Aims Smoking prevalence is higher among persons enrolled in addiction treatment as compared to the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally. Methods PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation, and substance use disorders using AND/OR Boolean connectors. For 4,549 papers identified, abstracts were reviewed by multiple raters. 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. 54 studies, collectively including 37,364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated, and smoking prevalence. Results The random-effect pooled estimate of smoking across persons in addiction treatment was 84% (CI 79%, 88%), while the pooled estimate of smoking prevalence across matched population samples was 31% (CI 29%, 33%). The difference in the pooled estimates was 52% (CI 48%, 57%, p < .0001). Smoking rates were higher in programs treating opiate use as compared to alcohol use (OR = 2.52, CI 2.00, 3.17), and higher in ORT compared to outpatient programs (OR = 1.42, CI 1.19, 1.68). Conclusions Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder.

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.

Objectives We assessed changes in smoking prevalence and other measures associated with the July 2008 New York Office of Alcoholism and Substance Abuse Services tobacco policy, which required that all publicly funded addiction treatment programs implement smoke-free grounds, have “no evidence” of smoking among staff, and make tobacco dependence treatment available for all clients. Methods In a random sample of 10 programs, staff and clients were surveyed before the policy and 1 year later. Measures included tobacco-related knowledge, attitudes, and practices used by counselors and received by clients. Results Client smoking decreased from 69.4% to 62.8% (P = .044). However, response to the policy differed by program type. Outpatient programs showed no significant changes on any of the staff and client survey measures. In methadone programs, staff use of tobacco-related practices increased (P < .01), client attitudes toward tobacco treatment grew more positive (P < .05), and clients received more tobacco-related services (P < .05). Residential clients were more likely to report having quit smoking after policy implementation (odds ratio = 4.7; 95% confidence interval = 1.53, 14.19), but they reported less favorable attitudes toward tobacco treatment (P < .001) and received fewer tobacco-related services from their program (P < .001) or their counselor (P < .001). Conclusions If supported by additional research, the New York policy may offer a model that addiction treatment systems can use to address smoking in a population where it has been prevalent and intractable. Additional intervention or policy supports may be needed in residential programs, which face greater challenges to implementing tobacco-free grounds.

The rate of cigarette smoking is greater among persons with mental health and/or substance abuse problems. There are few population-based datasets with which to study tobacco mortality in these vulnerable groups. The Oregon Health Authority identified persons who received publicly-funded mental health or substance abuse services from January 1996 through December 2005. These cases were then matched to Oregon Vital Statistics records for all deaths (N= 148,761) in the period 1999-2005. The rate of tobacco-related death rates was higher among persons with substance abuse problems only (53.6%) and those with both substance abuse and mental health problems (46.8%), as compared to the general population (30.7%). The rate of tobacco-related deaths among persons with mental health problems (30%) was similar to that in the general population. Persons receiving substance abuse treatment alone, or receiving both substance abuse and mental health treatment, were more likely to die and more likely to die prematurely of tobacco-related causes as compared to the general population. Persons receiving mental health services alone were not more likely to die of tobacco-related causes, but tobacco-related deaths occurred earlier in this population.

Background Smoking prevalence among persons in addiction treatment is 3–4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence. Methods The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked. Results From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163) = 7.15, p = 0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123) = 3.66, p = 0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235) = 10.58, p = 0.0013) and clients received more tobacco-related services from their program (F(1, 235) = 92.86, p < 0.0001) and from their counselors (F(1, 235) = 61.59, p < 0.0001). Most changes remained at follow-up. Conclusions The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.

This paper reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to either PCM (n=92) or standard probation (n=91), and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support and service utilization. Arrest data were collected from administrative datasets. The sample (N=183) included mostly African American (57%) and White (20%) women, with a mean age of 34.7 (SD = 9.2) and mean education of 11.6 years (SD = 2.1). Cocaine and heroin were the most frequently reported drugs of abuse, 86% reported prior history of incarceration, and 74% had children. Women assigned to both PCM and standard probation showed change over time in the direction of clinical improvement on 7 of 10 outcomes measured. However, changes observed for the PCM group were no different than those observed for the standard probation group. Higher levels of case management, drug abuse treatment, and probationary supervision may be required to achieve improved outcomes in this population. KeywordsSubstance Abuse; Drug Abuse; Women; Probation; Case Management; Criminal Justice Many women in the criminal justice system are drug-involved (Mosher & Phillips, 2006) and substance abuse, in concert with changes in drug laws and sentencing procedures, has led to increases in arrest and incarceration of women offenders (Grella & Greenwell, 2006;Prendergast, Wellisch, & Wong, 1996;Strauss & Falkin, 2001). At the end of 2005, there were 4.9 million adults on probation or parole nationally and, among probationers, 23% were women (United States Department of Justice, 2006; Glaze & Palla, 2004). In one survey of probationers, many women reported past drug (68%) or alcohol (25%) use, and 12% reported drug use at the time of the offense (United States Department of Justice, 1998). Compared to non-users, women reporting drug use were more likely to have been involved in criminal activity and to have been arrested in the past year (Substance Abuse and Mental Health Services Administration, 1997). NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptIn addition to substance abuse, many women offenders have mental health disorders including depression, posttraumatic stress disorder, cognitive impairments and problems controlling violent behavior (Oser et al. 2005;Henderson, Schaeffer, & Brown, 1998;Jordan et al., 2002;Teplin, Abram, & McClelland, 1996). Incarcerated women report high rates of victimization (Lake, 1993), sexual and physical abuse (Henderson, 1998;Snell & Morton, 1994), intimate partner violence (Staton, Leukefeld, & Logan, 2001), and specialized service needs upon release including family support, parenting assistance, and legal help (Alemagna, 2001). Health problems in this population include HIV infection, Hepatitis B and C, sexually transmitted diseases, and tuberculosis (Golembeski & Fullilove 2005;Hammett, Gaiter, & Crawford, 1998;Marquart, Brewer, & Mullings, 1999;Young, 1998...

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This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals' readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support for EBPs. A total of 119 addiction treatment providers completed pre-test measures, and 82% completed a post-test. Eighty-three percent of participants reported using some EBPs in the past year, and 75% reported currently using EBPs. Participants who were currently licensed or certified in addictions had less negative attitudes toward EBPs than those without credentials. While respondents reported agency support for EBPs, most expressed interest in further training. This study underscores the movement toward EBPs in addiction treatment and the need for effective dissemination and training in this area.Accountability, constrained budgets and a growing demand for more effective services highlight the need for Evidence-Based Practices (EBPs) in addiction treatment. EBPs integrate the best available research with clinical expertise, taking into account patient characteristics, culture, and preferences (Levant, 2005). Effective substance abuse treatments are available, but difficult to disseminate into routine clinical settings (Ball et al., 2002;McGovern & Carroll, 2003). Few studies have systematically tracked how EBPs are transferred to the field (McGovern & Carroll, 2003), and community addiction providers' experiences, beliefs, and readiness to adopt EBPs is largely unknown.Current research suggests that community treatment providers' experience with EBPs is limited (Ball et al., 2002), and when there is some exposure to EBPs, certain EBPs (e.g., Motivational Interviewing, Twelve-Step Facilitation) are more accepted than others (e.g., Contingency Management, addiction-specific medications) (McGovern et al., 2004). Lack of basic knowledge and skills required to assimilate EBPs into daily practice is often cited as a barrier to dissemination and implementation (Corrigan et al., 2001). Organizational characteristics and dynamics may also impact clinician adoption of EBPs (Gotham, 2004).These findings are consistent with a survey of a large national sample of licensed psychologists regarding their attitudes and beliefs about the role of treatment manuals in clinical practice (Addis & Krasnow, 2000). Thirty-seven percent of the sample did not have a clear idea of what a treatment manual was, and 47% reported never using a treatment manual. In addition, some NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript participants held negative views toward treatment manuals, expressing concerns regarding the constraints treatment manuals place on client-therapist relationships and actual impact on improved treatment outcomes. In order to disseminate EBPs effectively, it is useful to identify which treatments clinicians are likely to accept, and the attit...