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Rogova A, Leal IM, Britton M, Chen TA, Lowenstein LM, Kyburz B, Casey K, Skeene K, Williams T, Reitzel LR. Implementing a tobacco-free workplace program at a substance use treatment center: a case study. BMC Health Serv Res 2024; 24:201. [PMID: 38355470 PMCID: PMC10865640 DOI: 10.1186/s12913-024-10629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center. METHODS This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice. RESULTS Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center. CONCLUSIONS Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.
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Affiliation(s)
- Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America.
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America.
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Maggie Britton
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Tzuan A Chen
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Lisa M Lowenstein
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
| | - Bryce Kyburz
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kathleen Casey
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kim Skeene
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Teresa Williams
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Lorraine R Reitzel
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
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Implementing Clinical Practice Guidelines for Tobacco Cessation in a Women's Residential Substance Use Treatment Facility. J Addict Nurs 2021; 32:159-164. [PMID: 34060768 DOI: 10.1097/jan.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tobacco is the leading cause of preventable death, and over 200,000 women die each year of diseases caused by tobacco. Women with substance use disorders (SUDs) are disproportionately affected. Smoking prevalence among individuals enrolled in SUD treatment is 2-4 times higher than that of the general population, yet less than half of all treatment facilities offer tobacco treatment services. However, when individuals combine treatment, they have a greater likelihood of long-term abstinence from alcohol and other substances of use. METHODS A quality improvement project was undertaken to implement the U.S. Public Health Service guideline for tobacco cessation in a women's residential substance use treatment facility. Tobacco users were advised on their health risk and recommended to cut down or quit. They were advised that help was available using nicotine replacement therapy, behavioral counseling, or both. RESULTS Upon admission, 67% of clients received brief advice to quit, and 30% participated in an intensive treatment aimed at reducing or eliminating cigarette use. At discharge, counseling participants (n = 21) smoked an average of nine cigarettes per day, reduced from 23, which was statistically significant. IMPLICATIONS FOR PRACTICE Interventions reduced cigarette smoking in a population at a high risk for adverse outcomes related to use. Results suggest that more clients are interested in tobacco treatment than previously estimated. Increased administrative, clinical, and pharmacy support can sustain and further assist clients with cessation efforts.
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Williams JM, Poulsen R, Chaguturu V, Tobia A, Palmeri B. Evaluation of an Online Residency Training in Tobacco Use Disorder. Am J Addict 2019; 28:277-284. [DOI: 10.1111/ajad.12885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/07/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jill M. Williams
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscataway New Jersey
| | - Raul Poulsen
- Department of Psychiatry, Miller School of MedicineJackson Memorial Hospital, University of MiamiMiami Florida
| | - Vamsee Chaguturu
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscataway New Jersey
| | - Anthony Tobia
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscataway New Jersey
| | - Barbara Palmeri
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscataway New Jersey
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Kenney SR, Anderson BJ, Bailey GL, Stein MD. Expectations about alcohol, cocaine, and benzodiazepine abstinence following inpatient heroin withdrawal management. Am J Addict 2018; 28:36-42. [PMID: 30548526 DOI: 10.1111/ajad.12834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/19/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Polysubstance use is associated with relapse and poor treatment outcomes among people dependent on heroin. Despite the high prevalence of polysubstance use among patients detoxifying from heroin, little is known about patients' expectations to abstain or use non-opiate substances. The current study examined factors associated with expectations about abstaining from alcohol, cocaine, and benzodiazepines (BZDs) following heroin withdrawal management. METHODS Between May and December of 2015, we surveyed 417 patients (71.9% male, 31.7 [±8.39] mean years old) initiating short-term inpatient heroin withdrawal management who reported alcohol, cocaine, or BZD use in the past 30 days. We used logistic regression to evaluate the adjusted associations of background characteristics with expectations about using each substance following discharge. RESULTS Approximately half of respondents reported past month alcohol (52%), cocaine (47.0%), or BZD (47.0%) use, and 25.9% reported using all three substances. Approximately half of those reporting drinking, 6.6% reporting cocaine use, and 27% of reporting BZD use expected to abstain from using that substance following heroin withdrawal. Prior opioid withdrawal was associated with a lower likelihood of expecting to stop using alcohol and BZDs, and more days of BZD use was associated with a greater likelihood of expecting to abstain from BZDs following discharge. CONCLUSION Persons with opioid use disorder often do not expect to stop using other substances following withdrawal management, with very few planning cocaine cessation. SCIENTIFIC SIGNIFICANCE Inpatient heroin withdrawal programs need to address and educate patients about how polysubstance use complicates recovery from heroin use. (Am J Addict 2019;28:36-42).
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Affiliation(s)
- Shannon R Kenney
- Behavioral Medicine Department, Butler Hospital, Providence 02906, Rhode Island.,Warren Alpert Medical School of Brown University, Providence 02912, Rhode Island
| | - Bradley J Anderson
- Behavioral Medicine Department, Butler Hospital, Providence 02906, Rhode Island
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence 02912, Rhode Island.,Stanley Street Treatment and Resources, Inc., Fall River 02720, Massachusetts
| | - Michael D Stein
- Behavioral Medicine Department, Butler Hospital, Providence 02906, Rhode Island.,Boston University School of Public Health, Boston 02118, Massachusetts
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Berman BA, Jones L, Jones F, Jones A, Pacheco BA, McCarthy WJ. How can we help African American substance users stop smoking? client and agency perspectives. J Ethn Subst Abuse 2017; 18:428-444. [PMID: 29257942 DOI: 10.1080/15332640.2017.1404955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Research is needed to better understand barriers to smoking cessation and sustained abstinence among racial/ethnic minority polydrug users. We conducted community dialogue groups involving 49 clients in substance use treatment programs with predominantly ethnic minority clientele and individual dialogues/interviews with seven program providers (stakeholders). Most clients were African American, under 40 years old, women, current smokers, and high school graduates. Smoking cessation services in these programs were considered inadequate and community programs insufficiently culturally tailored and economically and geographically inaccessible. Participants discussed individual "willpower" and choice; agency tobacco-related programs and policies; the relationships between smoking, smoking cessation, and treatment goals; and steps needed to reshape agency services and policies to provide greater support for smoking cessation in this at-risk population.
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Affiliation(s)
- Barbara A Berman
- a Department of Health Policy and Management , UCLA Fielding School of Public Health , Los Angeles , California
| | - Loretta Jones
- b Division of Community Engagement Healthy African American Families , Los Angeles , California.,c Department of Preventive and Social Medicine, Community Faculty , Charles R. Drew University of Medicine and Science , Los Angeles , California
| | - Felica Jones
- b Division of Community Engagement Healthy African American Families , Los Angeles , California
| | - Andrea Jones
- b Division of Community Engagement Healthy African American Families , Los Angeles , California.,d Charles R. Drew University of Medicine and Science , Los Angeles , California
| | | | - William J McCarthy
- a Department of Health Policy and Management , UCLA Fielding School of Public Health , Los Angeles , California
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Gentry S, Craig J, Holland R, Notley C. Smoking cessation for substance misusers: A systematic review of qualitative studies on participant and provider beliefs and perceptions. Drug Alcohol Depend 2017; 180:178-192. [PMID: 28910690 DOI: 10.1016/j.drugalcdep.2017.07.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/19/2017] [Accepted: 07/22/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Smoking prevalence among those in substance misuse treatment remains much higher than the general population, despite evidence for effective cessation interventions that do not negatively impact substance misuse outcomes. This systematic review summarises qualitative data on barriers and facilitators to smoking cessation for people in substance misuse treatment, participants' and providers' perceptions about effects of smoking cessation on substance misuse treatment, timing of intervention delivery and aspects of interventions perceived to be effective. METHODS Systematic review of qualitative studies and thematic synthesis of published qualitative data. RESULTS 10939 records and 132 full texts were screened. 22 papers reporting on 21 studies were included. Key themes identified were: strong relationships between smoking and other substance misuse; environmental influences; motivation; mental health; aspects of interventions perceived to be effective/ineffective; barriers and facilitators to intervention implementation; smoking bans/restrictions; and relationships with professionals. Many service users were motivated toward smoking cessation but were not offered support. Some felt interventions should be delivered after substance misuse treatment, whilst others felt concurrent/dual interventions would be beneficial, due to strong associations between smoking and other substances. Treatment providers felt they lacked training and resources for supporting smoking cessation, and were concerned about impact on substance misuse outcomes. CONCLUSIONS Many substance misusers who also smoke are motivated to quit but perceive a lack of support from professionals. Additional training and resources are required to enable professionals to provide the support needed. More research is required to develop enhanced packages of care for this deprived group of smokers.
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Affiliation(s)
- Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Jean Craig
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Rash CJ, Stitzer M, Weinstock J. Contingency Management: New Directions and Remaining Challenges for An Evidence-Based Intervention. J Subst Abuse Treat 2017; 72:10-18. [PMID: 27746057 PMCID: PMC5154900 DOI: 10.1016/j.jsat.2016.09.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/23/2016] [Indexed: 12/24/2022]
Abstract
This article introduces the special issue on contingency management (CM), an efficacious intervention for the treatment of substance use disorders with low uptake in clinical settings that is not commensurate with evidence for efficacy. In this special issue of the Journal of Substance Abuse Treatment, we present 16 articles representing the latest research in efficacy, implementation, and technological advances related to CM. Combined, this collection of articles highlights the diverse populations, settings, and applications of CM in the treatment of substance use disorders. We conclude by highlighting directions for future research, particularly those that may increase CM's appeal and uptake in routine clinical care.
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Affiliation(s)
- Carla J Rash
- Calhoun Cardiology Center - Behavioral Health, UConn Health Center, 263 Farmington Avenue (MC 3944), Farmington, CT 06030-3944.
| | - Maxine Stitzer
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD 21224
| | - Jeremiah Weinstock
- Department of Psychology, Saint Louis University, 3700 Lindell Boulevard, Morrissey Hall Rm 2735, St. Louis, MO 63108
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Quitting smoking during substance use disorders treatment: Patient and treatment-related variables. J Subst Abuse Treat 2016; 73:40-46. [PMID: 28017183 DOI: 10.1016/j.jsat.2016.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/19/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022]
Abstract
Although individuals in substance use disorders (SUD) treatment continue to smoke at high rates, regulatory, policy and programming changes promoting tobacco cessation are being implemented and some patients quit successfully. We examined associations of smoking patterns, tobacco advertising receptivity, anti-tobacco message awareness, health risk perception, attitudes towards addressing smoking and availability of smoking cessation services with quitting smoking during SUD treatment. Surveys were completed by 1127 patients in 24 programs chosen randomly, stratified by program type (residential, methadone maintenance, outpatient), from among publicly funded, adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network. Among respondents who had been in SUD treatment for at least one month, there were 631 current smokers and 52 former smokers who reported quitting smoking during treatment for at least one month prior to survey completion; these respondents comprised our sample (N=683). Results showed that participants who reported health concerns as a reason for quitting were 1.27 times more likely to have quit during treatment (p=0.015) than those reporting health concerns affected quitting a little or not at all. Additionally, participants who reported that smoking cessation was part of their personal treatment plan during SUD treatment were 1.08 times more likely to have quit during treatment (p<0.001). Participants in methadone treatment were 49% less likely to report successfully quitting during treatment than those in outpatient treatment (95%CI: 0. 35-0.75, p<0.001). Leveraging health concerns about smoking and including smoking cessation in an individualized treatment plan may help increase smoking cessation during SUD treatment.
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Sheals K, Tombor I, McNeill A, Shahab L. A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses. Addiction 2016; 111:1536-53. [PMID: 27003925 PMCID: PMC5025720 DOI: 10.1111/add.13387] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/25/2015] [Accepted: 03/07/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS People with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally placed to deliver interventions, but their attitudes may prevent this. This systematic review therefore aimed to identify and estimate quantitatively MHPs attitudes towards smoking and main barriers for providing smoking cessation support and to explore these attitudes in-depth through qualitative synthesis. METHODS The online databases AMED, EMBASE, Medline, PsychINFO, HMIC and CINAHL were searched in March 2015 using terms relating to three concepts: 'attitudes', 'mental health professionals' and 'smoking cessation'. Quantitative or qualitative studies of any type were included. Proportions of MHPs' attitudes towards smoking and smoking cessation were pooled across studies using random effects meta-analysis. Qualitative findings were evaluated using thematic synthesis. RESULTS Thirty-eight studies including 16 369 participants were eligible for inclusion. Pooled proportions revealed that 42.2% [95% confidence interval (CI) = 35.7-48.8] of MHPs reported perceived barriers to smoking cessation interventions, 40.5% (95% CI = 30.4-51.0) negative attitudes towards smoking cessation and 45.0% (95% CI = 31.9-58.4) permissive attitudes towards smoking. The most commonly held beliefs were that patients are not interested in quitting (51.4%, 95% CI = 33.4-69.2) and that quitting smoking is too much for patients to take on (38%, 95% CI = 16.4-62.6). Qualitative findings were consistent with quantitative results, revealing a culture of smoking as 'the norm' and a perception of cigarettes as a useful tool for patients and staff. CONCLUSIONS A significant proportion of mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions; many report a lack of time, training and confidence as main barriers to addressing smoking in their patients.
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Affiliation(s)
- Kate Sheals
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Ildiko Tombor
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience UK Centre for Tobacco and Alcohol Studies, London, UKKing's College LondonLondonUK
| | - Lion Shahab
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
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Knudsen HK. Implementation of smoking cessation treatment in substance use disorder treatment settings: a review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:215-225. [PMID: 27314884 DOI: 10.1080/00952990.2016.1183019] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The high prevalence of smoking among individuals receiving treatment for substance use disorder (SUD) has led to repeated calls for integrating smoking cessation treatment into these settings. OBJECTIVES This review summarizes key findings from the research on the implementation of smoking cessation in SUD treatment. METHODS PubMed searches of articles published from 2000 to 2015 yielded 48 empirical studies that focused on the delivery of smoking cessation in the US specialty SUD treatment settings in which organizations and counselors were the unit of analysis. Most studies used observational designs to gather data from organizations and counselors. Organizational studies show that few SUD treatment programs offer cessation counseling or pharmacotherapy. Organizational barriers include limited training, inadequate resources, and cultural norms that do not recognize smoking cessation as part of the organization's mission. Smoking cessation services are more likely to be available in medically oriented treatment settings, larger treatment programs, those offering a broader array of comprehensive services, and those that are more reliant on fee-for-service reimbursement (e.g., insurance, Medicaid). Surveys of counselors also show very low implementation. Counselors' personal skills and attitudes, their perceptions of managerial and coworker support for smoking cessation, and the availability of resources and reimbursement to support these services are correlated with implementation. State policies requiring treatment programs to offer tobacco treatment increase both adoption and implementation, yet these services continue to reach only modest percentages of the patients. CONCLUSIONS Few studies have tested specific implementation strategies. Such research is needed to determine how to accelerate the diffusion of these evidence-based practices to the SUD treatment field.
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Affiliation(s)
- Hannah K Knudsen
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
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Koch JR, Breland A. Behavioral Healthcare Staff Attitudes and Practices Regarding Consumer Tobacco Cessation Services. J Behav Health Serv Res 2015; 44:399-413. [DOI: 10.1007/s11414-015-9477-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cooperman NA, Richter KP, Bernstein SL, Steinberg ML, Williams JM. Determining Smoking Cessation Related Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers in Methadone Treatment. Subst Use Misuse 2015; 50:566-81. [PMID: 25559697 PMCID: PMC4646090 DOI: 10.3109/10826084.2014.991405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. OBJECTIVE To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related IMB factors in this population. METHODS Current or former smokers in methadone treatment (n = 35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. RESULTS Commonly known IMB factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with emotions, finding social support, and pharmacotherapy adherence (behavioral skills). IMB factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). IMB strengths and deficits varied by individual. CONCLUSIONS Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population.
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Affiliation(s)
- Nina A Cooperman
- 1Rutgers Robert Wood Johnson Medical School, Division of Addiction Psychiatry , New Brunswick, New Jersey , United States
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Stuyt EB. Enforced abstinence from tobacco during in-patient dual-diagnosis treatment improves substance abuse treatment outcomes in smokers. Am J Addict 2015; 24:252-257. [PMID: 25907814 DOI: 10.1111/ajad.12179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although the prevalence of tobacco use in those in substance abuse treatment is known to be quite high, most treatment programs do not address tobacco. The purpose of this study was to determine substance abuse recovery rates a year after treatment in a fully integrated, 90-day inpatient, dual diagnosis treatment program where patients are required to quit tobacco use in addition to drug and alcohol use for the duration of their 3 month stay. Tobacco is treated in the same way as other drugs and alcohol. METHODS One hundred fifty-four patients enrolled in a yearlong follow-up after treatment study consisting of monthly phone contact to assess recovery from substance abuse. RESULTS One hundred forty (n=140) patients completed the year follow-up. At the time of entry into the program 120 (86%) were using tobacco daily. At the end of the year this decreased to 102 (73%). Patients who were using tobacco were more likely to relapse to other drugs or alcohol (p = .01). Patients who actively attempted to abstain from tobacco after treatment were significantly more likely to remain continuously abstinent throughout the year (p = .03). CONCLUSIONS This study demonstrates that tobacco use is correlated with relapse and addressing tobacco in treatment as seriously as and in the same fashion as other drugs, improves outcomes. SCIENTIFIC SIGNIFICANCE When provided with a tobacco free treatment environment for 90 days, patients with substance abuse and mental illness can and do make the decision to quit tobacco and stay quit, aiding their ability to remain sober.
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Affiliation(s)
- Elizabeth B Stuyt
- Department of Psychiatry, University of Colorado, Denver, Colorado
- Circle Program, Colorado Mental Health Institute at Pueblo, Pueblo, Colorado
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14
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Martínez C, Guydish J, Le T, Tajima B, Passalacqua E. Predictors of quit attempts among smokers enrolled in substance abuse treatment. Addict Behav 2015; 40:1-6. [PMID: 25218064 DOI: 10.1016/j.addbeh.2014.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/31/2014] [Accepted: 08/20/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study investigates factors predicting past year quit attempts among smokers enrolled in substance abuse treatment in New York State. METHODS Data were drawn from two prior cross-sectional surveys conducted among clients treated in 10 randomly selected substance abuse treatment programs. Among 820 clients recruited, 542 self-identified as current smokers, and 485 provided information about their quit attempts. The main outcome was reporting a quit smoking attempt in the past year, dichotomized as quit attempters or non-quit attempters. Univariate and multivariate logistic regression analyses were performed to explore predictors of attempting to quit. RESULTS Half of substance abuse clients in treatment programs reported a past year quit attempt. Quit attempters were more likely to be in a preparation and contemplation stage of change (preparation: OR=2.68, 95% CI: 1.51-4.77; contemplation: OR=2.96 95% CI: 1.61-5.42), reported more positive attitudes toward quitting (OR=1.49; 95% CI: 1.11-1.99) and received more cessation services than non-quit attempters (OR=1.21; 95% CI: 1.11-1.99). CONCLUSIONS Addressing patient attitudes about quitting smoking, having clinicians address smoking in the course of addiction treatment, and offering interventions to increase readiness to quit may contribute to increased quit attempts in smokers enrolled in addiction treatment programs.
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Affiliation(s)
- Cristina Martínez
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Barbara Tajima
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Emma Passalacqua
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Hunt JJ, Cupertino AP, Gajewski BJ, Jiang Y, Ronzani TM, Richter KP. Staff commitment to providing tobacco dependence in drug treatment: Reliability, validity, and results of a national survey. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:389-95. [PMID: 24128292 PMCID: PMC4180218 DOI: 10.1037/a0034389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although most people in treatment for illicit drug use smoke cigarettes, few facilities offer any form of treatment for tobacco dependence. One reason for this may be that drug treatment staff have varying levels of commitment to treat tobacco. We developed and validated a 14-item Tobacco Treatment Commitment Scale (TTCS), using 405 participants in leadership positions in drug treatment facilities. We first conducted a confirmatory factor analysis to evaluate 4 a priori domains suggested by our original set of 38 items-this did not produce a good fit (comparative fit index [CFI] = 0.782, root mean square error of approximation [RMSEA] = 0.067). We then conducted a series of exploratory factor analyses to produce a more precise and reliable scale. The final confirmatory factor analysis indicated a 3-factor solution, produced a good fit (CFI = 0.950, RMSEA = 0.058), and had substantial unified reliability of 0.975. The final TTCS contained 14 items in 3 domains: "Tobacco is less harmful than other drugs," "It's not our job to treat tobacco," and "Tobacco treatment will harm clients." These constructs account for most of the variance in the survey items and emerged as major sentiments driving staff commitment to providing tobacco services. The TTCS can be used to understand the role of staff attitudes in the adoption of tobacco services in this important treatment setting.
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Affiliation(s)
- Jamie J Hunt
- School of Nursing and Health Studies, University of Missouri
| | - A Paula Cupertino
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center
| | - Byron J Gajewski
- Department of Biostatistics, University of Kansas Medical Center
| | - Yu Jiang
- Department of Biostatistics, University of Kansas Medical Center
| | - Telmo M Ronzani
- Department of Psychology, Federal University of Juiz de Fora
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center
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Laschober TC, Eby LT. Counselor and clinical supervisor perceptions of OASAS tobacco-free regulation implementation extensiveness, perceived accountability, and use of resources. J Psychoactive Drugs 2014; 45:416-24. [PMID: 24592668 DOI: 10.1080/02791072.2013.845329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
New York State required substance use disorder (SUD) treatment programs to be 100% tobacco-free in 2008. The current study examined counselor (N = 364) and clinical supervisor (N = 98) perceptions of how extensively the tobacco-free regulation was implemented in their treatment programs, perceived accountability for implementing the regulation, and use of OASAS-provided resources to aid implementation one year after the regulation went into effect. Results showed that compared to counselors, supervisors perceive greater implementation extensiveness and report using more resources, yet they perceive lower accountability. In addition, whereas perceived accountability is significantly and positively associated with implementation extensiveness perceptions for counselors, the relationship is negative for supervisors. The association between use of resources and implementation extensiveness perceptions is significant and positive for both counselors and supervisors. We conclude that implementation experiences differ between counselors and clinical supervisors, suggesting the importance of tailoring interventions to promote tobacco-free policies in SUD treatment programs.
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Affiliation(s)
- Tanja C Laschober
- Owens Institute for Behavioral Research, University of Georgia, Athens, GA 30206, USA.
| | - Lillian T Eby
- lndustrial-Organizational Psychology Program, University of Georgia, Athens, GA 30206, USA
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The index of tobacco treatment quality: development of a tool to assess evidence-based treatment in a national sample of drug treatment facilities. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:13. [PMID: 23497366 PMCID: PMC3704700 DOI: 10.1186/1747-597x-8-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 01/25/2013] [Indexed: 11/12/2022]
Abstract
Background Quitting smoking improves health and drug use outcomes among people in treatment for substance abuse. The twofold purpose of this study is to describe tobacco treatment provision across a representative sample of U.S. facilities and to use these data to develop the brief Index of Tobacco Treatment Quality (ITTQ). Methods We constructed survey items based on current tobacco treatment guidelines, existing surveys, expert input, and qualitative research. We administered the survey to a stratified sample of 405 facility administrators selected from all 3,800 U.S. adult outpatient facilities listed in the SAMHSA Inventory of Substance Abuse Treatment Services. We constructed the ITTQ with a subset of 7 items that have the strongest clinical evidence for smoking cessation. Results Most facilities (87.7%) reported that a majority of their clients were asked if they smoke cigarettes. Nearly half of facilities (48.6%) reported that a majority of their smoking clients were advised to quit. Fewer (23.3%) reported that a majority of their smoking clients received tobacco treatment counseling and even fewer facilities (18.3%) reported a majority of their smoking clients were advised to use quit smoking medications. The median facility ITTQ score was 2.57 (on a scale of 1–5) and the ITTQ displayed good internal consistency (Cronbach’s alpha = .844). Moreover, the ITTQ had substantial test-retest reliability (.856), and ordinal confirmatory factor analysis found that our one-factor model for ITTQ fit the data very well with a CFI of 0.997 and an RMSEA of 0.042. Conclusions The ITTQ is a brief and reliable tool for measuring tobacco treatment quality in substance abuse treatment facilities. Given the clear-cut room for improvement in tobacco treatment, the ITTQ could be an important tool for quality improvement by identifying service levels, facilitating goal setting, and measuring change.
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