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Guydish J, Le T, Hosakote S, Straus E, Wong J, Martínez C, Delucchi K. Tobacco use among substance use disorder (SUD) treatment staff is associated with tobacco-related services received by clients. J Subst Abuse Treat 2022; 132:108496. [PMID: 34111773 DOI: 10.1016/j.jsat.2021.108496] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite disproportionately high rates of smoking among people in residential substance use disorder (SUD) treatment, few receive tobacco cessation services. Little is known about how smoking among treatment staff may impact this disparity. We explored the relationship between staff tobacco use and client tobacco use. Additionally, we examined the relationship between staff tobacco use and tobacco-related services reported by staff and clients. METHODS Staff (n = 363) and clients (n = 639) in 24 California publicly-funded residential SUD treatment programs were surveyed in 2019-20. Staff self-reported current tobacco use, as well as their beliefs, self-efficacy, and practices regarding smoking cessation. Clients reported their tobacco use and they services received while in treatment. Regression analyses examined the adjusted and unadjusted associations between staff and client tobacco use and other outcomes. RESULTS Use of any tobacco product by staff ranged from 0% to 100% by program, with an average of 32% across programs. Adjusted analyses found that higher rates of staff tobacco use were associated with higher rates of client tobacco use, and with fewer clients receiving tobacco-related counseling. In programs that had higher rates of staff tobacco use, staff were less likely to believe that clients should quit smoking in treatment and had lower self-efficacy to address smoking. CONCLUSION Higher rates of tobacco use among staff are associated with higher rates of client tobacco use and fewer clients receiving cessation counseling. Efforts to reduce tobacco use among SUD clients should be supported by efforts to reduce tobacco use among staff. SUD treatment programs, and agencies that fund and regulate those programs, should aim to reduce the use of tobacco products among staff.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Sindhushree Hosakote
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Elana Straus
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Jessie Wong
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, United States of America.
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Taing M, Nitturi V, Chen TA, Kyburz B, Martinez Leal I, Correa-Fernández V, Obasi EM, Williams T, Casey K, O’Connor DP, Koshy L, Britton M, Drenner K, Reitzel LR. Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:239. [PMID: 35010499 PMCID: PMC8744608 DOI: 10.3390/ijerph19010239] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/03/2021] [Accepted: 12/24/2021] [Indexed: 05/25/2023]
Abstract
Tobacco use is exceedingly high among individuals receiving care for opioid addiction, but not commonly addressed by clinicians in treatment settings. Taking Texas Tobacco Free (TTTF) is a comprehensive tobacco-free workplace (TFW) program that builds treatment centers' capacity to address tobacco use with evidence-based tobacco cessation policies and practices. Here, we examine the process and outcomes of TTTF's implementation within 7 opioid addiction centers. Program goals were structured according to the RE-AIM framework. Pre- and post-implementation data were collected from client facing and non-client facing employees to assess changes in education, training receipt, knowledge, and intervention behaviors, relative to program goals. Centers reported tobacco screenings conducted and nicotine replacement therapy (NRT) delivered through 6 months post-implementation. Overall, 64.56% of employees participated in TTTF-delivered tobacco education, with a 54.9% gain in tobacco control and treatment knowledge (p < 0.0001), and significant increases in exposure to education about tobacco use and harms among individuals with opioid use disorder (p = 0.0401). There were significant gains in clinicians' receipt of training in 9/9 tobacco education areas (ps ≤ 0.0118). From pre- to post-implementation, there were mean increases in the use of the 5A's (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with statistically significant gains seen in NRT provision/referral (p < 0.0001). Several program goals were achieved or exceeded; however, 100% center participation in specialized clinical trainings was among notable exceptions. One program withdrew due to competing pandemic concerns; all others implemented comprehensive TFW policies. Overall, TTTF may have improved participating opioid treatment centers' capacity to address tobacco use, although study limitations, including lower post-implementation evaluation response rates, suggest that results require replication in other opioid addiction treatment settings.
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Affiliation(s)
- Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Vijay Nitturi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Daniel P. O’Connor
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA
| | - Litty Koshy
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Maggie Britton
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Kelli Drenner
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
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Leone FT, Zhang Y, Evers-Casey S, Evins AE, Eakin MN, Fathi J, Fennig K, Folan P, Galiatsatos P, Gogineni H, Kantrow S, Kathuria H, Lamphere T, Neptune E, Pacheco MC, Pakhale S, Prezant D, Sachs DPL, Toll B, Upson D, Xiao D, Cruz-Lopes L, Fulone I, Murray RL, O’Brien KK, Pavalagantharajah S, Ross S, Zhang Y, Zhu M. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e5-e31. [PMID: 32663106 PMCID: PMC7365361 DOI: 10.1164/rccm.202005-1982st] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.
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Abstract
While prevalence of tobacco use in the US general population is declining, prevalence among those with opioid use disorder (OUD) remains high and results in excessive tobacco-related disease and premature mortality. Among smokers with OUD, tobacco cessation rates are negligible without treatment. However, both low-intensity behavioral interventions and more intensive motivational interventions yield negligible cessation rates. While contingency management has potent short-term cessation effects, effects are not maintained at post-intervention follow-up. Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with OUD. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared with standard treatment regimens. Targeting the unique challenges faced by smokers with OUD, including nicotine-opioid interactions and poor medication adherence, has potential to improve cessation outcomes, but further research is needed to optimize intervention efficacy among smokers with OUD.
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Nahvi S, Arnsten JH. Missed opportunities to test the neuropsychiatric safety--and efficacy--of varenicline among smokers with substance use disorders. Drug Alcohol Depend 2018; 185:245-247. [PMID: 30369710 PMCID: PMC6201286 DOI: 10.1016/j.drugalcdep.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shadi Nahvi
- Departments of Medicine, and of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine / Montefiore Medical Center, 111 East 210th Street, Bronx, NY, USA,
| | - Julia H. Arnsten
- Departments of Medicine, of Psychiatry & Behavioral Sciences, and of Epidemiology & Population Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA,
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Knudsen HK, Roman PM. Medicaid, Private Insurance, and the Availability of Smoking Cessation Interventions in Substance Use Disorder Treatment. Psychiatr Serv 2015; 66:1213-20. [PMID: 26234332 PMCID: PMC4630091 DOI: 10.1176/appi.ps.201400451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Integration of smoking cessation services in substance use disorder treatment would benefit many patients. Although prior studies have identified organizational characteristics associated with delivery of these services, less is known regarding associations between financial factors and the availability of smoking cessation services. This study examined whether reliance on Medicaid and private insurance revenues is associated with the availability of a formal counseling-based smoking cessation program and medications (sustained-release bupropion, varenicline, and nicotine replacement) within U.S. specialty treatment organizations. METHODS Administrators of a national sample of 372 treatment organizations participated in face-to-face structured interviews from October 2011 to December 2013. Participants provided data regarding smoking cessation services, revenue sources, and other organizational characteristics. Multiple imputation was used to address missing data, and models were estimated by using logistic regression with adjustment for clustering of organizations within states. RESULTS Greater reliance on Medicaid revenues was positively associated with the odds of offering counseling-based smoking cessation programs, sustained-release bupropion, varenicline, and nicotine replacement. For example, a 10-percentage point increase in Medicaid revenues was associated with a 12% increase in the odds of offering a smoking cessation program. Reliance on private insurance revenues was positively associated with the odds of offering the three medications. CONCLUSIONS The findings point to future potential increases in the availability of smoking cessation services in the context of expanding insurance coverage under health care reform. Longitudinal research will be needed to examine whether this impact is realized.
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Affiliation(s)
- Hannah K Knudsen
- Dr. Knudsen is with the Department of Behavioral Science, University of Kentucky, Lexington (e-mail: ). Dr. Roman is with the Department of Sociology and the Owens Institute for Behavioral Research, University of Georgia, Athens
| | - Paul M Roman
- Dr. Knudsen is with the Department of Behavioral Science, University of Kentucky, Lexington (e-mail: ). Dr. Roman is with the Department of Sociology and the Owens Institute for Behavioral Research, University of Georgia, Athens
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7
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Substance Use Disorder Counselors' Reports of Tobacco Cessation Services Availability, Implementation, and Tobacco-related Knowledge. J Adolesc Health 2015; 57:327-33. [PMID: 26299559 PMCID: PMC4548273 DOI: 10.1016/j.jadohealth.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Adolescence is a prime developmental stage for early tobacco cessation (TC) intervention. This study examined substance use disorder counselors' reports of the availability and implementation of TC services (behavioral treatments and pharmacotherapies) in their treatment programs and the relationship between their tobacco-related knowledge and implementation of TC services. METHODS Survey data were collected in 2012 from 63 counselors working in 22 adolescent-only treatment programs. Measures included 15 TC behavioral treatments, nine TC pharmacotherapies, and three tobacco-related knowledge scales (morbidity/mortality, modalities and effectiveness, pharmacology). RESULTS First, nine of the 15 behavioral treatments are reported as being available by more than half of counselors; four of the 15 behavioral treatments are used by counselors with more than half of adolescents. Of the nine pharmacotherapies, availability of the nicotine patch is reported by almost 40%, buproprion by nearly 30%, and clonidine by about 21% of counselors. Pharmacotherapies are used by counselors with very few adolescents. Second, counselors' tobacco-related knowledge varies based on the knowledge scale examined. Third, we only find a significant positive relationship between counselors' implementation of TC behavioral treatments and TC modalities and effectiveness knowledge. DISCUSSION Findings suggest that more behavioral treatments should be made available in substance use disorder treatment programs considering that they are the main treatment recommendation for adolescents. Counselors should be encouraged to routinely use a wide range of available behavioral treatments. Finally, counselors should be encouraged to expand their knowledge of TC modalities and effectiveness because of the relationship with behavioral treatments implementation.
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Muilenburg JL, Laschober TC, Eby LT. Relationship between Low-Income Patient Census and Substance Use Disorder Treatment Programs' Availability of Tobacco Cessation Services. JOURNAL OF DRUG ISSUES 2015; 45:69-79. [PMID: 25530629 PMCID: PMC4266556 DOI: 10.1177/0022042614552020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low income adults with substance use disorders (SUDs) have a high prevalence of tobacco use and often limited access to tobacco cessation treatment. This study examines the relationship between low-income SUD patient census (i.e., percentage of patients whose treatment costs are covered by Medicaid and Federal block grants) and SUD programs' availability of three evidence-based tobacco cessation services: behavioral treatments, system-level support, and pharmacotherapy. Data were collected from a random sample of 1,006 program administrators in 2010. Mixed-effects models results show that the percentage of low-income patients is significantly positively associated with the availability of behavioral treatments and system-level support but not pharmacotherapy. Thus, low-income patients may have similar access to tobacco cessation pharmacotherapy but greater access to behavioral treatments and system-level support. However, the availability of tobacco cessation services is not widespread overall, which may hamper access to extensive services to address low-income SUD patients' high smoking rates.
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Affiliation(s)
- Jessica L. Muilenburg
- University of Georgia, 322 Psychology Building, Athens, GA 30602, USA, Phone: 706-542-4365, Fax: 706-542-4956
- Department of Health Promotion and Behavior
| | - Tanja C. Laschober
- University of Georgia, 322 Psychology Building, Athens, GA 30602, USA, Phone: 706-542-4365, Fax: 706-542-4956
- Owens Institute for Behavioral Research
| | - Lillian T. Eby
- University of Georgia, 322 Psychology Building, Athens, GA 30602, USA, Phone: 706-542-4365, Fax: 706-542-4956
- Owens Institute for Behavioral Research
- Industrial-Organizational Psychology Program
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Eby LT, Laschober TC, Muilenburg JL. Sustained, new, never, and discontinued tobacco cessation services adopters. J Subst Abuse Treat 2014; 49:8-14. [PMID: 25178991 DOI: 10.1016/j.jsat.2014.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/21/2014] [Accepted: 07/29/2014] [Indexed: 11/17/2022]
Abstract
This study examined longitudinal adoption patterns of tobacco cessation (TC) counseling and TC pharmacotherapy in substance use disorder treatment programs and baseline predictors (program characteristics and program culture) of these patterns 12-months later. Telephone survey data were collected in 2010 from 685 randomly sampled program administrators working in geographically representative treatment programs across the U.S. Regarding TC counseling, about 41% of programs never adopt, 33% sustain, and 27% change adoption patterns. Concerning TC pharmacotherapy, about 62% of programs never adopt, 19% sustain, and 18% change adoption patterns. The three most consistent predictors of counseling adoption patterns are TC reimbursement, TC financial resource availability, and smoking culture. For TC pharmacotherapy adoption patterns, the most consistent predictors include profit status, TC reimbursement, level of care, TC financial resource availability, and smoking culture. Findings provide insights into program characteristics and program culture as both potential barriers and facilitators of longitudinal TCS adoption.
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Affiliation(s)
- Lillian T Eby
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA; Industrial-Organizational Psychology Program, 325 Psychology Building, Athens, GA 30602, USA.
| | - Tanja C Laschober
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA
| | - Jessica L Muilenburg
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Department of Health Promotion and Behavior, 325 Psychology Building, Athens, GA 30602, USA
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Malekshahi T, Tioleco N, Ahmed N, Campbell ANC, Haller D. Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse. J Subst Abuse Treat 2014; 48:8-12. [PMID: 25216812 DOI: 10.1016/j.jsat.2014.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/08/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022]
Abstract
Non-medical use of atypical antipsychotics by substance abusers has been reported in the literature, although no detailed studies exist. Among 429 addiction treatment inpatients screened, 73 (17.0%) reported misuse of antipsychotics with alcohol, opioids, cocaine, methamphetamine and/or cannabis; 39 (9.1%) within the past year. Of past year misusers, 25 (64.1%) were interviewed. Most were male (76.0%), non-Caucasian (56.0%), and polysubstance abusers (84.0%). Quetiapine, the most abused drug (96.0%), was obtained primarily from doctors (52.0%) and family/friends (48.0%). Reasons for use included to "recover" from other substances (66.7%), "enhance" the effects of other substances (25.0%), and "experiment" (20.8%). The most frequently reported positive effect was "feeling mellow" (75.0%); negative effects were consistent with antipsychotic use (e.g., feeling thirsty, trouble concentrating). Compared to a normative sample of inpatient substance abusers, ASI composite scores were higher. Findings suggest that physicians should assess for use/misuse of atypical antipsychotics among patients with addiction.
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Affiliation(s)
- Tara Malekshahi
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA
| | - Nina Tioleco
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA
| | - Nahima Ahmed
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA
| | - Aimee N C Campbell
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA; Columbia University Medical Center, College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA.
| | - Deborah Haller
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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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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12
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Organizational factors as predictors of tobacco cessation pharmacotherapy adoption in addiction treatment programs. J Addict Med 2014; 8:59-65. [PMID: 24365803 DOI: 10.1097/adm.0000000000000008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study investigated 3 organizational factors (ie, counseling staff clinical skills, absence of treatment program obstacles, and policy-related incentives) as predictors of tobacco cessation pharmacotherapy (TCP) adoption (comprised of the 9 available TCPs) in addiction treatment programs using the innovation implementation effectiveness framework. METHODS Data were obtained in 2010 from a random sample of 1006 addiction treatment program administrators located across the United States using structured telephone interviews. RESULTS According to program administrator reports, TCP is adopted in approximately 30% of treatment programs. Negative binomial regression results show that fewer treatment program obstacles and more policy-related incentives are related to greater adoption of TCP. Counter to prediction, clinical skills are unrelated to TCP adoption. CONCLUSIONS Our findings suggest that organizational factors, on the basis of established theoretical frameworks, merit further examination as facilitators of the adoption of diverse TCP in addiction treatment programs.
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Rieckmann TR, Abraham AJ, Kovas AE, McFarland BH, Roman PM. Impact of research network participation on the adoption of buprenorphine for substance abuse treatment. Addict Behav 2014; 39:889-96. [PMID: 24594902 DOI: 10.1016/j.addbeh.2014.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 01/18/2014] [Accepted: 01/29/2014] [Indexed: 11/24/2022]
Abstract
There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N=198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.
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Gielen N, Krumeich A, Havermans RC, Smeets F, Jansen A. Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: a qualitative study. Eur J Psychotraumatol 2014; 5:22821. [PMID: 24511368 PMCID: PMC3916674 DOI: 10.3402/ejpt.v5.22821] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/20/2013] [Accepted: 01/02/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Healthcare providers working in addiction facilities do not often implement integrated treatment of comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD) while there is empirical evidence to do so. OBJECTIVE This study aims to get insight into the views of clinicians with regard to the diagnosis and treatment of PTSD in SUD patients. METHOD A qualitative research method was chosen. Fourteen treatment staff members of different wards of an addiction care facility were interviewed by an independent interviewer. RESULTS Despite acknowledging adverse consequences of trauma exposure on SUD, severe underdiagnosis of PTSD was mentioned and treatment of PTSD during SUD treatment was not supported. Obstacles related to the underestimation of PTSD among SUD patients and to the perceptions of SUD clinicians concerning the treatment of comorbid SUD/PTSD were reported. CONCLUSIONS It is concluded that SUD facilities should train their clinicians to enable them to provide for integrated treatment of SUD/PTSD.
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Affiliation(s)
- Nele Gielen
- Mondriaan, MAIAR, Heerlen, The Netherlands
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anja Krumeich
- Department of Health, Ethics & Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Remco C. Havermans
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Feikje Smeets
- Department of Psychiatry & Psychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Muilenburg JL, Laschober TC, Eby LT. Climate for innovation, 12-step orientation, and tobacco cessation treatment. J Subst Abuse Treat 2013; 46:447-55. [PMID: 24355811 DOI: 10.1016/j.jsat.2013.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/10/2013] [Accepted: 10/29/2013] [Indexed: 11/30/2022]
Abstract
This study examined the relationship between (1) three indicators of climate for innovation (clinician skills, absence of program obstacles, policy-related incentives) and adoption extensiveness of both behavioral treatments for tobacco cessation (TC) and system-level support for TC in substance use disorder treatment programs, (2) a program's 12-step treatment orientation and adoption extensiveness, and (3) whether 12-step treatment orientation moderates the relationship between climate for innovation and adoption extensiveness. Data were obtained from a random sample of 1006 program administrators. Hierarchical regression results showed that both absence of program obstacles and policy-related incentives are positively related to adoption extensiveness. Twelve-step treatment orientation is neither related to adoption extensiveness nor a moderator of the relationship between climate for innovation and adoption extensiveness. Although the adoption of both behavioral treatments for TC and system-level support for TC is not extensive, we conclude that a 12-step treatment orientation neither hampers nor promotes adoption extensiveness.
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Affiliation(s)
- Jessica L Muilenburg
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Department of Health Promotion and Behavior, 325 Psychology Building, Athens, GA 30602, USA.
| | - Tanja C Laschober
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA.
| | - Lillian T Eby
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA; Industrial-Organizational Psychology Program, 325 Psychology Building, Athens, GA 30602, USA.
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16
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McClure EA, Acquavita SP, Dunn KE, Stoller KB, Stitzer ML. Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities. J Subst Abuse Treat 2013; 46:194-201. [PMID: 23988192 DOI: 10.1016/j.jsat.2013.07.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/14/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) versus non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics.
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Affiliation(s)
- Erin A McClure
- Medical University of South Carolina School of Medicine, Charleston, SC 29407, USA.
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17
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Eby LTDT, Laschober TC. Perceived implementation of the Office of Alcoholism and Substance Abuse Services (OASAS) tobacco-free regulation in NY State and clinical practice behaviors to support tobacco cessation: a repeated cross-sectional study. J Subst Abuse Treat 2013; 45:83-90. [PMID: 23375360 DOI: 10.1016/j.jsat.2013.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 12/22/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
This study measured substance use disorder clinicians' perceptions regarding the implementation extensiveness of the Office of Alcohol and Substance Abuse Services (OASAS) tobacco-free regulation, passed in New York State in July of 2008, at three time-points and across organizations with varying characteristics. Repeated cross-sectional data were collected from clinicians approximately 4months pre-regulation (time 0, n=362), 10-12months post-regulation (time 1, n=462), and 20-24months post-regulation (time 2, n=509). Clinician perceptions of implementation extensiveness (number of required policies in effect), use of tobacco cessation-related intake procedures, and use of guideline recommended counseling for treating tobacco dependence are significantly greater at time 1 and time 2 compared to time 0. Additionally, differences are found in perceived implementation extensiveness based on hospital-based status, profit status, and level of care offered, although the pattern of effects differed some over the three time-points under investigation.
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Affiliation(s)
- Lillian T de Tormes Eby
- Industrial-Organizational Psychology Program, 325 Psychology Building, Athens, GA 30602, USA.
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18
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Guydish J, Ziedonis D, Tajima B, Seward G, Passalacqua E, Chan M, Delucchi K, Zammarelli L, Levy M, Kolodziej M, Brigham G. Addressing Tobacco Through Organizational Change (ATTOC) in residential addiction treatment settings. Drug Alcohol Depend 2012; 121:30-7. [PMID: 21906892 PMCID: PMC3335347 DOI: 10.1016/j.drugalcdep.2011.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/03/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Smoking prevalence among persons in addiction treatment is 3-4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence. METHODS The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked. RESULTS From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163)=7.15, p=0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123)=3.66, p=0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235)=10.58, p=0.0013) and clients received more tobacco-related services from their program (F(1, 235)=92.86, p<0.0001) and from their counselors (F(1, 235)=61.59, p<0.0001). Most changes remained at follow-up. CONCLUSIONS The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.
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Affiliation(s)
- Joseph Guydish
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94118, United States.
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