Smoking prevalence for persons in addiction treatment exceeds national prevalence in 23 countries

Background: Tobacco-related disease accounts for nearly 6 million deaths worldwide each year (WHO). While tobacco use is decreasing in many countries, prevalence remains high in subgroups. Prior research in the U.S. found that smoking prevalence was 70% among persons enrolled in addictions treatment, compare to a 19% national prevalence. This paper was designed to learn whether very high tobacco use prevalence among persons enrolled in addiction treatment programs is also observed internationally. Methods: Electronic literature search in PubMed and PsychINFO. Search parameters included papers published 1987-2012, available in English, reporting from studies outside the U.S. Search terms such as “tobacco, patients, and substance-related disorders” were used to capture papers reporting tobacco use prevalence in addiction treatment samples. Results: 4529 abstracts were reviewed and 39 papers were found reporting smoking rates for persons receiving addiction treatment in 23 countries. Smoking rates ranged from 33-100%. Most papers reported smoking rates over 50%, and 28 papers reported rates above 75%. In every case, prevalence of tobacco use in addiction treatment samples was 2-3 times higher than national prevalence for the same country and the same time period. Conclusions: While international tobacco control efforts have achieved significant successes, they have not reached to persons in addictions treatment systems, where very high tobacco use prevalence is reported. This is true in the U.S. and worldwide. Further reducing prevalence of tobacco use, among current users, will require interventions and policy initiatives directed to this population, and other populations where prevalence is highest.