Service users' perceptions of the relationships between cigarette use and recovery from substance use disorders

Abstract

Introduction Information on the relationship between cigarette use and recovery from substance use disorders (SUDs) is contradictory and limited to studies conducted in high-income countries characterised by a predominance of injection drug use. In South Africa, a low-and-middleincome country where drugs are mainly smoked, there is an absence of research examining the relationship between smoking and SUD treatment outcomes. This study seeks to bridge this gap by exploring service users' perceptions of smoking and how cigarette use affects their recovery from SUDs. Methods This exploratory study employed a qualitative research design. Twenty participants were recruited from six Matrix Outpatient SUD treatment programmes in the greater Cape Town region for in-depth interviews. A semi-structured interview guide structured the interviews. Interviews were audio-recorded before being transcribed verbatim. Qualitative data were analysed using the framework approach. Results Three main findings emerged from the data. First, powerful socio-cultural and contextual factors seem to underpin participants early initiation and maintenance of cigarette use. Participants identified socio-cultural processes that strongly influenced their perceptions of smoking and the social and emotional functions it served, which contributed to continued cigarette use. Second, participants described the intertwining of cigarettes and other substances, with shared modes of administration and mixing of substances - they thought this made it very challenging to maintain recovery from substances while continuing to smoke tobacco. Third, although service users perceive benefits to tobacco cessation for health and recovery from SUDs, most participants using tobacco expressed ambivalence about quitting and seem to lack confidence in their ability to stop smoking and maintain their abstinence from other substances. Conclusion The current study suggests that SUD service users view cigarette use as potentially detrimental to their SUD treatment and recovery. As such, this study provides support, from a service user perspective, for (i) the introduction of interventions to prevent tobacco initiation among young people as part of SUD prevention and (ii) the integration of tobacco cessation interventions into SUD treatment programming to improve the likelihood of successful treatment outcomes for people who smoke tobacco. More specifically, findings highlight the potential value of a client-centred approach in screening service users for tobacco use as they enter SUD treatment, educating them about the potential impacts of continued smoking on SUD recovery, and integrating evidence-based smoking cessation programmes into SUD treatment.