Background: Smoking prevalence among clients in publicly-funded substance use disorder (SUD) treatment programs is 3-4 times that of the general US population. While 40% of smokers want with quitting, few SUD treatment programs offer cessation counseling or pharmacotherapy. We examined whether clients who want help quitting receive services, what services they receive and compared services with clients who did not want help quitting.

Methods: 562 clients in 20 California residential SUD treatment programs were surveyed in 2019. Among current smokers (n = 340), we compared five tobacco-related services – asking, advising, counseling, referral, and pharmacotherapy offered to smokers who wanted help with quitting (n=128) vs those who did not (n=210). In multivariate analyses, we controlled for demographics, healthcare coverage, smoking behaviors, program level measures and nesting of participants within clinics.

Results: 38% of clients wanted help with quitting. Among them, 72% were asked if they smoke, 51% were given advice on how to quit, 45% received referral, 66% received counseling and 38% were offered NRT/pharmacotherapy. Additionally, smokers who wanted help with quitting were more likely to receive advice on how to quit (OR = 1.59, 95% CI 1.01, 2.52) and more likely to receive tobacco-related counseling (OR = 2.17, CI 1.34, 3.50), referral (OR = 2.01, CI 1.04, 3.86) and NRT/pharmacotherapy (OR = 2.68, CI 1.47, 4.90).

Conclusion: In this sample, clients who wanted help with quitting smoking were on average two times more likely to receive tobacco related services. However, only half of those who wanted help received advice or referral, and only a third received tobacco-cessation medication. Interventions should be tailored towards motivating more clients to quit, and ensuring that all clients who want help with quitting smoking receive the necessary services.