Factors Underlying Lower Tobacco Cessation Success Probability Among People in Inpatient Care for Substance Use Disorder

OBJECTIVE: Tobacco smoking is highly prevalent among people undergoing inpatient treatment for substance use disorders (SUDs) and is associated with worse outcomes. Tobacco cessation treatment offered in inpatient care is also generally less successful than in other populations. We conducted an analysis to identify factors that underlie outcome differences between inpatients and outpatients in addiction treatment. METHODS: We used data on 1378 people in SUD inpatient care and 1692 in outpatient care enrolled in the Smoking Treatment for Ontario Patients program, which provides free nicotine replacement therapy (NRT), to examine service use, retention in care, and cessation at last contact. We used marginal probability differences following logistic regression to decompose group differences. RESULTS: Relative to people in outpatient care, those treated as inpatients had fewer clinical contacts (3.2 v. 4.2, p<0.001) and received fewer weeks of NRT (5.4 v. 10.5, p<0.001). Inpatient status was associated with lower quit probability in all models, but was attenuated by the inclusion of motivation (percentage point difference reduction [ppdr] = 2.9) and treatment (ppdr = 4.6) variables. Sociodemographic and clinical variables did not meaningfully change the group difference. CONCLUSIONS: Differences in treatment received and in motivation or goals partly explain the lower cessation probability among people in inpatient care. Although the role of motivation probably reflects the presence of people seeking only to avoid nicotine withdrawal during inpatient stays, the very high rate of early discontinuation implies a need to improve continuity of care.