Smoking cessation experiences during alcohol and cannabis treatment in substance use programmes in Catalonia: A qualitative study

Tobacco use remains disproportionately high among people receiving treatment for alcohol or cannabis use, yet it is rarely addressed in substance use services. This study explored the lived experiences of people who smoke while undergoing treatment for alcohol and/or cannabis use, aiming to identify barriers and facilitators to integrating tobacco cessation into public substance use services. This phenomenological study formed part of the qualitative phase of an observational follow-up investigation conducted in Catalonia (Spain) with people receiving treatment for alcohol and/or cannabis use. In-depth, semi-structured video interviews were conducted with nine adults (seven men, two women; aged 22–67 years) attending Centres for the Care and Follow-up of Substance Use Disorders. Data were collected between May and October 2024 and analysed using reflexive thematic analysis. Five interconnected themes captured participants’ experiences: (1) Tobacco use dynamics—smoking was perceived as an emotional regulator, ingrained habit, and possible substitute during abstinence from other substances; (2) Processes of reflection and change— participants favoured gradual, sequential approaches to cessation and reported heightened health awareness when reducing tobacco use; (3) Support networks and interpersonal relationships—family support and strong clinical alliances facilitated motivation, whereas inconsistent professional follow-up undermined it; (4) Stigma and social perceptions—internalised and external stigma about smoking and substance use shaped participants’ attitudes toward quitting; and (5) Sustainability and relapse prevention strategies—continued professional support, access to affordable pharmacotherapy, and smoke-free environments were viewed as essential, yet often unavailable. Participants endorsed addressing tobacco cessation in alcohol and cannabis treatment but reported multiple structural, financial, and attitudinal barriers within public substance use services. Systematically integrating tobacco assessment, personalised counselling, and subsidised pharmacological support into these programmes could enhance cessation outcomes and potentially improve recovery outcomes for co-occurring substance use disorders. Findings support policy initiatives aimed at embedding comprehensive tobacco cessation pathways in Spanish addiction services.