Trends in cigarette smoking among Italian substance use disorder patients

Background. High rates of cigarette smoking are common among polydrug users, especially those with Alcohol (AUD), Cocaine (CUD) and Heroin (HUD) Use Disorder. It has been reported that patients may benefit from cigarette smoking, including managing mood disturbances (such as in calming, reducing anxiety, depression, stress, anger) and as a substitute for illicit drug use. Methods: To answer these questions, we compared tobacco use among 2,016 mono- and polydrug users entering Therapeutic Community (TC) treatment, with a particular reference to different diagnoses and degree of intoxication at treatment entry. Results: Lifetime tobacco use was more pervasive in poly- than in mono-user (chi(2)=40.41; p<0.001). Age at first tobacco use was younger in poly- than in mono-users (T=-6.00; p<0.001). No differences were found regarding daily tobacco use, nor monthly or daily cigarette use. Regarding the number of monthly cigarettes used, no differences were found between poly- and mono-users (F=1.30; p=0.253). Statistically significant differences at the multivariate level were found between AUD, HUD and CUD (F=4.10; p=0.017). In particular, AUD patients were using more cigarettes than those diagnosed with HUD. Detoxified patients were using fewer cigarettes than non-detoxified ones. (F=7.25; p=0.007). No significant interactions were found between poly-/mono-users, diagnosis (F=1:59; p=0.204) and detoxified status (F=0.01; p=0.921), nor between diagnosis and detoxified status (F=0.84; p=0.432), nor between poly-/mono-users, diagnosis, and detoxified status (F=0.22; p=0.802). Conclusions: Our data further support the hypothesis that tobacco use is a modality of relieving substance use discomfort during Substance Use Disorder.