Strategies for staying smoke-free after rehab

(Press-News.org) For people recovering from substance use disorders, quitting smoking remains one of the most difficult—but most crucial—steps toward long-term health.

New research from Flinders University reveals that providing consistent support and access to a range of nicotine replacement therapies (NRTs) can help people in recovery take that vital step.

A first-of-its-kind trial to compare vapes with combination nicotine replacement therapy (cNRT) - patches, gum, and lozenges - in people leaving smoke-free drug and alcohol rehab facilities was published today in the prestigious journal, The Lancet Public Health.

“Quitting smoking is never easy—but for people emerging from detox, it can be even harder,” says lead author Professor Billie Bonevski, Dean (Research) and Director of Flinders Health and Medical Institute (FHMRI).

“People recovering from substance use are more than twice as likely to smoke as the general population—and far more likely to suffer and die from tobacco-related illness.

“Yet, despite the overwhelming health burden, effective quit strategies tailored for those navigating addiction recovery have been in too short a supply.”

Tobacco smoking among people with substance use disorder (SUD) is a leading cause of health burden, with the prevalence of smoking more than double (84%) that of people without SUD (31%).

People with SUD also tend to experience complex comorbidities, including respiratory ill-health associated with smoking, and mental health challenges.

The study tracked more than 360 adults leaving detox facilities who were randomly given either a 12-week supply of vapes or a combination of nicotine gum, lozenge, inhalator and mouth spray. Both groups were also given Quitline behavioural smoking-cessation counselling.

At the nine-month follow-up, around 10% of people in both groups reported abstaining from smoking – a notable achievement in a cohort where long-term quit rates are typically near zero.

“Our findings underscore the importance of offering comprehensive support to people in drug and alcohol services who want to quit smoking,” says Professor Bonevski.

“This isn’t about one therapy outperforming another—it’s about building a system that gives people the best chance to succeed.

“What matters most is ensuring that people in recovery have access to a range of proven tools, because all nicotine replacement options appear to help.

“That means integrating smoking cessation into addiction treatment, providing tailored support, and ensuring that all effective nicotine therapies are readily available.”

The research contributes to a growing body of evidence that quitting smoking should be a key component of addiction recovery and that with the right support, it is possible.

“We need to treat tobacco dependence with the same urgency and support we give to other substances,” she says.

“Helping people in recovery quit smoking can save lives—and now we know there’s more than one way to do it.”

The paper, ‘Nicotine e-cigarettes for smoking cessation following discharge from smokefree inpatient alcohol and other drug withdrawal services: A pragmatic randomized controlled trial’, by Billie Bonevski, Jane Rich, Dan I Lubman, Catherine Segan, Amanda Baker, Ron Borland, Chris Oldmeadow, Coral Gartner, Natalie Walker, Adrian Dunlop, Mark Daglish, Christopher Bullen, Linda Bauld, David Jacka, Joshua B B Garfield, Rose McCrohan, Ashleigh Guillaumier and Victoria Manning was published in The Lancet Public Health journal.

Post embargo link: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(25)00101-X/fulltext 

Acknowledgments: Authors thank the National Health and Medical Research Council of Australia for funding the trial with a Project Grant (GNT1160245). Authors also thank trial participants, the many study-related staff at the withdrawal service trial sites and coordinating trial centre, and the Quitline Victoria staff who contributed to the conduct of this trial.

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