Open Access Research article

Smoking and its treatment in addiction services: Clients’ and staff behaviour and attitudes

Camilla Cookson1, John Strang14, Elena Ratschen23, Gay Sutherland1, Emily Finch4 and Ann McNeill13*

Author Affiliations

1 National Addiction Centre, Institute of Psychiatry, King’s College London, Addiction Sciences Building, 4, Windsor Walk, Denmark Hill, London SE5 8AF, UK

2 Division of Epidemiology & Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, City Hospital, Nottingham NG5, UK

3 UK Centre for Tobacco & Alcohol Studies, Nottingham, UK

4 Addictions Clinical Academic Group and Consultant Addictions Psychiatrist, South London & Maudsley NHS Foundation Trust, London, UK

For all author emails, please log on.

BMC Health Services Research 2014, 14:304  doi:10.1186/1472-6963-14-304

Published: 14 July 2014



High smoking prevalence has been observed among those misusing other substances. This study aimed to establish smoking behaviours and attitudes towards nicotine dependence treatment among clients and staff in substance abuse treatment settings.


Cross-sectional questionnaire survey of staff and clients in a convenience sample of seven community and residential addiction services in, or with links to, Europe’s largest provider of mental health care, the South London and Maudsley NHS Foundation Trust. Survey items assessed smoking behaviour, motivation to quit, receipt of and attitudes towards nicotine dependence treatment.


Eighty five percent (n = 163) and 97% (n = 145) response rates of clients and staff were achieved. A high smoking prevalence was observed in clients (88%) and staff (45%); of current smokers, nearly all clients were daily smokers, while 42% of staff were occasional smokers. Despite 79% of clients who smoked expressing a desire to quit and 46% interested in receiving advice, only 15% had been offered support to stop smoking during their current treatment episode with 56% reported never having been offered support. Staff rated smoking treatment significantly less important than treatment of other substances (p < 0.001), and only 29% of staff thought it should be addressed early in a client’s primary addiction treatment, compared with 48% of clients.


A large unmet clinical need is evident with a widespread failure to deliver smoking cessation interventions to an extraordinarily high prevalence population of smokers in addiction services. This is despite the majority of smokers reporting motivation to quit. Staff smoking and attitudes may be a contributory factor in these findings.

Smoking; Substance misuse; Nicotine dependence treatment; NHS; Addictions; Staff; Alcohol; Heroin