Tobacco Rates are Decreasing Among Adults with Depression, Substance Use Disorder

A new analysis of national survey data reveals significant reductions in cigarette use among U.S. adults with major depression, substance use disorder or both from 2006 to 2019. These findings suggest that groups at higher risk of cigarette smoking can be reached by, and may have benefited from, tobacco use prevention and cessation efforts that have led to significant tobacco use declines in the general population. 

The study, conducted by NIDA and the Substance Abuse and Mental Health Services Administration, was published in JAMA.  

Cigarette smoking, the leading preventable cause of disease, disability and death in the U.S., has been declining overall. Experts attribute this in part to increases in available treatments, insurance coverage of these treatments, cigarette prices, smoke-free policies and media and educational campaigns in recent decades. But, until now, smoking rates remained unchanged in people with substance use disorders, major depression or other psychiatric disorders. 

Analyzing data from more than 558,000 adults who participated in the National Survey on Drug Use and Health between 2006 and 2019, researchers found that while people with major depression, substance use disorder or both were more likely to smoke cigarettes, improvements in smoking cessation were seen during this timeframe. 

After controlling for factors such as age, sex, race/ethnicity, education and family income, researchers found that past-month smoking rates declined by 13.1 percent among adults with a past-year major depressive episode and by 10.9 percent among adults with past-year substance use disorder from 2006 to 2019. Similar smoking rate declines were seen in people with co-occurring substance use disorder and major depression.

“These declines tell a public health success story,” said NIDA deputy director Dr. Wilson Compton, senior study author. “However, there’s still a lot of work to be done to ensure [these numbers] continue to decrease.” To that end, Compton recommended that health care providers integrate smoking cessation therapies into existing behavioral health treatments.

Only one racial and ethnic subgroup did not experience a past-month smoking decline: non-Hispanic American Indian or Alaska Native adults. They face the highest smoking and lowest quitting rates in the U.S., highlighting the need to channel additional prevention and treatment efforts into these communities.