Smoking in Substance Use Disorder Patients: Prevalence, Comorbidities, Impulsivity, and Patterns of Readiness to Change.

Introduction: Tobacco use is highly prevalent in individuals with other substance use disorders (SUDs) and is associated with greater smoking-related illnesses and premature death. To inform intervention strategies, the current study examined the prevalence and clinical features of smoking, including motivation for change, comorbid psychiatric symptoms, and self-regulatory indicators, in a large sample of treatment-seeking SUD patients.

Aims and methods: Participants were 1893 patients in three clinical programs who were assessed for tobacco use, other substance misuse, psychiatric symptoms, measures of self-regulation (ie, delay discounting, UPPS-P impulsive behavior scales, mindfulness), and readiness rulers (ie, readiness, importance, and confidence). Psychiatric and impulsivity indicators were further examined among patients in precontemplative, contemplative, and actively ready stages of change.

Results: Overall, 73.7% of patients reported combustible tobacco use, with almost half reporting that they were contemplating or actively ready to change. Patients who smoked reported significantly greater psychiatric symptoms, higher illicit substance use, more impulsive delay discounting, and personality traits (ie, positive and negative urgency, lack of premeditation, and sensation seeking), and lower mindfulness. Those who smoked and were actively ready to change their behavior were older, smoked fewer cigarettes per day, and exhibited significantly less impulsive delay discounting and lack of perseverance.

Conclusions: The prevalence of smoking is high in SUD treatment programs and is associated with greater psychiatric symptom severity, substance misuse, psychiatric severity, and impulsivity. Differing levels of readiness suggest three distinct intervention pathways.