title: Smoking prevalence in addiction treatment: a review.
abstract: BACKGROUND
  This review explores whether smoking prevalence in addiction treatment samples exceeds that shown in epidemiological data for persons with alcohol or other drug use disorders and whether smoking may have decreased over time in the addiction treatment population as it has done in the general population.
  
  
  METHODS
  English language papers published between 1987 and 2009 were searched electronically. Forty papers reporting smoking prevalence for addiction treatment samples in the United States were identified, and key predictor variables were abstracted. Random logistic models were used to assess relationships between each individual predictor (year, treatment modality, primary drug treated, government status, and public/private funding status) and smoking prevalence.
  
  
  RESULTS
  The lowest smoking prevalence aggregated for studies reported in any single year was 65%, well above epidemiological estimates reported among those with alcohol use and drug use disorders. The odds of smoking were higher in methadone maintenance programs (odds ratio [OR] = 2.25, CI = 1.08, 4.68) as compared with outpatient programs. No other variables in the model were significant. Reanalysis omitting recent studies that may represent outliers or confounding with type of treatment showed a small but significant decrease in smoking over time (OR = 0.9891, CI = 0.9888, 0.9893).
  
  
  CONCLUSIONS
  The very high smoking rates reported in addiction treatment samples warrant significant, organized, and systemic response from addiction treatment systems, from agencies that fund and regulate those systems, and from agencies concerned with tobacco control.
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Suite 265, San Francisco, CA 94118, USA. joseph.guydish@ucsf.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Guydish
authors.forename: Emma
authors.initials: E
authors.lastname: Passalacqua
authors.forename: Barbara
authors.initials: B
authors.lastname: Tajima
authors.forename: Mable
authors.initials: M
authors.lastname: Chan
authors.forename: Jongserl
authors.initials: J
authors.lastname: Chun
authors.forename: Alan
authors.initials: A
authors.lastname: Bostrom
mesh_terms: D019973:Alcohol-Related Disorders / Q000150:complications / Q000628:therapy; D016739:Behavior, Addictive / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D016017:Odds Ratio; D058850:Opiate Substitution Treatment; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D014481:United States / Q000453:epidemiology
chemical_list: D009294:Narcotics; D008691:Methadone