REVIEW OF: Parks MJ et al, JAMA Psychiatry 2025;82(10):1002–1008

STUDY TYPE: Longitudinal cohort study

People with substance use disorders (SUDs) smoke at much higher rates than the general population, yet tobacco treatment is still often sidelined in addiction care. This large national study asks a practical clinical question: Does quitting smoking help or hurt recovery from other SUDs?

To answer this question, researchers utilized data from the ongoing Population Assessment of Tobacco and Health (PATH) Study and followed 2,652 adults with an SUD for 4 years (www.pathstudy.nih.gov). Recovery was defined as past-year remission from SUD symptoms among individuals with a prior history of significant SUD. Using within-person comparisons, the investigators examined whether individuals were more likely to be in recovery during years when they had quit smoking cigarettes versus years when they continued to smoke.

During years when participants had quit smoking, they were about 30% more likely to be in recovery compared to years when they were still smoking, even after accounting for changes in mental health and health care use. But here’s the key question: Did quitting smoking help recovery, or did people already doing better simply become more likely to quit? This is the problem of reverse causation. To find out, researchers looked at whether quitting smoking in one year predicted recovery the following year—and it did. The effect was actually a bit stronger, suggesting that stopping smoking genuinely supports sobriety.

Importantly, quitting smoking was not associated with worsening mental health or clinical destabilization. If anything, improvements in mental health tended to parallel recovery.

CARLAT TAKE
This study challenges the idea that smoking is a “lesser evil” during recovery. Quitting cigarettes was not associated with relapse and was instead linked to better odds of sustained remission. If a patient with an SUD is ready to quit smoking, there is no reason to delay, and treating it may support rather than undermine recovery.