Regular article Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment Jennifer Cole, (Ph.D.) ⁎ , Erin Stevenson, (M.S.W.), Robert Walker, (L.C.S.W.), TK Logan, (Ph.D.) University of Kentucky, Center on Drug and Alcohol Research, Lexington, KY, USA Received 2 May 2011; received in revised form 18 October 2011; accepted 19 October 2011 Abstract Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040–0.587, p b .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105–0.970, p b .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use. © 2012 Elsevier Inc. All rights reserved. Keywords: Adolescents; Smoking; Substance abuse; Mental health; Comorbidity; Posttreatment 1. Introduction Tobacco use, primarily cigarette smoking, has higher mortality rates than other drugs or alcohol (U.S. Department of Health and Human Services, 2004) and is one of the most widely used substances among adolescents (Johnston, O'Malley, Bachman, & Schulenberg, 2011). Adolescents in substance abuse treatment have high rates of cigarette smoking—approximately four times higher than adolescents in the general population (Griffin, Ramchand, Harris, McCaffrey, & Morral, 2007; McDonald, Roberts, & Descheemaker, 2000; Myers & Macpherson, 2004; Upadhyaya, Deas, Brady, & Kruesi, 2002). Adolescence is a crucial time in the development of nicotine dependence: most adult smokers (80%) initiated tobacco use during adolescence (American Health Association, 1995; CDC, 1997; Moolchan, Ernst, & Henningfield, 2000). In a sample of adolescents identified as at-risk of substance abuse based on parental substance use or history of anxiety disorders, use of alcohol and other drugs significantly increased the progression to nicotine dependence (Dierker, Avenevoli, Merikangas, Flaherty, & Stolar, 2001). In another sample of individuals who were in substance abuse treatment in their adolescence, heavy drinking was significantly associated with cigarette smoking at each of the follow-up assessments over an 8-year period (Myers, Doran, & Brown, 2007). Furthermore, cigarette smoking in adolescence is associated with substance use disorders in adulthood (Lewinsohn, Rohde, & Brown, 1999). 1.1. Tobacco use and substance abuse treatment Tobacco use remains high in adolescents in substance abuse treatment, even when alcohol and drug use signifi- cantly decrease posttreatment (Campbell, Chi, Sterling, Journal of Substance Abuse Treatment 43 (2012) 20 – 29 ⁎ Corresponding author. University of Kentucky, Center on Drug & Alcohol Research, 333 Waller Avenue, Suite 480, Lexington, KY 40504, USA. Tel.: +1 859 257 9332. E-mail address: jecole2@uky.edu (J. Cole). 0740-5472/11/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2011.10.024