[CDC], 2009a; Department of Health Education and Welfare, 1964). The benefits of this achievement are not spread evenly, however, as people living in poverty, those with lower education, and persons with mental health diagnoses continue to smoke at high rates. As smoking prevalence decreases in the general population but remains high in subgroups, these subgroups bear a disproportionate burden of smoking-related illness and also frame new targets for both smoking cessation intervention and tobacco control.One population with elevated smoking prevalence includes those with substance use disorders. A developed literature indicates that smokers with other addictions smoke more heavily (Hays et al., 1999;J. Hughes, 2002;J. R. Hughes, 1996;Kozlowski, Jelinek, & Pope, 1986;Marks, Hill, Pomerleau, Mudd, & Blow, 1997;Sobell, 2002), are less successful in their attempts to quit smoking (Bobo, Gilchrist, Schilling, Noach, & Schinke, 1987;Drobes, 2002;Joseph, Nichol, & Anderson, 1993;Kozlowski, Skinner, Kent, & Pope, 1989;Sobell, 2002;Zimmerman, Warheit, Ulbrich, & Auth, 1990), and are more likely to die from smoking-related causes than from other substance-related causes (Hser, McCarthy, & Anglin, 1994;Hurt et al., 1996).The National Comorbidity Study (NCS) was a national sample (n = 8,098) of noninstitutionalized U.S. persons aged 15-54 years, designed to estimate national prevalence of mental illness. NCS data reported smoking prevalence of 56.1% among persons with past-month alcohol disorders and 67.9% among those with substance use disorders (Lasser et al., 2000). The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is a general population survey (N = 43,093) including noninstitutionalized U.S adults and weighted to be representative of the larger U.S population. NESARC data show that smoking prevalence is 34.5% among those with alcohol disorders and 52.4% among those with substance use disorders (Grant, Hasin, Chou, Stinson, & Dawson, 2004).Smoking prevalence may be even higher among those who seek treatment for their alcohol or other drug addiction. Current literature cites smoking prevalence among addiction treatment clients as ranging between 49% and 98% (Schroeder, AbstractIntroduction: This review explores whether smoking prevalence in addiction treatment samples exceeds that shown in epidemiological data for persons with alcohol or other drug use disorders and whether smoking may have decreased over time in the addiction treatment population as it has done in the general population.Methods: English language papers published between 1987 and 2009 were searched electronically. Forty papers reporting smoking prevalence for addiction treatment samples in the United States were identified, and key predictor variables were abstracted. Random logistic models were used to assess relationships between each individual predictor (year, treatment modality, primary drug treated, government status, and public/ private funding status) and smoking prevalence. Results:The lowest smoking prevalence aggre...

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.

Since the first drug court in Miami in 1989, the drug court movement has spread throughout the United States, influencing how drug-involved offenders are treated in the criminal justice system. This paper reports on an outcome evaluation of a drug court in San Mateo County, California. Arrest rates were compared for drug court participants (N=618) and non-participants (N=75), and for graduates (N=257) and non-graduates (N=361). Factors associated with rearrest were assessed for participants in both groups. During a two-year follow-up period, there were no significant differences in rearrest rates between the participant and non-participant groups. Comparisons between graduates and non-graduates showed lower rearrest rates for graduates (19% vs. 53%, χ(2)(1)=73.5, p<0.01). In a model including participants and non-participants, only a prior history of conviction predicted an increased likelihood of rearrest whereas being female and older decreased the likelihood of rearrest. In addition, among drug court participants only, graduating decreased the likelihood of rearrest.

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.

Introduction Smoking rates among addiction treatment clients are 3–4 times higher than those of the general population. Recent studies indicate that ceasing tobacco use during treatment may improve recovery outcomes. Across the United States, publicly funded addiction treatment programs vary widely in terms of their tobacco policies and tobacco cessation services offered to clients. Methods The study reported here is the qualitative component of a larger study. Twenty-four programs were recruited from a random sample of publicly funded programs participating in the NIDA Clinical Trials Network. Semistructured interviews were administered by phone to program directors. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. Findings While all directors expressed interest in helping clients to quit smoking, they cited numerous barriers to implementing tobacco policies and services. These included smoking culture, client resistance, lack of resources, staff smoking, and environmental barriers. Directors also cited several factors that they believed would support tobacco cessation. These included financial support, enhanced leadership, and state mandates against smoking in addiction treatment programs. Conclusion Addiction treatment programs are beginning to place more emphasis on tobacco cessation during treatment. However, furthering this goal requires substantial infrastructural and cultural change. These qualitative study findings may help to inform Single State Agencies (SSAs) to support publicly funded addiction treatment programs in their tobacco cessation efforts. In order to maximize effectiveness, state-level policies regarding tobacco cessation during treatment should be informed by ongoing dialogue between service providers and SSAs.

This study evaluated treatment outcomes for the reduction of criminal justice involvement and substance use among opioid dependent clients in a therapeutic community setting under California's Proposition 36. We compared treatment outcomes between those mandated to treatment under Proposition 36 (n = 24) and those on probation but not involved in Proposition 36 (n = 61) over 12 months. Over time, both groups showed significant improvement on drug use and employment measures, were more likely to be involved in job training and less likely to be engaged in work activity, and had similar retention in treatment. There was no evidence that treatment outcomes were different between the two groups. These findings may be helpful in guiding policy makers and clinicians in states where similar initiatives are under consideration.

Compared to the general population, persons entering addiction treatment are three to four times more likely to be tobacco dependent and even addiction treatment staff members are two to three times more likely to be tobacco dependent. In these settings, tobacco use continues to be the norm; however addiction treatment programs are increasingly aware of the need to assess for and treat tobacco dependence. The problem is a cultural issue that is so ingrained that assumptions about tobacco use and dependence in addiction treatment are rarely questioned. Denial, minimization, and rationalization are common barriers to recovery from other addictions; now is the time to recognize how tobacco use and dependence must be similarly approached. This article describes the Addressing Tobacco through Organizational Change (ATTOC) model which has successfully helped many addiction treatment programs to more effectively address tobacco use. The article will review the six core strategies used to implement the ATTOC intervention, the 12-Step approach guiding the model, and describe a case study where the intervention was implemented in one clinic setting. Other treatment programs may use the experience and lessons learned from using the ATTOC organizational change model to better address tobacco use in the context of drug abuse treatment.

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