Smoking is a habit that has plagued public health for decades. The nicotine is addictive, the secondhand smoke is problematic, and the cigarettes themselves are carcinogenic. Still though, tobacco isn’t illegal, and a fair amount of people around the world continue to use it. Often viewed as less harmful than many illicit drugs because of its ubiquity and legality, tobacco is sometimes used as a crutch or replacement for other drugs.

A review of research from 20 countries around the world showed that people in addiction treatment programs are using tobacco at two to three times the rate of people who are not being treated for addiction. The review was lead by Dr. Joseph R. Guydish, a professor of medicine and health policy at UC San Francisco.

“When people come into treatment for drugs and alcohol, we are not treating another addiction that has a significant chance of eventually killing them, which is tobacco use,” said Guydish in a statement. “At a public health level, this means that our addiction treatment efforts should address smoking and tobacco use better than they do now.”

The overall rate of smoking among people in treatment for drug and alcohol use was 84 percent, compared with a rate of 31 percent for members of the general population. Guydish and his colleagues reviewed a total of 54 studies, which in turn involved 37,364 participants and were published from 1987 to 2013.

This review produced results that agree with an earlier study led by Guydish, which looked at smoking addiction treatment programs in the U.S. The authors of that paper found that median smoking rate among those in addiction treatment was 76.3 percent, compared to the smoking rate of the general U.S. population, which is now estimated at around 18 percent.

“Every person who enters substance abuse treatment ought to have their tobacco use evaluated and treated,” Guydish said. “If they don’t want to be treated and quit right away, they should have som education to help them think more about quitting.”

Guydish noted that many studies suggest that addressing smoking among patients in treatment improves substance treatment outcomes. He said that the World Health Organization (WHO) created a policy package called MPOWER, a program designed to assist countries in implementing anti-smoking initiatives.

“We would recommend that WHO pay attention to this finding and use it to extend their MPOWER strategies,” Guydish said. “Anyone who is interested in smoking reduction internationally could use this information at the policy level.”

Source: Guydish J, Pagano A, Tajima B, Docto L, Garina D, Delucchi K, et al. An International Systematic Review of Smoking Prevelance in Addiction Treatment. Addiction. 2015.