This article reviews cigarette smoking in patients with psychiatric disorders (PD) and substance use disorders (SUD). Rates of smoking are approximately 23% in the U.S. population but approximately two-to four-fold higher in patients with PD and SUD. Many remaining smokers have had repeated smoking cessation failures, possibly due to the presence of co-morbid PD and SUDs. There is modest, evidence-based support for effective treatment interventions for nicotine addiction in PD and SUD. Further research is needed to increase our understanding of nicotine addiction in PD and SUD and develop more effective treatment interventions.Although smoking prevalence in the United States has decreased from 43.8% in 1965 to 23.3% in 2000, 1 there are many cigarette smokers who have been unable to quit. An important subset of refractory smokers are those with psychiatric disorders (PD) and substance use disorders (SUD), among whom smoking rates exceed those in the general population by two-to fourfold. 2 In a population-based study of smoking prevalence in the U.S., Lasser and colleagues found that smoking prevalence among persons with and without a psychiatric disorder were 41% and 22.5%, respectively. 2 The highest prevalence (67.9%) was found among persons with drug abuse. Consistent with these results, Degenhardt and Hall 3 reported similar findings in their study of smoking prevalence in Australia. The prevalence of smoking in various PD and SUD 4 is presented in Fig. 1. Other studies have found that individuals with PD and SUD are at higher risk for many tobacco-related diseases, including cardiovascular illness, respiratory disease, and cancer, than individuals in the general population. 5-8 Among "ever smokers," persons with PD or SUD are less likely to be former smokers than other smokers. Lasser et al. 2 found that the quit rate among ever smokers with no history of PD or SUD was 42.5%. Significantly lower quit rates were associated with several other PD and SUD, including alcohol use disorder (16.9%), bipolar disorder (25.9%), major depression (26.0%), and post-traumatic stress disorder (23.2%). Clearly, improved treatments for nicotine addiction are needed for these populations.Several explanations have been proposed for the high prevalence of smoking in individuals with PD and SUD. First, there may be intrinsic factors (eg, shared genes, abnormalities in brain

Despite the declining overall rate of cigarette smoking in the general population in the United States, the prevalence of smoking is estimated to be as high as 80% among treatment-seeking alcoholics. The serious adverse health effects of tobacco and heavy alcohol use are synergistic and recent evidence suggests that smoking slows the process of cognitive recovery following alcohol abstinence.In addition, substantial evidence shows that treatment for tobacco dependence does not jeopardize alcohol abstinence. In this paper, we focus on the impact and treatment implications of tobacco dependence among treatment-seeking alcoholics through a review of five areas of research. We begin with brief reviews of two areas of research: studies investigating the genetic and neurobiological vulnerability of comorbid tobacco and alcohol dependence and studies investigating the consequences of comorbid dependence on neurobiological and cognitive functioning. We then review literature on the effects of smoking cessation on drinking urges and alcohol use and the effectiveness of smoking cessation interventions with alcoholic smokers. Finally, we offer recommendations for research with an emphasis on clinical research for enhancing smoking cessation outcomes in this population.

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