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Patient experiences with tobacco use during substance use disorder treatment and early recovery: a mixed method analysis of phone interview responses. J Addict Dis 2022:1-7. [PMID: 35930400 DOI: 10.1080/10550887.2022.2103352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Tobacco use and related mortality remain disproportionately high among individuals with substance use disorders (SUDs). Though engagement in tobacco cessation interventions is associated with improved long-term recovery, many individuals in SUD treatment do not participate. The goal of the present study was to better understand patient views regarding tobacco use/cessation during residential SUD treatment, in order to decrease barriers for this vulnerable population. This study utilized a cross-sectional design and mixed methods analysis. Following discharge from residential SUD treatment, individuals who reported any use of tobacco were invited to participate in a brief phone interview. Forty-one of the 60 who were reached (68%) agreed to participate. Responses were quantified for analysis when appropriate, and descriptive statistics were calculated for quantitative data. Thematic analysis was used to analyze qualitative responses. Most respondents (83%) reported that tobacco cessation was an important goal and were open to tobacco cessation treatment. The vast majority (85%) did not think tobacco use interfered with their recovery from other SUDs. Respondents noted the socially-reinforcing nature of tobacco use in treatment, and indicated a desire for increased access to cessation services. Results suggest increased patient education and changes to treatment center tobacco policies may assist individuals recovering from SUD with tobacco cessation.
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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: 1] [Impact Index Per Article: 0.5] [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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Pacek LR, Reboussin BA, Green KM, LaFlair LN, Storr CL, Alvanzo AAH, Mojtabai R, Cullen B, Young AS, Tormohen K, Riehm K, Crum RM. Current tobacco use, nicotine dependence, and transitions across stages of alcohol involvement: A latent transition analysis approach. Int J Methods Psychiatr Res 2019; 28:e1789. [PMID: 31141253 PMCID: PMC6791727 DOI: 10.1002/mpr.1789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/29/2019] [Accepted: 05/05/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES This study aims to examine the (a) probability of transition between stages of alcohol involvement and (b) influence of tobacco use and nicotine dependence on transitions. METHODS Data came from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent transition analysis estimated the probability of transitioning between stages of alcohol involvement across waves and the impact of tobacco use and nicotine dependence at Wave 1 on transitions. RESULTS Males reporting current tobacco use but no dependence at Wave 1 were more likely to progress from No Problems to Moderate Problems (adjusted odds ratio [aOR] = 1.79; 95% confidence interval [CI] [1.44, 2.22]) and from No Problems to Severe Problems (aOR = 2.44; 95% CI [1.25, 4.77]) than nontobacco users. Females reporting current tobacco use but no dependence were more likely to progress from No Problems to Moderate Problems (aOR = 2.00; 95% CI [1.37, 2.94]) and from No Problems to Severe Problems (aOR = 2.87; 95% CI [1.34, 6.13]). Females reporting current tobacco use and dependence were more likely than females not using tobacco to transition from Moderate to No Problems (aOR = 2.10; 95% CI [1.04, 4.22]). CONCLUSIONS Results suggest that tobacco use is a preceding correlate of progression in alcohol involvement among males and females. Among females, tobacco use and nicotine dependence are also related to alcohol involvement recovery.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Carla L Storr
- Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anika A H Alvanzo
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kayla Tormohen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kira Riehm
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Wood W, Jauncey M, Salmon AM, McCrabb S, Palazzi K, Bonevski B. Integrating smoking cessation care into routine service delivery in a medically supervised injecting facility: An acceptability study. Addict Behav 2018; 84:193-200. [PMID: 29723802 DOI: 10.1016/j.addbeh.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Among people who inject drugs (PWIDs) the prevalence of tobacco smoking exceeds 80%; making smoking cessation intervention a priority for this population. This study aims to examine staff and client perspectives from a supervised injecting facility regarding: i) whether an organizational change intervention increased rates of smoking cessation care delivery (pre- to post-intervention); and ii) acceptability of the intervention. METHODS A pre-and-post intervention pilot study in a supervised injecting facility was conducted in Sydney, Australia between July 2014-December 2015. The intervention employed an organizational change approach and included six components. Cross-sectional samples of staff (pre n = 27, post n = 22) and clients (pre n = 202, post n = 202) completed online surveys pre and post intervention. RESULTS From pre to post-intervention staff reported smoking cessation practices significantly increased for the provision of verbal advice (30% to 82%; p < 0.001), offer of free or subsidized nicotine replacement therapy (30% to 91%; p < 0.001), referral to a general practitioner (19% to 64%; p = 0.001), and follow-up to check on quit smoking progress (18.5% to 64%; p = 0.001). Significantly more clients reported receiving all smoking cessation strategies post-intervention. Over 85% of staff agreed that it was acceptable to address client smoking as part of usual care and 95% of clients agreed that it was acceptable to be asked by staff about their tobacco smoking. CONCLUSIONS Increasing the provision of smoking cessation care using an organizational change approach is both feasible for staff and acceptable to staff and clients of supervised injecting facilities.
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5
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Derefinko KJ, Salgado García FI, Sumrok DD. Smoking Cessation for Those Pursuing Recovery from Substance Use Disorders. Med Clin North Am 2018; 102:781-796. [PMID: 29933829 DOI: 10.1016/j.mcna.2018.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This article summarizes the literature regarding the similar biopsychosocial mechanisms of tobacco use and alcohol and substance use disorders, and the evidence for and against the provision of tobacco cessation for those in treatment for alcohol and substance use disorders. The practicality of treatment, focusing on methods, timing, and breadth of intervention strategies, are also presented. Common methodologies that may be used across tobacco use and alcohol and substance use disorder to prevent lapse and relapse are discussed. Physicians can and should adhere to the policy that tobacco use is a common and dangerous comorbid condition that demands concomitant treatment.
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Affiliation(s)
- Karen J Derefinko
- University of Tennessee Health Science Center, 66 North Pauline Street, Suite 305, Memphis, TN 38163-2181, USA.
| | - Francisco I Salgado García
- University of Tennessee Health Science Center, 66 North Pauline Street, Suite 305, Memphis, TN 38163-2181, USA
| | - Daniel D Sumrok
- University of Tennessee Health Science Center, Department of Addiction Medicine, 6401 Popular Avenue, Suite 500, Memphis, TN 38119, USA
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The Untreated Addiction: Going Tobacco-Free in a VA Substance Abuse Residential Rehabilitation Treatment Program (SARRTP). J Behav Health Serv Res 2018; 45:659-667. [PMID: 29721729 DOI: 10.1007/s11414-018-9610-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite negative effects of tobacco on the human body and the high prevalence of smoking among those who enter treatment for substance use, few residential programs endorse a tobacco-free policy. Conventional wisdom suggests that it is overwhelming to quit more than one substance at a time, and as a result, many clinicians believe that a shift to a tobacco-free treatment environment is unfeasible. However, the most recent scientific literature suggests the opposite: targeting tobacco use during substance use treatment can increase abstinence rates from both smoking and substances of choice. Therefore, the purpose of the current project is to outline the process by which a residential substance use treatment program within a Veterans Affairs (VA) medical center implemented a tobacco-free policy. In addition, preliminary program evaluation data dispels the myth that eliminating tobacco use in a residential treatment program leads to a decline in patient interest and program utilization.
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McHugh RK, Votaw VR, Fulciniti F, Connery HS, Griffin ML, Monti PM, Weiss RD. Perceived barriers to smoking cessation among adults with substance use disorders. J Subst Abuse Treat 2016; 74:48-53. [PMID: 28132700 DOI: 10.1016/j.jsat.2016.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/06/2016] [Accepted: 12/28/2016] [Indexed: 11/19/2022]
Abstract
The majority of adults seeking substance use disorder treatment also smoke. Smoking is associated with greater substance use disorder severity, poorer treatment outcome, and increased mortality among those with substance use disorders. Yet, engaging this population in smoking cessation treatment is a significant challenge. The aim of this study was to examine perceived barriers to smoking cessation among treatment-seeking adults with alcohol or opioid use disorder. Additionally, we examined whether anxiety sensitivity - a known risk factor for barriers to smoking cessation in the general population - was associated with more barriers to smoking cessation in this sample. A sample of 208 adults was recruited for a one-time study and completed self-report measures of anxiety sensitivity and perceived barriers to smoking cessation. Results indicated that the most common barriers were anxiety (82% of the sample), tension/irritability (76%), and concerns about the ability to maintain sobriety from their primary substance of abuse (64%). Those who reported more barriers also reported lower confidence in the ability to change their smoking behavior. Higher anxiety sensitivity was associated with more perceived barriers to smoking cessation, even when controlling for cigarette dependence severity. These results suggest that there are several perceived barriers to smoking cessation among treatment-seeking adults with substance use disorders. In addition to psychoeducational interventions aimed to modify negative beliefs about smoking cessation, anxiety sensitivity may be a promising therapeutic target in this population.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Victoria R Votaw
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Francesca Fulciniti
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Margaret L Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Providence, RI 02903, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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8
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Apollonio D, Philipps R, Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database Syst Rev 2016; 11:CD010274. [PMID: 27878808 PMCID: PMC6464324 DOI: 10.1002/14651858.cd010274.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Smoking rates in people with alcohol and other drug dependencies are two to four times those of the general population. Concurrent treatment of tobacco dependence has been limited due to concern that these interventions are not successful in this population or that recovery from other addictions could be compromised if tobacco cessation was combined with other drug dependency treatment. OBJECTIVES To evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and clinicaltrials.gov databases, with the most recent search completed in August 2016. A grey literature search of conference abstracts from the Society on Nicotine Research and Treatment and the ProQuest database of digital dissertations yielded one additional study, which was excluded. SELECTION CRITERIA We included randomised controlled trials assessing tobacco cessation interventions among people in concurrent treatment for alcohol or other drug dependence or in outpatient recovery programmes. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study risk of bias and extracted data. We resolved disagreements by consensus. The primary outcome was abstinence from tobacco use at the longest period of follow-up, and the secondary outcome was abstinence from alcohol or other drugs, or both. We reported the strictest definition of abstinence. We summarised effects as risk ratios and 95% confidence intervals (CI). Two clustered studies did not provide intraclass correlation coefficients, and were excluded from the sensitivity analysis. We used the I2 statistic to assess heterogeneity. MAIN RESULTS Thirty-five randomised controlled trials, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of nicotine replacement therapy (NRT) or non-NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear.Analyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta-analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.60, 95% CI 1.22 to 2.12, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow-up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I2 = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).Interventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40).Offering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I2 = 66%)).Data on adverse effect of the interventions were limited. AUTHORS' CONCLUSIONS The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence. There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs. The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency. The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment. Certain results were sensitive to the length of follow-up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non-NRT or combined pharmacotherapy. Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence.
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Affiliation(s)
- Dorie Apollonio
- University of California San FranciscoClinical Pharmacy3333 California StreetSuite 420San FranciscoCAUSA94143‐0613
| | | | - Lisa Bero
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney6th Floor (6W76)The University of SydneySydneyNew South Wales 2006Australia
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Koch JR, Breland A. Behavioral Healthcare Staff Attitudes and Practices Regarding Consumer Tobacco Cessation Services. J Behav Health Serv Res 2015; 44:399-413. [DOI: 10.1007/s11414-015-9477-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Shadel WG, Tucker JS, Mullins L, Staplefoote L. Providing smoking cessation programs to homeless youth: The perspective of service providers. J Subst Abuse Treat 2014; 47:251-7. [DOI: 10.1016/j.jsat.2014.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/08/2014] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
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Hill KP, Toto LH, Lukas SE, Weiss RD, Trksak GH, Rodolico JM, Greenfield SF. Cognitive behavioral therapy and the nicotine transdermal patch for dual nicotine and cannabis dependence: a pilot study. Am J Addict 2013; 22:233-8. [PMID: 23617864 DOI: 10.1111/j.1521-0391.2012.12007.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/04/2012] [Accepted: 02/21/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We assessed the feasibility of a new cognitive behavioral therapy (CBT) manual, plus transdermal patch nicotine replacement therapy (NRT), to treat co-occurring nicotine and cannabis dependence. METHOD Seven of 12 (58.3%) adults with DSM-IV diagnoses of both nicotine and cannabis dependence completed 10 weeks of individual CBT and NRT. RESULTS Participants smoked 12.6 ± 4.9 tobacco cigarettes per day at baseline, which was reduced to 2.1 ± 4.2 at the end of treatment (F[5] = 23.5, p < .0001). The reduction in cannabis use from 10.0 ± 5.3 inhalations per day at baseline to 8.0 ± 5.3 inhalations per day at 10 weeks was not significant (F[5] = 1.12, p = .37). There was a significant decrease from the mean baseline Fagerstrom Test for Nicotine Dependence scores at weeks 4, 6, 8, and 10 of treatment (F[4] = 19.8, p < .001) and mean Client Satisfaction Questionnaire scores were uniformly high (30.6 ± 1.9). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE A CBT plus NRT treatment program significantly reduced tobacco smoking but did not significantly reduce cannabis use in individuals with co-occurring nicotine and cannabis dependence. There was no compensatory increase in cannabis use following the reduction in tobacco smoking, suggesting that clinicians can safely pursue simultaneous treatment of co-occurring nicotine and cannabis dependence. The intervention was well-liked by the 7 of the 12 enrollees who completed the study.
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Affiliation(s)
- Kevin P Hill
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.
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12
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Implementation of a Smoking Cessation Treatment Study at Substance Abuse Rehabilitation Programs: Smoking Behavior and Treatment Feasibility Across Varied Community-based Outpatient Programs. J Addict Med 2013; 1:154-60. [PMID: 21768951 DOI: 10.1097/adm.0b013e31813872e4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cigarette smoking is widely prevalent among individuals in treatment for drug or alcohol dependence; however, the treatment of nicotine addiction in this population has numerous obstacles at both programmatic and patient levels. Despite these difficulties, recent studies have demonstrated moderate success in implementing smoking cessation treatment in drug rehabilitation programs. The National Drug Abuse Treatment Clinical Trials Network sponsored a smoking cessation study in 13 community-based outpatient substance abuse rehabilitation programs across the country. The study evaluated the effectiveness of smoking cessation treatment provided as an adjunct to substance abuse treatment-as-usual. This report summarizes the practical and clinical experiences encountered at each of the study sites with regard to implementing the smoking cessation treatment intervention. Smoking behavior of the treatment clientele was assessed by anonymous survey at each site. In addition, sites were systematically characterized by using program review and assessment tools completed by the respective staff and program directors at the site. Survey and recruitment data indicated that cigarette smoking is more prevalent and that smoking cessation treatment is more feasible, in methadone maintenance treatment programs. Other factors associated with smoking behavior and with the recruitment of drug- and alcohol-dependent individuals into the smoking cessation treatment study are described.
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13
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Gifford EV, Tavakoli S, Wang R, Hagedorn HJ, Hamlett-Berry KW. Tobacco dependence diagnosis and treatment in Veterans Health Administration residential substance use disorder treatment programs. Addiction 2013; 108:1127-35. [PMID: 23297756 DOI: 10.1111/add.12105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/24/2012] [Accepted: 12/24/2012] [Indexed: 11/30/2022]
Abstract
AIMS To explore tobacco dependence (TD) diagnosis and treatment utilization, and identify predictors of nicotine replacement therapy (NRT) among veterans with substance use disorders (SUDs) enrolled in Veterans Health Administration (VHA) SUD residential treatment programs (SRTPs). DESIGN Retrospective cohort study. SETTING VHA SRTPs, which treat veterans with SUD and multiple severe psychosocial deficits, from 1 October 2009 to 31 September 2010. PARTICIPANTS Identified tobacco users among veterans with SUD treated in SRTPs during fiscal year 2010 (FY10). MEASUREMENTS Rates of documented TD diagnosis and pharmacotherapy were assessed nationally, regionally and by facility. Patient-level predictors of NRT were examined using a mixed-effects logistic regression model with facility as a random effect. FINDINGS A total of 12 097 of the 15 320 veterans in SRTPs in FY10 (79%) were identified as probable tobacco users. Among these, 33% had a documented TD diagnosis, 34% were treated with pharmacotherapy and only 11% were both diagnosed and treated for TD while in SRTP. NRT was more common among patients with a current documented TD diagnosis, recent history of TD treatment, comorbid mental health disorder, age 55 years or younger and identified as white. CONCLUSIONS Most veterans in Veterans Health Administration substance use disorders residential treatment programs appear to use tobacco, yet only one in 10 receives a documented ICD-9 TD diagnosis and pharmacotherapy while in a substance use disorders residential treatment program.
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Affiliation(s)
- Elizabeth V Gifford
- Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road, Menlo Park, CA 94025,USA.
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14
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Apollonio D, Philipps R, Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance abuse. Cochrane Database Syst Rev 2012; 12:1-10. [PMID: 23833567 PMCID: PMC3698983 DOI: 10.1002/14651858.cd010274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of tobacco cessation therapy offered concurrently with treatment for drug and alcohol addiction.
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Affiliation(s)
- Dorie Apollonio
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Rose Philipps
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Lisa Bero
- Department of Clinical Pharmacy and Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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15
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Gonzales R, Anglin MD, Beattie R, Ong CA, Glik DC. Understanding recovery barriers: youth perceptions about substance use relapse. Am J Health Behav 2012; 36:602-14. [PMID: 22584088 DOI: 10.5993/ajhb.36.5.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To qualitatively explore how treatment-involved youth retrospectively contextualize relapse from substance use. METHODS Fourteen focus groups were conducted with 118 youth (78.3% male; 66.1% Latino) enrolled in participating substance abuse treatment programs (4 young adult and 10 adolescent) throughout Los Angeles County. Transcripts were analyzed for relapse perception themes. RESULTS Dominant relapse themes include emotional reasons (90%), life stressors (85%), cognitive factors (75%), socialization processes (65%), and environmental issues (55%). CONCLUSIONS Youth perceptions about relapse during treatment should be used to better inform clinical approaches and shape early-intervention recovery agendas for substance-abusing youth.
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Affiliation(s)
- Rachel Gonzales
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - M. Douglas Anglin
- Associate Director, Integrated Substance Abuse Programs, University of California, Los Angeles, CA,, USA; Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rebecca Beattie
- Staff Research Associate, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Chris Angelo Ong
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Deborah C. Glik
- Professor, School of Public Health, University of California, Los Angeles, CA, USA
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16
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Knudsen HK, Studts CR, Studts JL. The implementation of smoking cessation counseling in substance abuse treatment. J Behav Health Serv Res 2012; 39:28-41. [PMID: 21647812 DOI: 10.1007/s11414-011-9246-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research on the implementation of smoking cessation counseling within substance abuse treatment organizations is limited. This study examines associations among counselors' implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization- and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors' knowledge of the Public Health Service's clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors' knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky, Lexington, 40536-0086, USA.
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17
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Marijuana use and tobacco smoking cessation among heavy alcohol drinkers. Drug Alcohol Depend 2011; 119:194-200. [PMID: 21724341 PMCID: PMC3199036 DOI: 10.1016/j.drugalcdep.2011.06.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 06/03/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Whereas problem drinking impedes smoking cessation, less is known whether marijuana use affects smoking cessation outcomes and whether smoking cessation treatment leads to changes in marijuana smoking. METHODS In a randomized clinical trial that recruited 236 heavy drinkers seeking smoking cessation treatment, we examined whether current marijuana smokers (n=57) differed from the rest of the sample in tobacco smoking and alcohol use outcomes and whether the patterns of marijuana use changed during treatment. RESULTS Half of the marijuana users reported smoking marijuana at least weekly (an average of 42% of possible smoking days), the other half used infrequently, an average of 5% of possible days. There were no significant differences between the marijuana use groups and non-users on smoking outcomes and marijuana use did not predict smoking lapses. All participants made large reductions in weekly alcohol consumption during the trial, with weekly marijuana users reducing their drinking by 47% and at a faster rate than non-marijuana users after the 8-week follow-up. Weekly marijuana smokers also steadily decreased their marijuana use over the course of the study (at 8-, 16-, and 26-week follow-ups) by more than 24%. CONCLUSIONS These data suggest that frequent marijuana smokers may benefit from smoking cessation interventions, even when marijuana use is not explicitly discussed. These individuals do not show any more difficulty than other cigarette smokers in making efforts to reduce tobacco smoking and in fact, make meaningful changes in marijuana use and heavy drinking. Future clinical trials should examine whether smoking cessation treatment that addresses both marijuana and tobacco smoking leads to substantial reductions in marijuana use.
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18
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Brown E, Nonnemaker J, Federman EB, Farrelly M, Kipnis S. Implementation of a tobacco-free regulation in substance use disorder treatment facilities. J Subst Abuse Treat 2011; 42:319-27. [PMID: 22000325 DOI: 10.1016/j.jsat.2011.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 08/09/2011] [Accepted: 08/15/2011] [Indexed: 10/16/2022]
Abstract
We assessed the impact of a statewide tobacco-free services regulation on facility administrators' attitudes and the integration of tobacco dependence treatment into substance use disorder services. We surveyed substance use disorder treatment facility administrators in New York before (n = 285) and after (n = 205) tobacco-free services regulation implementation about their attitudes, their perceptions of staff and patient attitudes, and the facilities' services. We analyzed data on admissions and tobacco treatment pharmacotherapy administration. We found increased tobacco screening and cessation services offered, increased use of tobacco pharmacotherapy, and increased support for tobacco-free campus policies. Although patient resistance was a challenge, administrators reported a decrease in patient resistance to tobacco-free policies. Patient admissions did not decrease after the regulation went into effect. Tobacco-free services regulations in substance use disorder treatment facilities can be feasibly implemented, which has the potential to decrease the extremely high rates of tobacco use among people with substance use disorders.
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19
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Dunn KE, Saulsgiver KA, Sigmon SC. Contingency management for behavior change: applications to promote brief smoking cessation among opioid-maintained patients. Exp Clin Psychopharmacol 2011; 19:20-30. [PMID: 21341920 PMCID: PMC3131670 DOI: 10.1037/a0022039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cigarette smoking is highly prevalent among patients who are being treated for opioid-dependence, yet there have been limited scientific efforts to promote smoking cessation in this population. Contingency management (CM) is a behavioral treatment that provides monetary incentives contingent upon biochemical evidence of drug abstinence. This paper discusses the results of two studies that utilized CM to promote brief smoking cessation among opioid-maintained patients. Participants in a pilot study were randomly assigned for a 2-week period to a Contingent group that earned monetary vouchers for providing biochemical samples that met criteria for smoking abstinence, or a Noncontingent group that earned monetary vouchers independent of smoking status (Dunn et al., 2008). Results showed Contingent participants provided significantly more smoking-negative samples than Noncontingent participants (55% vs. 5%, respectively). A second randomized trial that utilized the same 2-week intervention and provided access to the smoking cessation pharmacotherapy bupropion replicated the results of the pilot study (55% and 17% abstinence in Contingent and Noncontingent groups, respectively; Dunn et al, 2010). Relapse to illicit drug use was also evaluated prospectively and no association between smoking abstinence and relapse to illicit drug use was observed (Dunn et al., 2009). It will be important for future studies to evaluate participant characteristics that might predict better treatment outcome, to assess the contribution that pharmacotherapies might have alone or in combination with a CM intervention on smoking cessation and to evaluate methods for maintaining the abstinence that is achieved during this brief intervention for longer periods of time.
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry, Johns Hopkins University, School of Medicine, 5200 Eastern Avenue, Suite 142 West, Baltimore, MD 21224, USA.
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20
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Knudsen HK, Studts JL, Boyd S, Roman PM. Structural and cultural barriers to the adoption of smoking cessation services in addiction treatment organizations. J Addict Dis 2010; 29:294-305. [PMID: 20635279 DOI: 10.1080/10550887.2010.489446] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Few studies have examined associations between the availability of smoking cessation services in addiction treatment organizations and specific cultural, staffing, and resource barriers. Telephone interviews were conducted with administrators of 897 addiction treatment organizations in the United States. These data revealed that few programs had adopted the full bundle of five recommended tobacco-related intake procedures, and that less than half of programs offered any smoking cessation services. Barriers to adoption of the intake bundle and availability of services included organizational culture and low levels of staff skills. Adoption of cessation services was associated with center type, location in a hospital setting, levels of care, and organizational size. Although a substantial proportion of organizations offer smoking cessation services, expansion of these services and greater adoption of tobacco-related intake procedures are needed to address the needs of nicotine-dependent individuals in addiction treatment.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086, USA.
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21
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Chisolm MS, Brigham EP, Lookatch SJ, Tuten M, Strain EC, Jones HE. Cigarette smoking knowledge, attitudes, and practices of patients and staff at a perinatal substance abuse treatment center. J Subst Abuse Treat 2010; 39:298-305. [PMID: 20667683 DOI: 10.1016/j.jsat.2010.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/24/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
This study compares cigarette smoking knowledge, attitudes, and practices (S-KAP) of opioid- and other substance-dependent patients and their multidisciplinary staff at an outpatient perinatal substance abuse treatment center. Consenting patients (n = 95) and staff (n = 41) concurrently completed a modified form of the S-KAP survey instrument. Ninety-five percent of patients reported currently smoking, and half endorsed wanting "to quit smoking now." This patient desire to quit smoking was significantly underrated by staff compared to the patients themselves (p = .028). Both patients and staff demonstrated suboptimal knowledge of smoking health risks, but 73% of patients reported trying to quit with past pregnancies to avoid harm to the fetus/baby. Although results show that patients could benefit from smoking cessation strategies centered on smoking's fetal/neonatal health risks, organizational interventions that focus on changing staff attitudes about patient desire to quit smoking may first need to be implemented.
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Affiliation(s)
- Margaret S Chisolm
- The Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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22
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Knudsen HK, Studts JL. The implementation of tobacco-related brief interventions in substance abuse treatment: a national study of counselors. J Subst Abuse Treat 2010; 38:212-9. [PMID: 20116960 DOI: 10.1016/j.jsat.2009.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 12/14/2009] [Accepted: 12/31/2009] [Indexed: 11/18/2022]
Abstract
Most individuals receiving substance abuse treatment also use tobacco, which suggests that smoking cessation is an important clinical target for most clients. Few studies have measured the extent to which addiction treatment counselors address clients' tobacco use. In this study, we examined counselors' implementation of brief interventions that are consistent with the U.S. Public Health Service's (PHS) clinical practice guideline, Treating Tobacco Use and Dependence, when counselors are engaging new clients in treatment. We hypothesized that counselors' implementation of tobacco-related brief interventions is associated with organizational and counselor-level factors. Data were collected from 2,067 counselors via mailed surveys. Implementation of recommended brief interventions during intake was significantly lower among counselors reporting greater barriers to smoking cessation services within their organizational context. Perceived managerial support for smoking cessation services was positively associated with implementation. Counselors with greater knowledge of the PHS guideline and who believed in the positive impact of smoking cessation interventions on sobriety reported greater implementation. Relative to counselors who have never been tobacco users, current tobacco users reported significantly lower implementation of these brief interventions. These findings suggest that attempts to increase the implementation of best practices in substance abuse treatment may require attention to organizational contexts and the individuals responsible for implementation.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 109 Medical Behavioral Science Building, Lexington, KY 40536-0086, USA.
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23
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Hall SM, Prochaska JJ. Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings. Annu Rev Clin Psychol 2009; 5:409-31. [PMID: 19327035 DOI: 10.1146/annurev.clinpsy.032408.153614] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article reviews the research on the treatment of cigarette smoking in individuals who have comorbid mental illnesses or non-nicotinic addictions. The prevalence of smoking in mentally ill and substance-abusing populations is presented, as well as reasons for this high prevalence. The historical role of cigarettes and tobacco in mental illness and addiction is reviewed to help the reader better understand the pervasiveness of smoking in these disorders and the relative absence of intervention efforts in mental heath and addiction treatment settings. The article then discusses the several reasons for integrating smoking treatment into mental health and addiction settings. The outcome research for adult and adolescent comorbid smokers is reviewed, and barriers to treatment are discussed. The review closes with a brief discussion of models of integration and thoughts about prevention.
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Affiliation(s)
- Sharon M Hall
- Psychiatry Department, University of California-San Francisco, CA 94143, USA.
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24
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Hill R, Cooper W, Harris J, Frederick M, Ahmad Z, Keaney F, Gossop M. ‘Don't you think we're giving up enough already?’ Attitudes of patients and staff on an in‐patient addiction treatment service towards a proposed ‘No Smoking’ policy. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890701476409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Friend KB, Levy DT. Adoption of Tobacco Treatment Interventions by Substance-abuse-treatment Clinicians. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000105038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Baker A, Ivers RG, Bowman J, Butler T, Kay-Lambkin FJ, Wye P, Walsh RA, Pulver LJ, Richmond R, Belcher J, Wilhelm K, Wodak A. Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention. Drug Alcohol Rev 2009; 25:85-96. [PMID: 16492581 DOI: 10.1080/09595230500459552] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings.
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Affiliation(s)
- Amanda Baker
- Centre for Mental Health Studies, University of Newcastle, Callaghan, and Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia.
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27
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Steiner JL, Weinberger AH, O'Malley SS. A survey of staff attitudes about smoking cessation. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2009. [PMID: 19411364 DOI: 10.1176/appi.ps.60.5.707-b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Dunn KE, Sigmon SC, Reimann E, Heil SH, Higgins ST. Effects of Smoking Cessation on Illicit Drug Use among Opioid Maintenance Patients: A Pilot Study. JOURNAL OF DRUG ISSUES 2009; 39:313-328. [PMID: 20401340 PMCID: PMC2855312 DOI: 10.1177/002204260903900205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Opioid treatment program patients and staff often have concerns that smoking cessation may jeopardize abstinence from illicit drug use. In this study, we evaluated whether smoking abstinence produced with a two-week contingency-management (CM) intervention was associated with relapse to illicit drug use among patients enrolled in opioid maintenance. Opioid-maintenance patients who were stable in treatment and abstinent from illicit drugs were enrolled in a 14-day smoking-cessation study. Participants were dichotomized into Abstainers (> 90% smoking-negative samples, n=12) and Smokers (< 10% smoking-negative samples, n=16). Illicit drug assays included opioids, oxycodone, propoxyphene, cannabis, amphetamines, cocaine and benzodiazepines. There were no differences between the Abstainers and Smokers, with 99% and 96% of samples testing negative for all illicit drugs in each group, respectively. Data from this study provide no evidence that smoking cessation among stable opioid-maintained patients undermines drug abstinence and lend support for programs that encourage smoking cessation during drug abuse treatment.
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29
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Delucchi KL, Tajima B, Guydish J. Development of the Smoking Knowledge, Attitudes, and Practices (S-KAP) Instrument. JOURNAL OF DRUG ISSUES 2009; 39:347-364. [PMID: 20717496 PMCID: PMC2921865 DOI: 10.1177/002204260903900207] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This report describes the development and measurement characteristics of a new measure of smoking knowledge, attitudes, and practices (S-KAP) among treatment providers. Data are based on survey responses from 336 paid staff working in one of three drug abuse treatment or HIV care settings. Exploratory factor analysis, used to examine the factor structure, pointed towards five underlying factors: a single "knowledge" factor, three "attitude" factors ('treatment barriers,' 'counselor self-factor. The Knowledge scale had a standardized Cronbach's alpha coefficient of .85. The coefficients for Barriers, Self-Efficacy, and Attitudes were .81, .72, and .74, respectively. The Practice scale had a standardized Cronbach's alpha coefficient of .91. These results indicate that the proposed scales have reasonably good psychometric characteristics and will allow researchers to quantify staff knowledge, attitudes, and practices regarding smoking cessation treatments and issues.
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30
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Targeting nicotine addiction in a substance abuse program. SCIENCE & PRACTICE PERSPECTIVES 2008; 2:33-40. [PMID: 18552720 PMCID: PMC2851041 DOI: 10.1151/spp032133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The potential benefits of addressing nicotine addiction as part of substance dependency treatment may include improved response to interventions for other addictions and, over the long term, reduced tobacco-related morbidity and mortality. The authors recount the experiences of three inpatient programs that instituted nicotine addiction interventions and a tobacco-free policy for both facilities and patients. After making adjustments to counter temporary adverse effects of the policy, two of the programs are achieving higher overall treatment completion rates than prior to implementation. Outstanding research issues include quantifying the costs and benefits of the antinicotine interventions, determining the long-term impact of tobacco-free treatment, and tailoring treatment to various patient groups.
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31
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Survey of clinician attitudes toward smoking cessation for psychiatric and substance abusing clients. J Addict Dis 2008; 27:55-63. [PMID: 18551888 DOI: 10.1300/j069v27n01_06] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The current study examined mental health clinician attitudes regarding smoking cessation for psychiatric and substance abusing patients. Participants included n = 15 never smokers, n = 12 former smokers, and n = 7 current smokers. There was a trend (p = 0.08) for current smokers as compared to former and never smokers to be less likely to encourage their clients to stop smoking. Overall, clinicians strongly agreed that an individual's motivation is the most important determinant of success in quitting. Clinicians were concerned that smoking cessation would initiate a relapse to substance abuse. We suggest that mental health clinicians can be instrumental in providing information, encouragement, and opportunities for their patients to attempt smoking cessation.
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32
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Guydish J, Passalacqua E, Tajima B, Manser ST. Staff smoking and other barriers to nicotine dependence intervention in addiction treatment settings: a review. J Psychoactive Drugs 2008; 39:423-33. [PMID: 18303699 DOI: 10.1080/02791072.2007.10399881] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aims of this review were to assess smoking prevalence among drug abuse treatment staff and summarize the range of barriers to provision of nicotine dependence intervention to clients receiving addictions treatment. A systematic literature search was conducted to identify publications reporting on workforce smoking prevalence, attitudes toward smoking, and perceived barriers to providing smoking cessation treatment in drug abuse treatment settings. Twenty papers met study inclusion criteria. Staff smoking prevalence estimates in the literature ranged from 14% to 40%. The most frequently reported barriers to providing nicotine dependence intervention in addiction treatment settings were lack of staff knowledge or training in this area, that smoking cessation concurrent with other drug or alcohol treatment may create a risk to sobriety, and staff are themselves smokers. Staff smoking is not uniformly elevated in the drug abuse treatment workforce. Smoking prevalence may be lower where staff are more educated or professionally trained, and may be higher in community-based drug treatment programs. Barriers to treating nicotine dependence may be addressed through staff training, policy development, and by supporting staff to quit smoking. State departments of alcohol and drug programs, and national and professional organizations, can also support treatment of nicotine dependence in drug abuse treatment settings.
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Affiliation(s)
- Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco 94118, USA.
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33
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Hall SM. Nicotine interventions with comorbid populations. Am J Prev Med 2007; 33:S406-13. [PMID: 18021916 DOI: 10.1016/j.amepre.2007.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 08/02/2007] [Accepted: 09/14/2007] [Indexed: 11/26/2022]
Abstract
This article reviews and comments on studies of treatment and prevention of cigarette smoking in individuals with comorbid psychiatric and non-nicotine substance abuse disorders. Despite a high prevalence of cigarette smoking in these populations and interest in quitting, treatment interventions and studies of these interventions are sparse. Multiple barriers to implementation of interventions exist. Existing data suggest that provision of cigarette-smoking interventions in substance abuse treatment patients is efficacious and does not appear to interfere with abstinence from alcohol or illicit drugs, but more research is needed. There are few studies in populations with psychiatric disorders, with the exception of studies of individuals with a history of major depressive disorder. The available data suggest at least moderate efficacy and little evidence of exacerbation of these disorders. Integration of interventions into existing treatment clinics appears desirable. Despite the identification of subgroups that are especially likely to adopt cigarette smoking, there have been no targeted prevention efforts. Further research is recommended in both the treatment and prevention of cigarette smoking in individuals with psychiatric and substance abuse disorders. It is reasonable to offer existing treatments to these subgroups of smokers, since there is some evidence of efficacy and little evidence of harm.
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Affiliation(s)
- Sharon M Hall
- Department of Health Psychology, University of California, San Francisco, San Francisco, California 94143-0984, USA.
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34
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Fuller BE, Guydish J, Tsoh J, Reid MS, Resnick M, Zammarelli L, Ziedonis DM, Sears C, McCarty D. Attitudes toward the integration of smoking cessation treatment into drug abuse clinics. J Subst Abuse Treat 2006; 32:53-60. [PMID: 17175398 PMCID: PMC3496385 DOI: 10.1016/j.jsat.2006.06.011] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 06/12/2006] [Accepted: 06/15/2006] [Indexed: 11/24/2022]
Abstract
This article examines the variables associated with the presence of smoking cessation interventions in drug abuse treatment units, as well as staff attitudes toward the integration of smoking cessation services as a component of care. Surveys were administered to 106 organizations, 348 treatment clinics, and 3,786 employees in agencies that participated in the National Drug Abuse Treatment Clinical Trials Network. Organizational factors, attributes of the treatment setting, and staff attitudes toward smoking cessation treatment were assessed. Use of smoking cessation interventions was associated with the number of additional services offered at clinics, residential detoxification services, and attitudes of the staff toward smoking cessation treatment. Staff attitudes toward integrating smoking cessation services in drug treatment were influenced by the number of pregnant women admitted, the number of ancillary services provided, the attitudes of staff toward evidence-based practices, and whether smoking cessation treatment was offered as a component of care.
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Affiliation(s)
- Bret E Fuller
- Oregon Health and Science University, Portland, OR 97239, USA.
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35
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Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict 2005; 14:106-23. [PMID: 16019961 PMCID: PMC1199553 DOI: 10.1080/10550490590924728] [Citation(s) in RCA: 409] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This article reviews cigarette smoking in patients with psychiatric disorders (PD) and substance use disorders (SUD). Rates of smoking are approximately 23% in the U.S. population but approximately two- to four-fold higher in patients with PD and SUD. Many remaining smokers have had repeated smoking cessation failures, possibly due to the presence of co-morbid PD and SUDs. There is modest, evidence-based support for effective treatment interventions for nicotine addiction in PD and SUD. Further research is needed to increase our understanding of nicotine addiction in PD and SUD and develop more effective treatment interventions.
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Affiliation(s)
| | | | - Tony P. George
- From the Department of Psychiatry, Boston University School of Medicine, Boston, Mass. (Drs. Kalman and Morissette); the Edith Nourse Rogers Veterans Affairs Medical Center, Bedford, Mass. (Dr. Kalman); the Anxiety Disorders Clinic and Psychology Service, VA Boston Healthcare System, Boston, Mass. (Dr. Morissette); and the Program for Research in Smokers with Mental Illness (PRISM), Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Dr. George)
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36
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Spiga R, Martinetti MP, Meisch RA, Cowan K, Hursh S. Methadone and nicotine self-administration in humans: a behavioral economic analysis. Psychopharmacology (Berl) 2005; 178:223-31. [PMID: 15526094 DOI: 10.1007/s00213-004-2020-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 08/24/2004] [Indexed: 10/26/2022]
Abstract
RATIONALE Prior research has revealed inconsistencies in the behavioral relations between nicotine and opiates among methadone-maintained patients. OBJECTIVES The current study examined whether the drug reinforcers cigarette puffs and methadone were economic complements or substitutes. METHODS Five methadone-maintained, nicotine-dependent participants were trained to self-administer methadone, cigarette puffs, or concurrently available methadone and puffs. Following training, the fixed ratio (FR) value ("price") was increased across sessions (FR 32, 64, 128, 256, and 512), first for methadone and then for puffs. Subsequently, methadone and puffs were concurrently available, and the price of each drug was increased independently, while the price of the alternative (puffs or methadone) remained constant at FR 32. RESULTS Demand for methadone and cigarette puffs decreased as a function of increases in methadone and cigarette puff prices, respectively. When methadone and puffs were concurrently available, an increase in methadone's price decreased puff consumption, and demand for methadone was less elastic than when puffs were not concurrently available. An increase in puff price decreased puff and methadone demand, but the elasticity of puff demand was unaffected. The concurrent presence of methadone had no effect on the elasticity of demand for cigarette puffs. CONCLUSIONS Methadone and cigarette puffs appear to be asymmetric economic complements.
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Affiliation(s)
- Ralph Spiga
- Department of Psychiatry and Behavioral Sciences, Temple University Health System, 100 East Lehigh Avenue, Suite 305, Philadelphia, PA 19125-1098, USA.
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Morral AR, McCaffrey DF, Ridgeway G. Effectiveness of Community-Based Treatment for Substance-Abusing Adolescents: 12-Month Outcomes of Youths Entering Phoenix Academy or Alternative Probation Dispositions. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2004; 18:257-68. [PMID: 15482081 DOI: 10.1037/0893-164x.18.3.257] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, little is known about the effectiveness of the substance abuse treatment approaches most commonly available to youths, their families, and referring agencies. This report compares the 12-month outcomes of adolescent probationers (N = 449) who received either Phoenix Academy, a therapeutic community for adolescents that uses a treatment model that is widely implemented across the U.S., or an alternative probation disposition. Across many pretreatment risk factors for relapse and recidivism, groups were well matched after case-mix adjustment. Repeated measures analyses of substance use, psychological functioning, and crime outcomes collected 3, 6, and 12 months after the baseline interview demonstrated that Phoenix Academy treatment is associated with superior substance use and psychological functioning outcomes over the period of observation. As one of the most rigorous evaluations of the effectiveness of a traditional community-based adolescent drug treatment program, this study provides evidence that one such program is effective. Implications of this finding for the dissemination of efficacious novel treatment approaches are discussed.
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Affiliation(s)
- Andrew R Morral
- Drug Policy Research Center, RAND, Arlington, VA 22202-5050, USA.
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Romberger DJ, Grant K. Alcohol consumption and smoking status: the role of smoking cessation. Biomed Pharmacother 2004; 58:77-83. [PMID: 14992787 DOI: 10.1016/j.biopha.2003.12.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Indexed: 10/26/2022] Open
Abstract
Cigarette smoking is common among persons with alcohol dependence or abuse with as many as 80% of persons who are alcohol dependent also being smokers. Not only is smoking common in persons with heavy alcohol consumption, but also nicotine dependence appears more severe in smokers with a history of alcohol dependence. This combined exposure to both tobacco smoke and alcohol results in major health consequences including additive risks for some diseases such as head and neck cancers. Although modest alcohol consumption has some positive health benefits, smoking typically negates these benefits. The cellular mechanisms impacted by combined smoking and alcohol exposure are poorly understood, but molecular epidemiology approaches are providing insights regarding the importance of effects on oxidant/antioxidant pathways and on metabolic pathways involving the cytochrome P450 system. Given the prevalence of smoking in the alcohol dependent population, smoking cessation in this group has the potential for tremendous impact. In recent years, smoking cessation approaches have been initiated in this population, but much work remains in order to define the optimal smoking cessation strategies for persons in alcohol treatment programs.
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Affiliation(s)
- Debra J Romberger
- Pulmonary and Critical Care Medicine Section, University of Nebraska Medical Center, Omaha 68198-5300, USA.
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Stein MD, Anderson BJ. Nicotine and drug interaction expectancies among methadone maintained cigarette smokers. J Subst Abuse Treat 2003; 24:357-61. [PMID: 12867210 DOI: 10.1016/s0740-5472(03)00030-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Smoking rates among persons being treated with methadone for opiate dependence are exceptionally high. Nevertheless, there is debate about whether smoking cessation has a negative effect on substance abuse treatment outcomes. To understand patient perceptions of the interaction between smoking and illicit drug use, we administered the Nicotine and Other Substances Interaction Expectancies questionnaire (NOSIE) to 168 smokers-79% Caucasian and 48% female-at two methadone programs in Providence, Rhode Island. The four summed-rating scales of this 20-item instrument exhibited good to excellent internal-consistency reliabilities. The scales measured the effect of drug use on smoking (5 items, alpha =.84), the effect of smoking on drug use (3 items, alpha =.73), smoking to cope with drug urges (9 items, alpha =.91), and the difficulty of concomitantly quitting smoking and drugs (3 items, alpha =.72).Most subjects believed drug use increased smoking, but that smoking did not trigger drug use. Relatively few reported smoking to cope with drug urges and most did not consider quitting smoking and quitting drug use to be incompatible goals. NOSIE was a reliable instrument that offers insight into patient expectations of the interaction of smoking and drug use.
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Affiliation(s)
- Michael D Stein
- Brown University and Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, 02903, Providence, RI, USA.
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Bowman JA, Walsh RA. Smoking intervention within alcohol and other drug treatment services: a selective review with suggestions for practical management. Drug Alcohol Rev 2003; 22:73-82. [PMID: 12745361 DOI: 10.1080/0959523021000059857] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This selective review was undertaken in order to highlight the need for alcohol and other drug treatment services to provide intervention for tobacco smoking to their clients. The reasons for the failure of treatment services to date to deal with nicotine addiction within their programmes are discussed and positive suggestions for change are proferred. In addition to the transformation of institutional culture which will be required, managers and staff of alcohol and other drug agencies need to know how best to implement smoking intervention within the treatment setting. The paper concludes with some practical suggestions for the management of intervention for tobacco smoking within treatment settings. These suggestions include: making decisions and formulating policies and procedures with regard to how tobacco smoking will be addressed; considering the particular physical, psychological and social/environmental factors that apply to substance abuse clients; building intervention around a simple structure such as the '5 A's'; encouraging and facilitating the use of nicotine replacement therapies; and allowing flexibility to tailor intervention to the individual. A great deal of further research is required to inform us as to how to intervene most effectively for tobacco smoking among this population group.
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Affiliation(s)
- Jennifer A Bowman
- Department of Psychology, School of Behavioural Sciences, University of Newcastle, Callaghan, Australia.
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Horn K, Leontieva L, Williams JM, Furbee PM, Helmkamp JC, Manley WG. Alcohol problems among young adult emergency department patients: making predictions using routine sociodemographic information. J Crit Care 2002; 17:212-20. [PMID: 12501148 DOI: 10.1053/jcrc.2002.37231] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The study aims were to explore the process of identifying young adult Emergency Department (ED) patients at risk for alcohol problems, examine the sociodemographic predictors of patient alcohol problems, and determine differences between patients who screened positive and those who screened negative for alcohol problems. Implications for ED practice are discussed. METHOD As part of a larger study, the Alcohol Use Disorders Identification Test was administered to consenting patients ages 18 to 29. A score of greater than 5 (out of 40) was considered a positive screen for alcohol problems. Sociodemographic information was collected from a generic Individual Information Form. RESULTS Approximately 48% (1855 of 3890) of patients screened positive for alcohol problems. Among screen-positive patients, 91% (1689) had scores that corresponded to mild to moderate alcohol problems. Compared with screen-negative patients, screen-positive patients were almost 3 times more likely to be men (odds ratio [OR] = 2.70); 2.5 times more likely to use tobacco (OR = 2.43); 2 times more likely to be single (OR = 2.03); and 1.5 times more likely to have some college education (OR = 1.41), be an 18- to 20-year-old adult (OR = 1.61), be a college student (OR = 1.60), be unemployed (OR = 1.39), and cohabitate with friends (OR = 1.19). Screen-positive patients also were more likely to have made at least one past attempt to change their drinking behavior (OR = 3.21). CONCLUSION Routine patient information presented an accurate risk profile for alcohol problems among patients in this study. If ED-based health care professionals routinely screened patients for alcohol problems or could predict potential alcohol problems by using routinely collected information, then intervention or referral for additional services may increase.
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Affiliation(s)
- Kimberly Horn
- Department of Community Medicine, Center for Rural Emergency Medicine, Office of Drug Abuse Intervention Studies, West Virginia University, Morgantown, WV 26506, USA.
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Hitsman B, Abrams DB, Shadel WG, Niaura R, Borrelli B, Emmons KM, Brown RA, Swift RM, Monti PM, Rohsenow DJ, Colby SM. Depressive symptoms and readiness to quit smoking among cigarette smokers in outpatient alcohol treatment. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2002. [DOI: 10.1037/0893-164x.16.3.264] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Harris J, Best D, Man LH, Welch S, Gossop M, Strang J. Changes in cigarette smoking among alcohol and drug misusers during inpatient detoxification. Addict Biol 2000; 5:443-50. [PMID: 20575863 DOI: 10.1111/j.1369-1600.2000.tb00214.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Smoking prevalence and changes during inpatient detoxification were examined among 135 admissions to an inpatient alcohol and drug detoxification unit, of whom 83 (61.5%) were re-interviewed one week later. Ninety-two per cent of the initial sample were currently smokers; 87% of alcohol misusers, 97% of drug misusers and 100% of drug/alcohol misusers. Smokers consumed a daily mean of 27 cigarettes before admission. Those classified as heavy smokers (smoking 40 or more cigarettes prior to admission) decreased their smoking levels by an average of 10.5 cigarettes during detoxification. Light smokers (1-19 cigarettes per day) increased by a daily average of 8.6 cigarettes and intermediate smokers (20-39 cigarettes) by 4.9 cigarettes. The findings suggest a dose-dependent relationship between cigarette smoking and inpatient detoxification that requires further study. Over three-quarters of the sample expressed a desire to change their smoking behaviour, many of whom felt they would like help to tackle this change. Given the high smoking prevalence and reported interest in smoking cessation/reduction, there is an opportunity to address the smoking behaviour of drug and alcohol misusers entering inpatient care, whether during or after their detoxification.
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Affiliation(s)
- J Harris
- National Addiction Centre (The Maudsley Hospital/Institute of Psychiatry), Windsor Walk, London, UK.
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Abstract
Since rates of smoking cessation in psychiatric patients are low, the manner in which information on the importance of abstinence is presented and the scope of the treatment provided to psychiatric patients who have decided not to smoke are very important. This article will describe the development and implementation of a smoking-cessation group for chronic mentally ill patients. Components of the program are described and a detailed case example is provided. The smoking behavior of patients who participated in the first year of programming is reviewed, along with patient evaluation of program effectiveness. Our experience demonstrates the importance of psychoeducation for chronic psychiatric patients who tend not to have received formal education on the dangers of smoking and the possibility of addiction. Our findings indicate that patients are willing to learn more about smoking and the consequences of this behavior, even though many of them were not able to set quit dates. The provision of information through education groups increases the possibility of moving patients to the precontemplation stage.
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Affiliation(s)
- C Rosen-Chase
- Department of Psychiatry, University of Illinois, Chicago 60612, USA
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FOSTER JH, MARSHALL EJ, PETERS TJ. Predictors of relapse to heavy drinking in alcohol dependent subjects following alcohol detoxification-the role of quality of life measures, ethnicity, social class, cigarette and drug use. Addict Biol 1998; 3:333-43. [PMID: 26734927 DOI: 10.1080/13556219872146] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Sixty DSM-IV alcohol dependent adults (39 males, 21 females) admitted to a voluntary sector alcohol detoxification unit in South London were studied. Socio-demographic data and information on level of alcohol dependence, quality of life, family history, cigarette smoking and the use of prescription/illicit drugs were collected. The subjects were followed-up at 12 weeks and subdivided into two groups, relapse and non-relapse. A relapse was defined as drinking 21 units or more per week for males and 14 units or more per week for females. Data were analysed for baseline and 12-week follow-up comparisons. At 12 weeks, 58 (97%) subjects (38 males, 20 females) were successfully followed-up and 36/58 (62%) had relapsed. After controlling for a Type I error there were significant differences between the relapse and non-relapse subgroups at 12-week followup on the following outcome measures; depression, life situation, withdrawal symptoms, energy, emotional reactions and social isolation. There were no significant differences at baseline between the relapse and nonrelapse subgroups for most of the socio-demographic variables, but Irish nationality and membership of lower social classes (IV and V) were associated with relapse. Major predictors of relapse at baseline after a forward stepwise logistic regression were (in order of increasing statistical significance) Irish nationality, lower social class, greater number of cigarettes smoked and disturbed sleep. The findings are discussed with reference to their consistency with existing research and potential clinical implications.
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Abstract
An addiction treatment program devoted two years to preparing to become a smokefree treatment unit that addressed nicotine dependence as another drug dependency. Data collected from September 1990 to July 1995 on 263 admissions before becoming smokefree and 2182 admissions after making the transition revealed that going smokefree did not affect the incidence of premature discharges or aggressive behavior, and did not change the overall rate of program completion by either smokers or nonsmokers. During the first three months after going smokefree, the program completion rate dropped for both smokers and nonsmokers; by the fourth month, it had returned to previous levels. Seventeen months after going smokefree, the program completion rate was higher than it had ever been. This suggests that the drop in the program completion rate was due to the disruption caused by a significant programmatic change and not due to the unit's smokefree status, and that the increasing experience of staff in treating nicotine dependence resulted in improved patient outcomes.
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Affiliation(s)
- T A Rustin
- Department of Psychiatry and Behavioral Sciences, University of Texas-Houston Medical School, USA
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Abstract
To test the effectiveness of providing chemical dependency (CD) staff with a knowledge-and-skills-building workshop on treatment of nicotine dependence, we employed a nested cross-sectional design with six outpatient CD programs in Nebraska (3 intervention, 3 control sites). Data on tobacco counseling provided by CD staff were obtained by telephone from sequential samples of smokers currently receiving alcohol treatment at each participating site. Intervention site clients with clinic visits after the staff training workshop were no more likely than intervention-site clients with clinic visits before the workshop to report having been counseled about their smoking (OR = 0.95, 95% confidence interval (CI): 0.74-1.21). However, control-site clients were significantly more likely to report having been counseled about smoking during the second half of the study (OR = 2.15, 95% CI: 1.49-3.08), even though staff training was not provided at control sites until data collection had been completed. These findings suggest that in some alcohol treatment programs simple monitoring of staff counseling practices may be sufficient to increase the frequency of attention to tobacco. In others, more intensive efforts might be needed to shift CD staff toward more consistent treatment of nicotine dependence.
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Affiliation(s)
- J K Bobo
- Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha 68198-4350, USA
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Bobo JK, McIlvain HE, Gilchrist LD, Bowman A. Nicotine dependence and intentions to quit smoking in three samples of male and female recovering alcoholics and problem drinkers. Subst Use Misuse 1996; 31:17-33. [PMID: 8838391 DOI: 10.3109/10826089609045796] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report gender-specific data on tobacco use and quitting smoking from three studies of nicotine-related issues during alcoholism treatment. Study 1 data are from 309 alcoholism treatment professionals who were current or former smokers with a personal history of alcoholism or problem drinking. Study 2 data are from 496 smokers receiving counseling for their problems with alcohol in outpatient alcoholism treatment centers. Study 3 data are from 90 smokers receiving intensive alcoholism treatment in residential or inpatient programs. Interest in smoking cessation was high in all groups. Significant gender differences were apparent among the recovering alcoholics but not among the problem drinkers. Severity of alcohol use problems also showed some association with smoking cessation behaviors.
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Affiliation(s)
- J K Bobo
- Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha 68198-4350, USA
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Bobo JK, Lando HA, Walker RD, McIlvain HE. Predictors of tobacco quit attempts among recovering alcoholics. JOURNAL OF SUBSTANCE ABUSE 1996; 8:431-43. [PMID: 9058355 DOI: 10.1016/s0899-3289(96)90004-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Reported here are findings from a randomized community intervention trial that followed 90 recovering alcoholic smokers for 6 months. Because the brief (10-min) study intervention had no effect on tobacco use, intervention and control participants were pooled to identify predictors of attempts to quit smoking that may inform clinical practice. During the first 6 months after discharge from residential alcohol treatment, 31% of all participants reported having quit smoking for 48 hrs or longer. Demographic and drug use history variables did not predict quit attempts, but two baseline tobacco use variables did, specifically the Fagerstrom Test for Nicotine Dependence and stage of readiness to quit smoking, p < .01. Participants with high or very high nicotine dependence scores were significantly less likely than those with moderate or low scores to attempt smoking cessation. Compared to those in precontemplation at baseline, those in the preparation stage of readiness to change were about 12 times more likely to make a serious quit attempt.
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Affiliation(s)
- J K Bobo
- Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha 68198-4350, USA.
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