Reductions in cigarette use in a pilot intervention for opioid use disorder and PTSD

Background: Posttraumatic stress disorder (PTSD) symptoms are associated with increased substance misuse, including cigarettes and opioids. People who use opioids often report a desire to quit cigarettes, but little research has explored concurrent reductions in opioid and cigarette use in treatments for PTSD and substance use disorders.Objective: This exploratory study examined changes in cigarette use in a pilot study of an integrated psychotherapy for co-occurring opioid use disorder (OUD) and PTSD.Method: Daily cigarette use was measured using the Timeline Followback at 30 days before baseline, during weekly intervention sessions, and at 1-month follow-up. Bootstrapped linear mixed effect models tested for self-reported reductions in cigarette use across a subsample (n=4) who reported using cigarettes at baseline.Results: Results showed reductions in the average number of cigarettes used per day (CPD) between baseline and 1-month follow-up (B=-.93, SE=.41, p=.04) from an average of 17.06 (SD=15.32) CPD at baseline to an average of 8.07 (SD=9.28) CPD at follow-up. Additionally, participants reported high satisfaction with the intervention, with a mean score of 28.33 (SD=2.78) on the Client Satisfaction Questionnaire and all participants completed the intervention.Conclusions: Exploratory findings suggest that the integrated treatment for OUD/PTSD may have assisted in reductions of co-occurring cigarette use. Notable limitations include the study's small sample size, lack of a control group, and lack of nicotine product-specific self-report and biological measures. Although exploratory, observed changes suggest future work should explore concurrent reductions in opioid and cigarette use in randomized clinical trials for OUD/PTSD.