A review of epidemiologic research on smoking behavior among persons with alcohol and illicit substance use disorders.

Persons with alcohol use disorders (AUDs) and substance use disorders (SUDs) appear to be heavily affected by cigarette smoking. In order to address the consequences of smoking in this population, an understanding of the current state of knowledge is needed. Epidemiologic research provides the opportunity to obtain detailed information on smoking behaviors in large community samples. The aim of this paper was to synthesize the epidemiologic evidence on smoking among persons with AUDs/SUDs and suggest directions for future research. Literature searches of Medline and PubMed were used to identify articles and additional articles were elicited from publication reference lists. To be included in the review, papers had to be published in English, analyze epidemiologic data, and examine an aspect of smoking behavior in persons with AUDs/SUDs. Twenty-nine studies met inclusion criteria and were included in the review. In summary, epidemiologic evidence to date suggests greater lifetime and current smoking, nicotine dependence, and non-cigarette tobacco use; lower quitting; and differences in quit attempts and withdrawal symptoms for persons with AUDs/SUDs compared to other people. Most studies examined nationally representative data and were conducted on persons in the United States and Australia. Few publications examined outcomes by demographics (e.g., gender, age) but these studies suggested that specific patterns differ by demographic subgroups. More research is needed on persons with AUDs/SUDs in order to develop the most effective public health and clinical interventions to reduce smoking behaviors, improve cessation outcomes, and reduce the harmful consequences of smoking for those with AUDs/SUDs.