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McCuistian C, Lisha NE, Campbell B, Cheng C, Le J, Guydish J. Reducing tobacco use in substance use treatment: The California tobacco free initiative. Addict Behav 2024; 155:108025. [PMID: 38593596 DOI: 10.1016/j.addbeh.2024.108025] [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: 01/25/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND People in substance use disorder (SUD) treatment have a smoking prevalence that is five times higher than the national average. California funded the Tobacco Free for Recovery Initiative, designed to support programs in implementing tobacco-free grounds and increasing smoking cessation services. In the first cohort of the initiative (2018-2020) client smoking prevalence decreased from 54.2% to 26.6%. The current study examined whether similar findings would be replicated with a later cohort of programs (2020-2022). METHOD Cross-sectional survey data were collected from clients in 11 residential SUD treatment programs at baseline (n = 185) and at post intervention (n = 227). Multivariate logistic regression assessed change over time in smoking prevalence, tobacco use behaviors, and receipt of cessation services across the two timepoints. RESULTS Client smoking prevalence decreased from 60.3 % to 40.5 % (Adjusted Odds Ratio [AOR] = 0.46, 95 % CI = 0.27, 0.78; p = 0.004). Current smokers and those who quit while in treatment reported an increase in nicotine replacement therapy (NRT)/pharmacotherapy from baseline to post intervention (31.9 % vs 45.6 %; AOR = 2.22, 95 % CI = 1.08, 4.58; p = 0.031). CONCLUSIONS Like the first cohort, the Tobacco Free for Recovery initiative was associated with decreased client smoking prevalence and an increase in NRT/pharmacotherapy. These findings strengthen the evidence that similar initiatives may be effective in reducing smoking prevalence among people in SUD treatment.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States.
| | - Nadra E Lisha
- Division of General Internal Medicine, School of Medicine University of California, San Francisco 530 Parnassus Ave, San Francisco, CA 94143, United States
| | - Barbara Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States
| | - Christine Cheng
- Smoking Cessation Leadership Center, University of California, San Francisco 490 Illinois Street, 9216, San Francisco, CA 94158, United States
| | - Jennifer Le
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, United States
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Davis JP, Rao P, Dilkina B, Prindle J, Eddie D, Christie NC, DiGuiseppi G, Saba S, Ring C, Dennis M. Identifying individual and environmental predictors of opioid and psychostimulant use among adolescents and young adults following outpatient treatment. Drug Alcohol Depend 2022; 233:109359. [PMID: 35219997 DOI: 10.1016/j.drugalcdep.2022.109359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The United States (US) continues to grapple with a drug overdose crisis. While opioids remain the main driver of overdose deaths, deaths involving psychostimulants such as methamphetamine are increasing with and without opioid involvement. Recent treatment admission data reflect overdose fatality trends suggesting greater psychostimulant use, both alone and in combination with opioids. Adolescents and young adults are particularly vulnerable with generational trends showing that these populations have particularly high relapse rates following treatment. METHODS We assessed demographic, psychosocial, psychological comorbidity, and environmental factors (percent below the poverty line, percent unemployed, neighborhood homicide rate, population density) that confer risk for opioid and/or psychostimulant use following substance use disorder treatment using two complementary machine learning approaches-random forest and least absolute shrinkage and selection operator (LASSO) modelling-with latency to opioid and/or psychostimulant as the outcome variable. RESULTS Individual level predictors varied by substance use disorder severity, with age, tobacco use, criminal justice involvement, race/ethnicity, and mental health diagnoses emerging at top predictors. Environmental variabels including US region, neighborhood poverty, population, and homicide rate around patients' treatment facility emerged as either protective or risk factors for latency to opioid and/or psychostimulant use. CONCLUSIONS Environmental variables emerged as one of the top predictors of latency to use across all levels of substance use disorder severity. Results highlight the need for tailored treatments based on severity, and implicate environmental variables as important factors influencing treatment outcomes.
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Affiliation(s)
- Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA.
| | - Prathik Rao
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Bistra Dilkina
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, USA
| | - Nina C Christie
- Department of Psychology, University of Sothern California & Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Graham DiGuiseppi
- Suzanne Dworak-Peck School of Social Work; USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, USA
| | - Shaddy Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Colin Ring
- Department of Psychology, Loma Linda University, USA
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Fokuo JK, McCuistian CL, Masson CL, Gruber VA, Straus E, Wong J, Guydish JR. Pre-implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California. Subst Use Misuse 2022; 57:1345-1355. [PMID: 35621319 PMCID: PMC10083040 DOI: 10.1080/10826084.2022.2079139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Across the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs. METHODS We conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. FINDINGS Themes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors' strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services. CONCLUSION To support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.
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Affiliation(s)
- J Konadu Fokuo
- Mood and Anxiety Disorders Program, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caravella L McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Carmen L Masson
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Valerie A Gruber
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Elana Straus
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Jessie Wong
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Joseph R Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Spaducci G, McNeill A, Hubbard K, Stewart D, Yates M, Robson D. Response to Commentary on Smoking-related violence in a mental health setting following the implementation of a comprehensive smoke-free policy: A content analysis of incident reports (Spaducci et al, 2019). Int J Ment Health Nurs 2020; 29:749-750. [PMID: 32356354 DOI: 10.1111/inm.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Gilda Spaducci
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Ann McNeill
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Kathryn Hubbard
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
| | - Mary Yates
- South London and Maudsley Mental Health NHS Trust, Bethlem Royal Hospital, London, UK
| | - Deborah Robson
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
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Miller SC, Hemmy Asamsama O, Silvestri MM, Bonanno C, Krondilou K. Commentary on a study of tobacco-related violence in a mental health setting. Int J Ment Health Nurs 2020; 29:747-748. [PMID: 32510782 DOI: 10.1111/inm.12731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shannon C Miller
- Veterans Affairs Medical Center, Dayton/Middletown, Ohio, USA
- Departments of Psychiatry & Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | | | | | - Christina Bonanno
- Veterans Affairs Medical Center, Indianapolis/Ft.Wayne, Indiana, USA
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