Background Globally, drug and alcohol service users are underserved by smoking cessation and tobacco control services despite their high rates of smoking, smoking-related disease and interest in quitting or cutting down. Smoking rates among people using drug and alcohol services are at least 2-4 higher than the general population. It is further estimated that approximately half of all smoking deaths are attributable to people with alcohol, drug or mental health problems. DASHES (drug and alcohol users help to exit smoking) is developing and evaluating a tobacco harm reduction intervention with service users and staff of specialist third sector and NHS services, public health, and policymakers. This presentation will present key findings from a rapid literature review where we sought evidence to inform the intervention components. The review was framed by three research questions: 1) What is best practice to develop and deliver a smoking cessation/tobacco harm reduction service or intervention for people with problematic drug and alcohol (PDA) use? 2) Is the service/intervention trauma informed and if so, how? 3) How effective was the service/intervention at reducing or stopping smoking?

Methods Rapid review of smoking cessation interventions for drugs and/or alcohol service users. Papers screened by title and abstract, extracted using Covidence and appraised by four researchers using CASP guidance. Included papers were quality reviewed.

Results We quality reviewed 29 eligible studies. Interventions identified fell into three main groups: those providing interventions with fewer components than recommended for the general population; those seeking to extend the implementation of existing national guidance on smoking cessation into drug and alcohol services and those evaluating new or additional interventions (more intensive, greater length) or services. In PDA, as in the general population, combining pharmacotherapy and psychological interventions is more likely to achieve higher rates of smoking cessation and reduction in cigarettes per day. None of the papers included in this review made explicit reference to their interventions being guided by trauma informed practice (TIP) or the best practice guidelines in their area [SAMHSA 2016]. However, six papers reported on five studies that contained elements of a trauma-informed approach.

Discussion Our review identified promising components for inclusion in DASHES but effective and equitable delivery of smoking cessation/reduction services for people using drug and alcohol services remains understudied. Lack of attention to smoking contributes to the ongoing burden of avoidable disease and death associated with tobacco-related harm in this population.