Cigarette Smoking among Adolescents with Alcohol and Other Drug Use Problems
Myers, Mark G., Kelly, John F., Alcohol Research
Cigarette and alcohol use often develop concurrently, and smoking is especially common among youth treated for alcohol and other drug (AOD) use disorders. Special considerations for adolescent smoking cessation treatment include peer influences, motivation, and nicotine dependence. Little research has addressed smoking cessation treatment for youth with AOD use disorders, but the few available studies suggest that tobacco cessation efforts are feasible and potentially effective for this population. Findings to date suggest that adolescents with AOD use disorders may benefit more from relatively intensive multicomponent programs rather than brief treatment for smoking cessation. Additional research is needed to further address the inclusion of tobacco-specific interventions for adolescents in AOD use disorder treatment programs. KEY WORDS: Alcohol and tobacco; alcohol, tobacco, and other drug (ATOD) use, abuse, and dependence; smoking; gateway drug; nicotine dependence; adolescent; youth; high-risk youth; alcohol and other drug use (AODU) treatment method; smoking cessation treatment; co-treatment; intervention; brief intervention; motivational interviewing; peer relations; treatment outcome
Studies examining the origins of alcohol and other drug (AOD) use problems (i.e., AOD abuse and dependence) consistently find that cigarette smoking is closely related with AOD use. Because the use of psychoactive substances significantly escalates during the high school years (Johnston et al. 2006), most research in this area has focused on high school-aged youth (e.g., 14-18 years old). Although researchers have identified a broad range of factors that influence the initiation and progression of tobacco and AOD use, peer influences are particularly salient given the key developmental tasks of this period (e.g., establishing an identity separate from ones' family). Ethnic and regional variations exist in the development of psychoactive substance use, yet adolescents typically start using cigarettes or alcohol prior to other drugs (Ellickson et al. 1992). Tobacco and alcohol, often referred to as "gateway drugs," are among the first substances consumed by adolescents. This is likely influenced by their ready availability along with other sociocultural (e.g., peer influences, acculturation) and biological factors (e.g., family history of substance use disorders) (Vega and Gil 2005).
As with alcohol, adolescent cigarette smoking is strongly associated with illicit drug use (e.g., Eckhardt et al. 1994). In addition to more frequent use of illicit drugs, youth who consistently smoke throughout adolescence are at significantly greater risk for marijuana and other drug abuse or dependence (Vega and Gil 2005). Much of the research in this area has focused on concurrent use of cigarettes and alcohol, which predicts a variety of problems, both during adolescence and beyond. For example, it has been found that youth who smoke and drink have an increased risk of having difficulties at school, delinquency, and use of other drugs (Hoffman et al. 2001).
Adolescents who report consistent smoking and drinking have higher rates of deviant behavior and violence and are more likely to have legal and substance use problems in their 20s than those who consistently drink but do not regularly smoke (Orlando et al. 2005). The authors of the latter study noted, "... while it is common during adolescence to drink but not smoke, it is very unusual to smoke and not drink" (Orlando et al. 2005), suggesting that smoking is a reliable marker of adolescent alcohol use.
This article examines the prevalence of cigarette smoking among adolescents with AOD use problems, smoking cessation efforts in this population, and special considerations for adolescent smoking cessation treatment, including peer influences, motivation, and nicotine dependence. This article concludes with a brief review of studies evaluating smoking cessation treatment for adolescents with AOD use problems and a discussion of the implications of these findings. …