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Gass JC, Morris DH, Winters J, VanderVeen JW, Chermack S. Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic. J Subst Abuse Treat 2018; 84:1-8. [PMID: 29195588 DOI: 10.1016/j.jsat.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.
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Affiliation(s)
- Julie C Gass
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States.
| | - David H Morris
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jamie Winters
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph W VanderVeen
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Stephen Chermack
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
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Abraham AJ, Bagwell-Adams G, Jayawardhana J. Availability of tobacco cessation services in substance use disorder treatment programs: Impact of state tobacco control policy. Addict Behav 2017; 71:12-17. [PMID: 28231493 DOI: 10.1016/j.addbeh.2017.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/27/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Given the high prevalence of smoking among substance use disorder (SUD) patients, the specialty SUD treatment system is an important target for adoption and implementation of tobacco cessation (TC) services. While research has addressed the impact of tobacco control on individual tobacco consumption, largely overlooked in the literature is the potential impact of state tobacco control policies on availability of services for tobacco cessation. This paper examines the association between state tobacco control policy and availability of TC services in SUD treatment programs in the United States. METHODS State tobacco control and state demographic data (n=51) were merged with treatment program data from the 2012 National Survey of Substance Abuse Treatment Services (n=10.413) to examine availability of TC screening, counseling and pharmacotherapy services in SUD treatment programs using multivariate logistic regression models clustered at the state-level. RESULTS Approximately 60% of SUD treatment programs offered TC screening services, 41% offered TC counseling services and 26% offered TC pharmacotherapy services. Results of multivariate logistic regression showed the odds of offering TC services were greater for SUD treatment programs located in states with higher cigarette excise taxes and greater spending on tobacco prevention and control. CONCLUSIONS Findings indicate cigarette excise taxes and recommended funding levels may be effective policy tools for increasing access to TC services in SUD treatment programs. Coupled with changes to insurance coverage for TC under the Affordable Care Act, state tobacco control policy tools may further reduce tobacco use in the United States.
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Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, McCrabb S, Palazzi K, Bonevski B. Addressing tobacco in Australian alcohol and other drug treatment settings: a cross-sectional survey of staff attitudes and perceived barriers. Subst Abuse Treat Prev Policy 2017; 12:20. [PMID: 28464898 PMCID: PMC5414160 DOI: 10.1186/s13011-017-0106-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within alcohol and other drug (AOD) services, staff attitudes and beliefs are important influences determining provision of smoking cessation care. This study of AOD staff aimed to examine: a) current attitudes toward smoking cessation care; b) service and staff characteristics associated with unsupportive smoking cessation care attitudes, and c) perceived barriers to providing smoking cessation care. METHODS Between July-October 2014, 506 staff from 31 Australian AOD services completed an online cross-sectional survey which assessed agreement with 6 attitudinal statements (supportive and unsupportive) and 10 perceived barriers to smoking cessation care in the AOD setting. Logistic regressions examined service (sector) and staff (age, gender, smoking status and number of years in AOD field) characteristics associated with unsupportive smoking cessation care attitudes. RESULTS A large proportion agreed with supportive statements: Smoking cessation care should be part of usual care (87%), smoking cessation care is as important as counselling about other drugs (72%) and staff have the organisational support to provide smoking cessation care (58%). Some respondents agreed with unsupportive statements: AOD clients are not interested in addressing their smoking (40%), increasing smoking restrictions would lead to client aggression (23%), smoking is a personal choice and it is not the service's role to interfere (16%). Respondents from non-government managed services, current tobacco smokers (compared to ex-smokers) and those with less AOD experience had higher odds of agreeing with unsupportive smoking cessation care statements. The most frequently identified barriers to providing smoking cessation care were: client inability to afford cessation medicines, insufficient funding and lack of a coordinated treatment approach (all 61%). CONCLUSIONS Overall, staff hold largely supportive smoking cessation care attitudes but perceive a large number of barriers to providing smoking cessation care.
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Affiliation(s)
- Eliza Skelton
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Flora Tzelepis
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
- Hunter New England Local Health District, Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute (HMRI), 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Anthony Shakeshaft
- The University of New South Wales, National Drug and Alcohol Research Centre, 22-32 King Street, Randwick, NSW 2031 Australia
| | - Ashleigh Guillaumier
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Adrian Dunlop
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
- Hunter New England Local Health District, Newcastle Community Health Centre, 670 Hunter Street, Newcastle West, NSW 2302 Australia
| | - Sam McCrabb
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute (HMRI), 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Billie Bonevski
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
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Muilenburg JL, Laschober TC, Eby LT, Moore ND. Prevalence of and Factors Related to Tobacco Ban Implementation in Substance Use Disorder Treatment Programs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:241-9. [PMID: 25677250 DOI: 10.1007/s10488-015-0636-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined the prevalence of and factors (psychological climate for change and staff attributes) related to indoor and outdoor tobacco bans for patients, employees, and visitors in U.S. substance use disorder treatment programs. Data were collected from a random sample of 1,026 program administrators. Almost all programs banned tobacco use indoors and around one third banned tobacco use outdoors. When there was no tobacco ban, the majority of programs restricted smoking to designated indoor and/or outdoor areas. Further, all psychological climate for change factors (perceived program support, perceived tobacco culture, and tobacco ban beliefs) but none of the staff attributes (percentage licensed/certified clinicians, percentage clinicians with master's degrees, total staff with education in health-related field) were significantly related to the implementation of comprehensive tobacco bans (both indoors and outdoors).
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Affiliation(s)
- Jessica L Muilenburg
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Tanja C Laschober
- Owens Institute for Behavioral Research, University of Georgia, 325 Psychology Building, Athens, GA, 30602, USA.
| | - Lillian T Eby
- Owens Institute for Behavioral Research, University of Georgia, 325 Psychology Building, Athens, GA, 30602, USA.,Industrial-Organizational Psychology Program, University of Georgia, Athens, GA, USA
| | - Nancy D Moore
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
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Skelton E, Bonevski B, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, McCrabb S, Palazzi K. Tobacco smoking policies in Australian alcohol and other drug treatment services, agreement between staff awareness and the written policy document. BMC Public Health 2017; 17:87. [PMID: 28095823 PMCID: PMC5240295 DOI: 10.1186/s12889-016-3968-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Comprehensive smoke-free policy in the alcohol and other drug (AOD) setting provides an opportunity to reduce tobacco related harms among clients and staff. This study aimed to examine within AOD services: staff awareness of their service’s smoking policy compared to the written policy document and staff and service factors associated with accurate awareness of a total ban and perceived enforcement of a total ban. Methods An audit of written tobacco smoking policy documents and an online cross-sectional survey of staff from 31 Australian AOD services. In addition, a contact at each service was interviewed to gather service-related data. Results Overall, 506 staff participated in the survey (response rate: 57%). Nearly half (46%) perceived their service had a total ban with 54% indicating that this policy was always enforced. Over one-third (37%) reported a partial ban with 48% indicating that this policy was always enforced. The audit of written policies revealed that 19 (61%) services had total bans, 11 (36%) had partial bans and 1 (3%) did not have a written smoking policy. Agreement between staff policy awareness and their service’s written policy was moderate (Kappa 0.48) for a total ban and fair (Kappa 0.38) for a partial ban. Age (1 year increase) of staff was associated with higher odds of correctly identifying a total ban at their service. Conclusions Tobacco smoking within Australian AOD services is mostly regulated by a written policy document. Staff policy awareness was modest and perceived policy enforcement was poor.
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Affiliation(s)
- Eliza Skelton
- School of Medicine & Public Health, Faculty of Health & Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.
| | - Billie Bonevski
- School of Medicine & Public Health, Faculty of Health & Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Flora Tzelepis
- School of Medicine & Public Health, Faculty of Health & Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Longworth Avenue, Wallsend, NSW, 2287, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Ashleigh Guillaumier
- School of Medicine & Public Health, Faculty of Health & Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Adrian Dunlop
- School of Medicine & Public Health, Faculty of Health & Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Drug & Alcohol Clinical Services, Newcastle Community Health Centre, Hunter New England Local Health District, Level 3 670 Hunter Street, Suite 8, Newcastle West, NSW, 2302, Australia
| | - Sam McCrabb
- School of Medicine & Public Health, Faculty of Health & Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Kerrin Palazzi
- Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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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: 62] [Impact Index Per Article: 7.8] [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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7
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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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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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10
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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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12
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Eby LT, Laschober TC, Muilenburg JL. Understanding counselors' implementation of tobacco cessation services with patients. J Subst Abuse Treat 2014; 47:314-20. [PMID: 25082757 DOI: 10.1016/j.jsat.2014.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/15/2014] [Accepted: 06/18/2014] [Indexed: 01/30/2023]
Abstract
This study aimed to understand substance use disorder counselors' implementation of evidence-based tobacco cessation services (TCS) with their patients who smoke. Drawing from an established adoption of innovations framework, we investigated the association between counselors' perceptions of the availability of TCS (both pharmacotherapies and behavioral treatments) in their treatment program and the implementation of TCS (both pharmacotherapies and behavioral treatments) with their patients who smoke and whether this association is moderated by the strength of an organization's climate for implementation and the fit of the innovation with users' values. Data were collected in 2010 from 682 counselors working in 239 treatment programs across the U.S. that offer evidence-based TCS. Mixed-effect models showed that perceived availability of TCS was related with greater TCS implementation. This relationship was moderated by several indicators of climate for implementation but not by the fit of the innovation with users' values.
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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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