# “Cigarettes led me back to smoking tik”: lived experience perspectives on tobacco use during substance use treatment and recovery in South Africa

## TL;DR

This study explores how people in South Africa using substance use treatment view tobacco use and its impact on recovery, highlighting the need for integrated cessation support.

## Contribution

The study provides novel insights into South African perspectives on tobacco use during substance use recovery, identifying barriers and needs for cessation support.

## Key findings

- Tobacco use is intertwined with other substance use, increasing cravings and hindering recovery.
- Participants use tobacco for coping, identity, and social connection, complicating cessation efforts.
- Integrated pharmacological and psychosocial interventions are needed to support tobacco cessation in SUD treatment.

## Abstract

Despite the high prevalence of tobacco use among people with substance use disorder (SUD), tobacco cessation is not a routine part of SUD treatment in South Africa. No studies have explored how people receiving SUD treatment view the effects of tobacco use on SUD treatment or their barriers to tobacco cessation. Clinicians need this information to develop locally relevant, person-centred tobacco cessation interventions. To address this gap, this study aimed to explore perceptions of tobacco use and its impact on SUD recovery among people receiving SUD treatment in South Africa.

In-depth interviews were conducted with 20 participants (14 males, 6 females) recruited from five outpatient SUD treatment programmes in Cape Town, South Africa. On average, participants were 34.6 years old (SD = 10.1) and began smoking tobacco when 13.4 years old (SD = 2.6). At the time of the study, 40.0% (n = 8) had quit tobacco. Interviews explored experiences of tobacco use and its impact on SUD recovery. Data were analysed using reflexive thematic analysis.

The analysis generated four themes: (1) tobacco interconnects with other substance use; (2) psychosocial functions of tobacco: identity, connection and coping; (3) detrimental impact on SUD recovery; and (4) ambivalence about tobacco cessation, despite acknowledged benefits. Participants reported that their tobacco use intertwined with and reinforced their substance use, heightening cravings and impacting efforts to remain abstinent. Participants identified barriers to cessation that included using tobacco as a coping mechanism and as a tool for social connection, difficulties managing physiological withdrawal symptoms, and limited cessation support within SUD treatment and their social environments.

Findings highlight the need for tobacco cessation interventions within South Africa’s SUD services. To overcome psychosocial and physiological barriers, SUD services should consider providing pharmacological interventions, psychosocial and behavioural counselling, and social support for tobacco cessation. Integrating these interventions into SUD treatment services could improve tobacco cessation rates and recovery outcomes for South Africans with SUDs.

The online version contains supplementary material available at 10.1186/s13722-026-00660-8.