders
Importance
Cigarette smoking is more common among people with other substance use disorders, yet smoking cessation services are often missing from SUD treatment settings. Understanding the relationship between smoking cessation and recovery from other SUDs can inform integrated care strategies.
Objectives
To evaluate whether within-person changes in cigarette smoking status are associated with sustained recovery from non-tobacco SUDs, using repeated measures in a nationally representative cohort.
Design, Setting, and Participants
This cohort study used data from the PATH Study, a longitudinal, nationally representative U.S. sample. Analyses included adults (aged 18 and older) from the 2013–2014 cohort assessed annually through 2016–2018 (wave 1 to wave 4). A second cohort (2016–2018 to 2022–2023) was used for sensitivity analyses. Data analysis was completed between June and September 2024.
Exposure
Cigarette smoking status (never, former, current).
Main Outcomes and Measures
The primary outcome was SUD recovery, defined using the Global Appraisal of Individual Needs–Short Screener SUD subscale: individuals with high lifetime SUD symptoms and zero past-year symptoms were classified as in sustained remission; those with any past-year symptoms were classified as current substance use or SUD. Fixed-effects logistic regression evaluated within-person smoking changes and their association with recovery while accounting for time-varying covariates and between-person confounding.
Results
Among 2,652 adults observed from 2013/2014 to 2016/2018, mean age was 39.4 years and 41.9% were female. Racial and ethnic composition included Hispanic (17.0%), non-Hispanic Black (13.9%), non-Hispanic White (63.1%), and other non-Hispanic races (6.0%). Within-person transition from current to former smoking was associated with higher odds of SUD recovery: the year-to-year change to former cigarette use corresponded to about a 30% increase in odds (OR, 1.30; 95% CI, 1.07–1.57) after adjusting for covariates. The association persisted when the predictor was lagged by one year (OR, 1.43; 95% CI, 1.00–2.05) and in the second cohort (OR, 1.37; 95% CI, 1.13–1.66).
Conclusions and Relevance
Within-person transitions from current to former cigarette smoking were associated with recovery from other substance use disorders in this nationally representative cohort. These findings suggest that smoking cessation could serve as a supportive component of recovery strategies and improve overall health among adults with SUDs. Further study is warranted to clarify causality and identify optimal methods for integrating tobacco treatment into addiction care.