For individuals recovering from substance use disorders, quitting smoking remains one of the most challenging yet crucial steps toward achieving long-term health. New research from Flinders University reveals that consistent support and access to a variety of nicotine replacement therapies (NRTs) can significantly aid people in recovery to take this vital step.
A groundbreaking trial, published today in the prestigious journal The Lancet Public Health, compared the effectiveness of vapes with combination nicotine replacement therapy (cNRT)—which includes patches, gum, and lozenges—among individuals leaving smoke-free drug and alcohol rehab facilities.
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 people with substance use disorder (SUD) is a leading cause of health issues, with a smoking prevalence of 84% compared to 31% in individuals without SUD. Additionally, people with SUD often face complex comorbidities, including respiratory and mental health challenges associated with smoking.
The Study and Its Findings
The study tracked over 360 adults leaving detox facilities, randomly assigning them to receive either a 12-week supply of vapes or a combination of nicotine gum, lozenge, inhalator, and mouth spray. Both groups also received Quitline behavioral smoking-cessation counseling.
At the nine-month follow-up, around 10% of participants 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.”
Implications and Future Directions
The research contributes to a growing body of evidence that quitting smoking should be a key component of addiction recovery. With the right support, it is possible for individuals to overcome tobacco dependence.
“We need to treat tobacco dependence with the same urgency and support we give to other substances,” Professor Bonevski emphasizes. “Helping people in recovery quit smoking can save lives—and now we know there’s more than one way to do it.”
The study, 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 Billie Bonevski and colleagues and published in The Lancet Public Health journal.
Looking Ahead
The findings from this research highlight the need for integrating smoking cessation into addiction treatment programs, providing tailored support, and ensuring that all effective nicotine therapies are readily available. This approach could revolutionize the way recovery services address tobacco dependence, ultimately improving health outcomes for individuals recovering from substance use disorders.
Acknowledgments for the study go to the National Health and Medical Research Council of Australia for funding the trial with a Project Grant (GNT1160245), as well as the trial participants, study-related staff at the withdrawal service trial sites, coordinating trial center, and Quitline Victoria staff who contributed to the trial.
