Embedding smoking cessation within recovery services to reduce health inequalities

Smoking prevalence remains significantly higher among people accessing drug and alcohol treatment services than within the general population. In Peterborough, individuals experiencing substance dependency, homelessness and multiple disadvantage face compounded health inequalities, with smoking contributing to long-term poor health outcomes and reduced life expectancy.

Traditional stop smoking services were not consistently engaging this cohort. Many clients did not initially present with an intention to quit smoking, and tobacco use was often deprioritised in the context of wider recovery needs.

Peterborough City Council recognised the need for a different approach; one that embedded tobacco dependency treatment within recovery pathways rather than delivering it as a standalone service.

Through targeted public health commissioning, the council invested in Change Grow Live (CGL) to deliver an integrated smoking cessation and harm reduction model embedded within substance misuse services.

Key features of the model include:

• a specialist smoking cessation advisor embedded within recovery services
• weekly behavioural support clinics within CGL settings
• access to nicotine replacement therapy (NRT) and vaping products
• outreach to vulnerable groups including people experiencing homelessness
• workforce training to embed Very Brief Advice (VBA) across the service
• carbon monoxide (CO) verification to ensure robust outcome reporting.

The service operates a dual pathway model, offering both a direct quit pathway and a harm reduction pathway depending on an individual’s readiness to quit. This ensures all clients are supported appropriately, either to make an immediate quit attempt or to reduce harm through safer nicotine alternatives while building the confidence, motivation, and readiness to progress towards quitting over time.

Importantly, the service is also strengthening pathways for pregnant smokers. Women accessing CGL who are pregnant will be supported to benefit from the local pregnancy incentive scheme, which combines behavioural support with financial incentives for verified quit outcomes. Work is underway to extend secure portal access and referral pathways so CGL practitioners can identify pregnant smokers earlier and ensure seamless integration with maternity services.

Early results demonstrate strong engagement and positive outcomes.

During Quarter 2:

• Thirteen clients set a quit date.
• Five achieved a four-week quit -100 per cent carbon monoxide verified.
• One hundred harm reduction referrals were made, with 39 individuals engaging in the 12-week programme.
• An 85 per cent CO-verified quit rate was achieved among those completing the four-week programme.

During Quarter 3, engagement with harm reduction support continued:

• Seventy three individuals were referred into the harm reduction pathway.
• Twenty four residents registered and began support.

Crucially, several individuals who initially entered the service with no intention of quitting smoking progressed from harm reduction to full cessation. By removing the pressure of immediate abstinence, the service has been able to maintain engagement long enough for confidence and readiness to develop.

Clients report improvements in breathing, sleep and mental wellbeing, alongside reductions in cigarette consumption.

• Integrating smoking cessation with recovery services increases engagement among populations traditionally considered “hard to reach”.
• Harm reduction acts as a gateway to quitting rather than a compromise on ambition.
• Embedding specialist staff within existing services reduces barriers, stigma and missed opportunities.
• Strong data verification and governance are essential to demonstrate impact and maintain confidence among commissioners and partners.

Rather than viewing smoking cessation as a secondary priority, Peterborough has positioned it as a core component of recovery and prevention.

From April 2026, the service will expand into additional community venues, including Family Hubs, to widen access.

Work will also continue to strengthen the pregnancy incentive pathway and improve data integration between services. Ongoing performance data will be used to increase progression from harm reduction to quit attempts and support residents to achieve sustained smoke-free lives.

This model is transferable to other local authorities with commissioned substance misuse services, using existing recovery infrastructure and public health commissioning levers.