ADVISORY

2 Issue • 10 Volume • 1 201March 

Tobacco Use Cessation During 

Substance Abuse Treatment Counseling 

Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

Smoking tobacco causes more deaths among clients 

in substance abuse treatment than the alcohol or drug 

use that brings them to treatment. A seminal 11-year 

retrospective cohort study of 845 people who had 

been in addictions treatment found that 51 percent 

of deaths were the result of tobacco-related causes.1 

 

This rate is twice that found in the general population 

and nearly 1.5 times the rate of death by other 

addiction-related causes. Despite these statistics, 

most substance abuse treatment programs do not 

address smoking cessation. 

Many people have already successfully quit using 

tobacco. For example, according to the National 

Health Interview Survey of U.S. households 

conducted by the Centers for Disease Control 

and Prevention (CDC) in 2008, “Of the estimated 

94 million persons who had smoked at least 100 

cigarettes during their lifetimes, 51.1 percent 

(48.1 million) were no longer smoking at the time of 

the interview.”2 

 

Although the focus of this Advisory is on cessation of 

smoked tobacco, many of the cessation methods are 

also applicable to smokeless tobacco such as snuff 

or chewing tobacco because they address addiction 

to nicotine, the addictive substance in tobacco. This 

Advisory offers substance abuse treatment counselors 

a brief introduction to tobacco use cessation 

during substance abuse treatment. Counselors who 

would like additional information on the topic are 

encouraged to consult the Resources for Additional 

Information section on page 7. Administrators of 

treatment facilities can find additional information 

in the Advisory Tobacco Use Cessation Policies in 

Substance Abuse Treatment: Administrative Issues.3 

Tobacco Use Among Substance 

Abuse Treatment Clients 

Clients entering treatment for a substance use 

disorder (SUD) are more likely to be dependent on 

nicotine than are members of the general public. 

Seventy-five percent of people ages 12 and older 

 

 

 

 

 

 

Exhibit 1. Tobacco Use in the Past Month, People Ages 12 and Older, 2008 

*Tobacco products include cigarettes, smokeless tobacco (i.e., chewing tobacco and snuff), cigars, or pipe tobacco. 

†

Refers to treatment received at a hospital (inpatient), rehabilitation facility (inpatient or outpatient), or mental health center to reduce or 

stop illicit drug or alcohol use or for medical problems associated with illicit drug or alcohol use. 

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

SUD treatment, specialty 

facility 

Any SUD (illicit drug or 

alcohol abuse or 

dependence) 

Any illicit drug use 

disorder (abuse or 

dependence) 

Alcohol use disorder 

(abuse or dependence) 

Both an illicit drug use 

disorder and an alcohol 

use disorder 

General population 

Tobacco Use* 

Cigarette Use 

† 

Source: Office of Applied Studies. (2008). National Survey on Drug Use and Health, unpublished data. Rockville, MD: Substance Abuse 

and Mental Health Services Administration. 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

 

ADVISORY
 

who received substance abuse treatment at a specialty 

facility in the past year reported smoking cigarettes in 

the past month, compared with 24 percent of the general 

population (see Exhibit 1, page 1). Fifty-four percent of 

those ages 12 and older who reported alcohol abuse or 

dependence in the past year reported smoking cigarettes. 

Data show that 63 percent of people ages 12 and older 

with any SUD (illicit drug and/or alcohol abuse or 

dependence) in the past year also reported tobacco use in 

the past month, compared with 28 percent of the general 

population. 

Health Effects of Tobacco Use 

The detrimental effects of tobacco use are well 

documented. From 2000 to 2004, cigarette smoking 

and exposure to secondhand smoke resulted in at least 

443,000 premature deaths each year and $96.8 billion in 

productivity losses annually in the United States.4

 From 

2001 to 2004, smoking-related healthcare costs were 

$96 billion annually. Tobacco use is the leading cause of 

preventable disease and deaths in the United States.5

 It can 

cause diseases of the lungs and cardiovascular system as 

well as many cancers. 

Health Benefits of Tobacco Use 

Cessation 

The most important effects of tobacco use cessation are 

the immediate and long-term beneficial health changes:6 

●		Cigarette smoking accelerates age-related decline in 

lung function. However, with sustained abstinence 

from smoking, the rate of decline in pulmonary 

function returns to that of people who never smoked. 

●		Smoking cessation reduces rates of cough, productive 

cough, and wheezing, as well as respiratory infections 

such as bronchitis and pneumonia, compared with 

rates among people who continued smoking. 

●		After 1 year, the risk of coronary heart disease (CHD) 

is half of that of a person who smokes. After 15 years 

of abstinence, risk of CHD is similar to that of persons 

who have never smoked. 

●		After several years, stroke risk is reduced to that of a 

person who has never smoked. 

●		After 10 years of abstinence, the lung cancer death 

rate is about 30 to 50 percent of the risk of people who 

continue to smoke. 

●		The risks of mouth, throat, esophagus, bladder, cervix, 

and pancreatic cancers also decrease. 

A more recent report endorses the findings of the 1990 

study.5 

Symptoms of Nicotine Withdrawal 

Nicotine withdrawal symptoms are similar to those of 

other substances and to the symptoms of some behavioral 

health disorders. Some symptoms include:7 

●		An intense craving for nicotine. 

●		Tension, irritability, frustration. 

●		Mild depression, reduced ability to experience 

pleasure (anhedonia), dysphoria. 

●		Anxiety. 

●		Anger. 

●		Restlessness, difficulty concentrating. 

●		Increased appetite. 

Acute physiological nicotine-related withdrawal 

symptoms usually peak 24 to 48 hours after a person quits 

and diminish within a matter of weeks. The physiological 

cravings for nicotine usually last about 7 days but 

psychological cravings frequently last longer. Other 

psychological symptoms, such as mild depression and 

anhedonia, can last months to years.7

 Counselors should be 

prepared to assess all possible causes of these symptoms 

for clients who stop using tobacco. 

Counselors Can Treat Nicotine 

Addiction 

Treatment for nicotine dependence requires screening, 

assessing for readiness to change tobacco use behavior, 

and intervention. Counselors should ask clients who 

smoke or use other tobacco products about their interest in 

quitting while in substance abuse treatment.8 

Screening, brief intervention, and referral to treatment 

(SBIRT) for tobacco use cessation can be used. The 

National Institute on Drug Abuse has two valuable 

2 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

resources on SBIRT for tobacco use cessation, Resource 

Guide: Screening for Drug Use in General Medical Settings 

and Screening Tool Quick Reference Guide, available at 

http://www.drugabuse.gov/nidamed/; the latter resource 

Tobacco Use Cessation During Substance Abuse Treatment Counseling 

March 2011, Volume 10, Issue 2 

includes a screening tool, information on providing feedback 

to clients, and information on brief interventions. 

The Alcohol, Smoking and Substance Involvement 

Screening Test (ASSIST) is a useful tool to screen for 

Pregnant Women 

In addition to jeopardizing a woman’s health, smoking during pregnancy can disrupt fetal development. Smoking is linked to 

stillbirth, premature labor, low birth-weight, sudden infant death syndrome, and other conditions. In addition, cognitive, emotional, 

and behavioral problems in children are associated with a woman’s smoking during pregnancy. 

Some pregnant women may conceal their smoking or not admit that they smoke, but this information can be obtained in an 

assessment, particularly through multiple-choice rather than yes/no questions. The Surgeon General provides the following 

example of a question to ask to assess a pregnant woman’s addiction to nicotine: 

Which statement best describes your cigarette smoking? 

•		 I smoke regularly now; about the same as before finding out I was pregnant. 

•		 I smoke regularly now, but I’ve cut down since I found out I was pregnant. 

•		 I smoke every once in a while. 

•		 I have quit smoking since finding out I was pregnant. 

•		 I wasn’t smoking around the time I found out I was pregnant, and I don’t currently smoke cigarettes. 

The effectiveness of nicotine replacement therapy (NRT) in pregnant women is inconclusive. Some effective interventions in 

pregnant women include providing health education, tips for quitting, self-help literature—especially literature written for pregnant 

women—and telephone counseling. 

The Public Health Service Clinical Practice Guideline recommends the following to help pregnant women quit smoking: 

•		 Motivate quit attempts by providing educational messages about the impact of smoking on both maternal and fetal health. 

•		 Give clear, strong advice to quit as soon as possible. Explain that quitting early in pregnancy provides the greatest benefit to 

the fetus. 

•		 Use problemsolving counseling methods and provide social support. 

•		 Arrange for followup assessments throughout pregnancy, including encouraging smoking cessation. 

•		 In the early postpartum period, assess for relapse and be prepared to continue or reapply tobacco use cessation 

interventions, recognizing that women may deny smoking.
	

Web resources created specifically for pregnant women include the following: 

•		 The National Partnership for Smoke-Free Families has an array of handouts, assessment forms, posters, and other 

resources to help pregnant women stop smoking. A curriculum designed by and for Native Americans, including facilitator and 

participant guides, is also available (http://smokefreefamilies.tobacco-cessation.org/). 

•		 Smokefree.gov offers several free publications, including Forever Free for Baby and Me, for pregnant women who have 

recently quit smoking (http://women.smokefree.gov/landing.aspx?rid=4).
	

•		 The National Association to Help Pregnant Smokers Quit has tips for smokers, booklets in English or Spanish, and other free 

materials that can be downloaded (http://www.helppregnantsmokersquit.org). 

•		 Campaign for Tobacco-Free Kids provides a fact sheet on smoking and pregnancy (http://www.tobaccofreekids.org/research/ 

factsheets/pdf/0288.pdf). 

•		 CDC has additional information and publications on pregnancy and smoking (http://www.cdc.gov/reproductivehealth/
	

tobaccousepregnancy/index.htm/). 

Based on Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J., et al. (2008). Treating tobacco use and dependence: 

2008 update. Clinical Practice Guideline. Rockville, MD: Public Health Service, U.S. Department of Health and Human Services. 

3 
 

ADVISORY
 

Weight Gain 

For some people, the fear of gaining weight can be a barrier 

to quitting. The decreased metabolism that follows stopping 

tobacco use, combined with increased appetite, means that 

most people gain weight. Most people gain fewer than 10 

pounds. NRT, particularly gum and lozenges, and bupropion 

sustained release (SR) may help delay (but not prevent) 

weight gain. Counselors should not minimize the likelihood 

of gaining weight or the difficulty in losing the added weight 

later. They should acknowledge these issues but emphasize 

that the weight gain poses a minimal health risk compared 

with the risk of continuing to smoke. Clients should be 

encouraged to lead a healthful lifestyle that includes attention 

to nutrition and exercise. Nutritional counseling may be 

helpful. 

Based on Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, 

N. L., Curry, S. J., et al. (2008). Treating tobacco use and dependence: 

2008 update. Clinical Practice Guideline. Rockville, MD: Public Health 

Service, U.S. Department of Health and Human Services. 

tobacco use; ASSIST is available at http://www.who. 

int/substance_abuse/activities/assist_v3_english.pdf. 

Treatment Improvement Protocol 45: Detoxification and 

Substance Abuse Treatment includes information on 

screening and assessment instruments and tools to measure 

severity of nicotine dependence and to assess medical 

complications of tobacco use.9 

 

Assessments for tobacco use should obtain information 

on previous quit attempts, use of nicotine use cessation 

medications and their effectiveness, and the circumstances 

leading to relapse to tobacco use. This information can 

be used to make specific treatment plans and help the 

client develop responses to relapse triggers. It also helps 

counselors determine the need for a more intensive 

intervention. 

Some American Indian/Alaska Native populations use 

tobacco in ceremonies, so a yes/no question about tobacco 

use may not give the counselor enough information 

with which to determine whether the client is nicotine 

dependent, and further assessment will be needed. 

Once clients have expressed a desire to quit using tobacco, 

counselors and clients determine the “when” and “how” 

and include this information in the substance abuse 

treatment plan. All cessation programs recommend setting 

a quit date. The quit date should be, at the latest, within 

2 weeks of the decision to quit so that clients remain 

motivated. 

The Five A’s of intervention8 summarizes the approach 

counselors can take when encouraging clients to quit 

smoking while in substance abuse treatment (Exhibit 2). 

It is most important to ask all clients whether they use 

tobacco and to determine whether they would like to quit 

while in treatment. 

Exhibit 2. The Five A’s of Intervention 

A Intervention 

Ask about tobacco use. Identify and document tobacco use status for every client at every visit. 

Advise to quit. In a clear, strong, and personalized manner, urge every client who uses tobacco to quit. 

Assess willingness to make 

a quit attempt. 

Ask about willingness to attempt to quit during substance abuse treatment. 

Assist in quit attempt. For the willing client, explain nicotine use cessation medication options and refer the client to a 

health professional, if necessary. Help the client determine the quit date. 

Provide counseling to help the client quit. Provide additional information such as quitlines. For 

clients unwilling to quit at this time, provide interventions to increase future quit attempts. 

Arrange followup. For the client willing to quit, include smoking cessation in the substance abuse treatment plan and 

discuss tobacco use cessation at every counseling session, beginning within the first week after 

the quit date. For the unwilling client, address tobacco dependence and willingness to quit at all 

counseling sessions. 

Based on Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J., et al. (2008). Treating tobacco use and dependence: 

2008 update. Clinical Practice Guideline. Rockville, MD: Public Health Service, U.S. Department of Health and Human Services. 

Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

4 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

Effective Treatment Approaches to 

Tobacco Use Cessation 

Quitting is difficult, and most people benefit from assistance.8 

Counseling and nicotine use cessation medications are the primary approaches used in smoking cessation, and these 

approaches are often combined. Quitlines are also a valuable 

resource for people who want to quit using tobacco. Internet 

assistance (http://www.smokefree.gov) can be helpful. 

Research has not identified a tobacco use cessation method 

(the “how”) that works best for everyone, and treatment needs 

to be individualized. Some treatments, such as hypnosis and 

acupuncture, have not been shown to be effective.8 

Tobacco use cessation support can be included as followup 

care in the discharge plan. Support can include telephone 

calls by the counselor, extended counseling, or continued 

connection to smoking cessation support including prescribed medications. 

Counseling 

Exhibit 3 lists two counseling approaches that help 

people stop tobacco use. Training in specific nicotine 

use cessation counseling techniques to help clients quit 

using tobacco is available for substance abuse counselors 

(see Training Resources for Smoking Cessation on page 

7). If a treatment program cannot offer counseling or 

medication to treat nicotine addiction, it can still encourage 

Tobacco Use Cessation During Substance Abuse Treatment Counseling 

March 2011, Volume 10, Issue 2 

and support clients in their attempts to quit, such as by 

referring clients to quitlines. Teaching coping skills that 

help clients deal with cravings for the primary substance 

being treated in the program also may be helpful for 

tobacco use cessation. Asking clients about how they 

are coping with tobacco cravings and about withdrawal 

symptoms may help clients feel supported. 

Exhibit 3. Effective Tobacco Use Cessation Counseling Approaches 

Approach Action 

Practical counseling Teach problemsolving and relapse prevention skills (e.g., recognizing and coping with cues that could 

precipitate relapse to tobacco use). 

Provide skills training (e.g., coping skills, anger management, lifestyle changes, relaxation techniques). 

Provide basic information about the harmful effects of tobacco, the benefits of quitting, and nicotine 

withdrawal symptoms. 

Supportive counseling Provide support in the treatment program or by referral to a smoking cessation program. 

Provide encouragement. 

Give examples of success stories. 

Communicate caring and concern. 

Based on Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J., et al. (2008). Treating tobacco use and dependence: 

2008 update. Clinical Practice Guideline. Rockville, MD: Public Health Service, U.S. Department of Health and Human Services. 

Tobacco Use Cessation Quitlines

Quitlines and online help, such as 1-800-QUIT NOW and 

http://www.smokefree.gov, provide assistance to people 

who want to cease tobacco use. Telephone quitlines 

provide support from trained counselors and are currently 

available in all 50 States and the District of Columbia. 

1-800-QUIT NOW is a portal telephone number that 

transfers callers to the State quitline. 

Although quitline services vary by State, in general, 

quitlines screen callers for their needs, mail the callers 

educational materials, and connect callers to trained 

specialists who develop a plan to quit and provide 

followup support in the form of callbacks from quitline 

counselors. In some States, quitlines provide access to 

nicotine use cessation medications. Many quitlines offer 

services in languages other than English. More information 

is at http://www.naquitline.net/flash//map_world/map_ 

world.html. 

5 
 

Tobacco Use Cessation Medications 

Clients willing to quit nicotine use can be referred to 

a medical professional who can assess for the need 

for tobacco use cessation medications. Not all people 

benefit from these medications. For example, these 

medications have not been shown to be effective for 

adolescents or people who smoke fewer than 10 cigarettes 

a day.8

 Several Food and Drug Administration (FDA)-

approved prescription medications and over-the-counter 

(OTC) treatments are available to treat nicotine addiction. 

These medications have proved to be effective. Exhibit 4 

presents information on tobacco use cessation medications. 

SUD treatment programs can contact local or State health 

departments to find out whether nicotine use cessation 

medications can be provided for clients at no or low 

cost. For example, the Community Tobacco Cessation 

Partnership in King County, Washington, provides free 

NRT for its partner health providers’ clients, including 

those in SUD and behavioral health treatment centers.10 

In addition, the Partnership provides training on best 

practices for treating tobacco use and dependence. Clients 

in many States may also be eligible for free or discounted 

tobacco use cessation medication through their States’ 

quitlines; eligibility varies by State. The Web site http:// 

www.smokefree.gov provides information about and links 

to services in specific areas. Clients may also be eligible to 

receive these medications if they are covered by Medicaid, 

depending on the State formulary. 

Clients Who Do Not Want To Quit 

Clients should be asked about their tobacco use whenever 

their SUD treatment plan is reviewed. Clients who do not 

want to quit smoking need to be reassessed periodically 

to determine whether their readiness to quit has changed. 

Conversations about tobacco use can address client 

ambivalence or resistance. Motivational interviewing can 

help move clients toward attempting to quit. The Five R’s 

also may be useful with clients resistant to quitting:8 

●		Relevance—help the client recognize reasons why quitting 

is personally relevant, such as health concerns, effects of 

second-hand smoke on others, or cost of smoking. 

Exhibit 4. Effective Tobacco Use Cessation Medications 

FDA-Approved Medication Special Issues 

First-line prescription and OTC NRT* 

medications: 

•		 Nicotine nasal spray (prescription) 

•		 Nicotine inhaler (prescription) 

•		 Nicotine patch (OTC) 

•		 Nicotine gum (OTC) 

•		 Nicotine lozenge (OTC) 

These medications should not be taken by people with serious heart palpitations 

(cardiac arrhythmias) or unstable chest pain (unstable angina) or by those who 

have had a heart attack (myocardial infarction) within 2 weeks. 

Other first-line medications: 

•		 Bupropion SR (Wellbutrin SR, Zyban)† 

•		 Varenicline (Chantix)‡ 

Exacerbation of psychiatric symptoms has been noted in some studies. People 

need to be observed very closely for any worsening of these symptoms. They 

should stop taking the medication and contact a healthcare provider immediately 

if they experience agitation, depressed mood, or any changes in behavior that are 

not typical of nicotine withdrawal or if they have suicidal thoughts or exhibit suicidal 

behavior. 

Bupropion SR is contraindicated for people with a history of seizures, heavy alcohol 

use, head trauma, or anorexia or bulimia. Bupropion can contribute to seizures in 

people who have a history of heavy drinking. A healthcare provider must carefully 

screen for these conditions before prescribing the medication. 

ADVISORY
 

*NRT provides enough nicotine to eliminate or reduce withdrawal symptoms when clients cease using tobacco. † Bupropion SR is an antidepressant. The mechanism in tobacco use cessation is not known. 

‡

Varenicline works by blocking the pleasant effects of smoking from the brain. 

Based on Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J., et al. (2008). Treating tobacco use and dependence: 

2008 update. Clinical Practice Guideline. Rockville, MD: Public Health Service, U.S. Department of Health and Human Services. 

Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

6 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

 

 

Tobacco Use Cessation During Substance Abuse Treatment Counseling 

March 2011, Volume 10, Issue 2 

●		Risks—help the client realize the short- and long-term 

risks of smoking, as well as environmental risks, such 

as increased risk of house fires that are due to falling 

asleep while smoking. 

●		Rewards—help the client identify potential benefits 

to quitting tobacco use such as improved sense of taste 

and smell, saving money, feeling better, and having 

more stamina. 

●		Roadblocks—help the client identify barriers or roadblocks to quitting (such as fear of failure, enjoyment of 

tobacco, possible weight gain, cravings, or loss of the 

pleasures of smoking) and provide practical, problemsolving counseling or other interventions to overcome 

these barriers. For example, clients can be encouraged 

to find ways to be more active now that they feel better 

as a way to address potential weight gain. 

●		Repetition—motivational interventions should be repeated with clients. Clients who have been unable to 

quit previously should be told that most people make 

repeated attempts to quit before being successful. 

Clients Who Relapse to Tobacco 

Use 

Nicotine dependence, like other substance dependence, 

is a chronic condition that is difficult to treat, and many 

clients relapse to smoking in the process of quitting 

permanently.8

 Clients who relapse should be encouraged 

to immediately make another quit attempt. More intensive 

treatment can be attempted, such as more counseling and 

ensuring the medication is being taken appropriately (e.g., 

correct dose, correct time). A change in medication or 

using two medications may also be helpful. The counselor 

should work with the client’s healthcare provider regarding 

medications. 

Resources 

Tobacco Use Cessation 

Substance Abuse and Mental Health Services 

Administration (SAMHSA) 

1-877-SAMHSA-7 (1-877-726-4727) (English and Español) 

http://www.store.samhsa.gov/home 

Centers for Disease Control and Prevention 

Smoking and Tobacco Use Resources 

http://www.cdc.gov/tobacco 

National Institute on Drug Abuse 

http://www.nida.nih.gov
	

NIDAMED (resources for medical and health professionals)
	

http://www.drugabuse.gov/nidamed/
	

Training Resources for Smoking Cessation 

Mayo Clinic Tobacco Treatment Specialist Certification 

http://mayoresearch.mayo.edu/mayo/research/ndc_ 

education/tts_certification.cfm 

NAADAC Tobacco Addiction Specialist Credentialing 

Program 

http://www.naadac.org/index.php?option=com_content& 

view=article&id=250&Itemid=77 

Northeast Addiction Technology Transfer Center 

Smoking Cessation Treatment at Substance Abuse 

Rehabilitation Programs (2006) 

http://store.ireta.org (enter “smoking” in the search box) 

State University of New York, University of Albany, 

Rockefeller College, Professional Development 

Program, Tobacco Recovery Resource Exchange 

http://www.tobaccorecovery.org 

University of Massachusetts Medical School, Center for 

Tobacco Treatment Research & Training 

http://www.umassmed.edu/tobacco/index.aspx 

University of Medicine and Dentistry of New Jersey 

Tobacco Dependence Program, Professional Education 

Programs 

http://www.tobaccoprogram.org 

7 
ADVISORY

University of Wisconsin—Center for Tobacco Research 

and Intervention

http://www.ctri.wisc.edu/HC.Providers/healthcare_mental.

health.htm

Notes

1 Hurt, R., Offord, K., Croghan, I., Gomez-Dahl, L., Kottke, T., Morse, 

R. M., et al. (1996). Mortality following inpatient addictions treatment. JAMA, 275, 1097–1103. 2 Centers for Disease Control and Prevention. (2009). Cigarette 

smoking among adults and trends in smoking cessation—United 

States, 2008. MMWR, 58(44), 1227–1232. 3 Substance Abuse and Mental Health Services Administration. (2011). 

Tobacco use cessation policies in substance abuse treatment: 

Administrative issues. Advisory, Volume 10, Issue 3. 4 Centers for Disease Control and Prevention. (2008). Smokingattributable mortality, years of potential life lost, and productivity 

losses—United States, 2000–2004. MMWR, 57(45), 1226–1228. 5 Centers for Disease Control and Prevention. (2004). The health 

consequences of smoking: A report of the Surgeon General.

Atlanta, GA: National Center for Chronic Disease Prevention and 

Health Promotion, Office on Smoking and Health.

6 Centers for Disease Control and Prevention. (1990). U.S. Surgeon 

General’s report: The health benefits of smoking cessation. HHS 

Publication No. (CDC) 90-8416. Atlanta, GA: Center for Chronic 

Disease Prevention and Health Promotion, Office on Smoking and 

Health. 7 Dani, J. A., Kosten, T. R., & Benowitz, N. L. (2009). The 

pharmacology of nicotine and tobacco. In R. K. Ries, S. C. Miller, 

D. A. Fiellin, & R. Saitz (Eds.), Principles of addiction medicine 

(4th ed., pp. 180–193). Chevy Chase, MD: American Society of 

Addiction Medicine. 8 Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., 

Curry, S. J., et al. (2008). Treating tobacco use and dependence: 

2008 update. Clinical Practice Guideline. Rockville, MD: Public 

Health Service, U.S. Department of Health and Human Services. 9 Center for Substance Abuse Treatment. (2006). Detoxification and 

substance abuse treatment. Treatment Improvement Protocol 45. 

HHS Publication No. (SMA) 06-4131. Rockville, MD: Substance 

Abuse and Mental Health Services Administration. 10 King County Public Health Department. (n.d.). Tobacco prevention 

program. Retrieved August 11, 2010, from http://www.kingcounty.

gov/healthservices/health/drugs/tobacco/ctcp.aspx

SAMHSA Advisory 

This Advisory was written and produced under contract numbers 270-04-7049 and 270-09-0307 by the Knowledge 

Application Program (KAP), a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. 

Department of Health and Human Services (HHS).

Disclaimer: The views, opinions, and content expressed herein do not necessarily reflect the views or policies of CSAT, 

SAMHSA, or HHS. No official support of or endorsement by CSAT, SAMHSA, or HHS for these opinions or for particular 

instruments, software, or resources is intended or should be inferred.

Public Domain Notice: All materials appearing in this document except those taken from copyrighted sources are in the 

public domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Citation of the 

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Electronic Access and Copies of Publication: This publication may be ordered from SAMHSA’s Publications Ordering 

Web page at http://www.store.samhsa.gov/home. Or, please call SAMHSA at 1-877-SAMHSA-7 

(1-877-726-4727). The document may be downloaded from the KAP Web site at http://www.kap.samhsa.gov.

Recommended Citation: Substance Abuse and Mental Health Services Administration. (2011). Tobacco use cessation during 

substance abuse treatment counseling. Advisory, Volume 10, Issue 2.

HHS Publication No. (SMA) 11-4636Clin

First Printed 2011

SAMHSA Advisory

Tobacco Use Cessation During Substance Abuse 

Treatment Counseling