For individuals recovering from substance use disorders, quitting smoking is one of the most challenging yet crucial steps toward achieving long-term health. Recent research from Flinders University highlights that consistent support and access to various nicotine replacement therapies (NRTs) can significantly aid those in recovery in taking this vital step.
A groundbreaking trial, published today in The Lancet Public Health, compared the effectiveness of vapes with combination nicotine replacement therapy (cNRT) — including patches, gum, and lozenges — for individuals leaving smoke-free drug and alcohol rehab facilities. The study’s findings offer new hope for integrating smoking cessation into addiction recovery programs.
Understanding the Challenge
“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.”
Despite the significant health burden, effective quit strategies tailored for those navigating addiction recovery have been scarce. Tobacco smoking among individuals with substance use disorder (SUD) remains a leading cause of health issues, with smoking prevalence more than double (84%) that of the general population (31%). These individuals often face complex comorbidities, including respiratory issues linked to smoking and mental health challenges.
Trial Findings and Implications
The study tracked over 360 adults leaving detox facilities, who were randomly assigned either a 12-week supply of vapes or a combination of nicotine gum, lozenge, inhalator, and mouth spray. Both groups received Quitline behavioral smoking-cessation counseling. At the nine-month follow-up, approximately 10% of participants in both groups reported abstaining from smoking — a notable achievement given the typically low long-term quit rates in this cohort.
“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.”
Professor Bonevski emphasizes that the key lies in ensuring access to a range of proven tools. “That means integrating smoking cessation into addiction treatment, providing tailored support, and ensuring that all effective nicotine therapies are readily available,” she adds.
Broader Context and Future Directions
This research adds to a growing body of evidence suggesting that quitting smoking should be a fundamental component of addiction recovery. With the right support, it is indeed possible. “We need to treat tobacco dependence with the same urgency and support we give to other substances,” Professor Bonevski asserts. “Helping people in recovery quit smoking can save lives — and now we know there’s more than one way to do it.”
The paper, titled “Nicotine e-cigarettes for smoking cessation following discharge from smokefree inpatient alcohol and other drug withdrawal services: A pragmatic randomized controlled trial,” was authored by a team of researchers including Billie Bonevski, Jane Rich, Dan I Lubman, and others. It was published in The Lancet Public Health journal, with the DOI: 10.1016/S2468-2667(25)00101-X.
The authors acknowledge the National Health and Medical Research Council of Australia for funding the trial, as well as the trial participants, study-related staff, and Quitline Victoria staff who contributed to the conduct of this trial.
As the conversation around addiction recovery continues to evolve, this study offers a promising direction for integrating smoking cessation into comprehensive treatment plans, potentially transforming the landscape of recovery support services.
