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Study flow diagram.
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Figure 1

Study flow diagram.

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Comparison 1 Abstinence, by intervention category, Outcome 1 Counselling.
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Analysis 1.1

Comparison 1 Abstinence, by intervention category, Outcome 1 Counselling.

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Comparison 1 Abstinence, by intervention category, Outcome 2 Pharmacotherapy.
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Analysis 1.2

Comparison 1 Abstinence, by intervention category, Outcome 2 Pharmacotherapy.

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Comparison 1 Abstinence, by intervention category, Outcome 3 Combined counselling and pharmacotherapy.
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Analysis 1.3

Comparison 1 Abstinence, by intervention category, Outcome 3 Combined counselling and pharmacotherapy.

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Comparison 2 Abstinence by treatment or recovery subgroup, Outcome 1 Abstinence.
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Analysis 2.1

Comparison 2 Abstinence by treatment or recovery subgroup, Outcome 1 Abstinence.

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Comparison 3 Abstinence by type of dependency, Outcome 1 Abstinence.
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Analysis 3.1

Comparison 3 Abstinence by type of dependency, Outcome 1 Abstinence.

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Comparison 4 Alcohol or other drug abstinence, Outcome 1 Abstinence at longest follow‐up.
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Analysis 4.1

Comparison 4 Alcohol or other drug abstinence, Outcome 1 Abstinence at longest follow‐up.

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Summary of findings for the main comparison. Tobacco cessation interventions compared to placebo or usual care for people in treatment for or recovery from alcohol or other drug dependency

Tobacco cessation interventions compared to placebo or usual care for people in treatment for or recovery from alcohol or other drug dependency

Patient or population: people in treatment for or recovery from alcohol or other drug dependency
Setting: inpatient and outpatient treatment programmes
Intervention: tobacco cessation interventions
Comparison: placebo or usual care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo or usual care

Risk with tobacco cessation interventions

Tobacco abstinence after counselling (counselling)
assessed with: biochemical validation
Follow‐up: range 6 weeks to 12 months

Study population

RR 1.33
(0.90 to 1.95)

1759
(11 RCTs)

⊕⊕⊝⊝
Low 1,2

Baseline risk assessed in study outcomes

47 per 1000

62 per 1000
(42 to 91)

Tobacco abstinence after pharmacotherapy (pharmacotherapy)
assessed with: biochemical validation
Follow‐up: range 8 weeks to 6 months

Study population

RR 1.88
(1.37 to 2.57)

1808
(11 RCTs)

⊕⊕⊝⊝
Low 1,3

Baseline risk assessed in study outcomes

58 per 1000

109 per 1000
(96 to 167)

Tobacco abstinence after combined counselling and pharmacotherapy (combined)
assessed with: biochemical validation
Follow‐up: range 13 weeks to 18 months

Study population

RR 1.74
(1.39 to 2.18)

2229
(12 RCTs)

⊕⊕⊝⊝
Low 1,2

Baseline risk assessed in study outcomes

92 per 1000

160 per 1000
(128 to 201)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Limited information provided regarding study designs; some cluster‐randomised studies and waiting list controls.

2 Clinical interventions had substantial variance, ranging from one‐time to daily counselling sessions and individual or group therapy.

3 Evidence of publication bias.

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Summary of findings for the main comparison. Tobacco cessation interventions compared to placebo or usual care for people in treatment for or recovery from alcohol or other drug dependency
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Comparison 1. Abstinence, by intervention category

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Counselling Show forest plot

11

1759

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.90, 1.95]

2 Pharmacotherapy Show forest plot

11

1808

Risk Ratio (M‐H, Fixed, 95% CI)

1.88 [1.37, 2.57]

2.1 Nicotine replacement therapy (NRT)

3

635

Risk Ratio (M‐H, Fixed, 95% CI)

7.74 [3.00, 19.94]

2.2 Other pharmacotherapy or combined NRT and other pharmacotherapy

8

1173

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.89, 1.77]

3 Combined counselling and pharmacotherapy Show forest plot

12

2229

Risk Ratio (M‐H, Fixed, 95% CI)

1.74 [1.39, 2.18]
Figuras y tablas -
Comparison 1. Abstinence, by intervention category
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Comparison 2. Abstinence by treatment or recovery subgroup

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Abstinence Show forest plot

34

5796

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [1.43, 1.99]

1.1 Participants in treatment

12

2134

Risk Ratio (M‐H, Fixed, 95% CI)

1.99 [1.59, 2.50]

1.2 Participants in recovery

22

3662

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [1.11, 1.82]
Figuras y tablas -
Comparison 2. Abstinence by treatment or recovery subgroup
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Comparison 3. Abstinence by type of dependency

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Abstinence Show forest plot

34

5796

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [1.43, 1.99]

1.1 Alcohol dependence

17

2467

Risk Ratio (M‐H, Fixed, 95% CI)

1.57 [1.27, 1.95]

1.2 Other drug (or combined) dependence

17

3329

Risk Ratio (M‐H, Fixed, 95% CI)

1.85 [1.43, 2.40]
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Comparison 3. Abstinence by type of dependency
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Comparison 4. Alcohol or other drug abstinence

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Abstinence at longest follow‐up Show forest plot

11

2231

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.91, 1.03]
Figuras y tablas -
Comparison 4. Alcohol or other drug abstinence
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