Yes, nicotine and cannabis use are connected. In more ways than one.
Here’s an interesting study that expands much of what researchers had already found about the links between the two. Not just among the young, but older users as well.
Cigarette use linked to onset of, relapse to cannabis use disorder among adults
For instance, among younger cannabis users, it had already been shown that:
- Beginning nicotine at an earlier age predicts increased risk for Cannabis Use Disorder (CUD) among older teens
- Evidence of nicotine dependence (per DSM IV) among youth correlates with an earlier onset, heavier use pattern, and greater number of symptoms with CUD.
Now, we can add the following for adults:
- Smoking tobacco increases the risk of a CUD among those adults who also use cannabis.
- when a CUD does develop, it will likely be of a more severe type if the person was also a cigarette user.
- Tobacco smoking increases the risk of relapse among CUD patients.
The researchers conclude that “Attention to tobacco use is warranted in clinical and public health efforts to reduce the incidence, prevalence and negative consequences of CUDs…”
All good to know, but what does it mean for people in addictions treatment? For instance, should the clinician or program:
- Devote extra attention to providing tobacco cessation education?
- As part of a treatment plan, recommend that a client quit smoking?
- Encourage people in treatment to join a separate program for smoking cessation? Or offer smoking cessation as part of CUD treatment?
Most rehabs I’ve visited already ban smoking (or at least greatly restrict it) on the premises or during activities. Same for IOP/ OP clinics. That’s largely on the grounds that second-hand smoke is harmful to others. A few programs take the position that smoking is a ‘crutch’ that interferes with the emotional processing needed for recovery, but that’s not based in science.
“We keep it simple. You can’t smoke while you’re here,” explained one clinical director. “We hope the experience of being off it, the potential for money saved, improved health, will encourage them to stay smoke-free once they leave.” I asked for his best guess on how many followed up on that. He had no idea.
Later, I saw him out back having a smoke.
There was a time when 12 Step meetings could be a real barrier for nonsmokers. Not so much now, I think.
On a personal note, I know that having to sit through a 60-90-minute group session without a cigarette did help me decide to abandon my own longstanding cigarette habit, when I was 28. And I was leading the group.
Probably the worst smoking addiction I ever saw was with one of our staff psychiatrists. He occasionally tried to quit but invariably relapsed. I recall one morning he came onto the unit looking thoroughly discouraged. Another failed attempt. “You broke down and had a cigarette?” I asked.
A nod, followed by a confession: “I smoked a whole pack in two hours.” Astonishing even himself.
Nicotine addiction is stubbornly persistent. And if now we have evidence it can promote relapse to other substances, we should probably be paying closer attention.