This study measured substance use disorder clinicians’ perceptions regarding the implementation extensiveness of the Office of Alcohol and Substance Abuse Services (OASAS) tobacco-free regulation, passed in New York State in July of 2008, at three time-points and across organizations with varying characteristics. Repeated cross-sectional data were collected from clinicians approximately 4 months pre-regulation (Time 0, N = 362), 10–12 months postregulation (Time 1, N = 462), and 20–24 months post-regulation (Time 2, N = 509). Clinician perceptions of implementation extensiveness (number of required policies in effect), use of tobacco cessation-related intake procedures, and use of guideline recommended counseling for treating tobacco dependence are significantly greater at Time 1 and Time 2 compared to Time 0. Additionally, differences are found in perceived implementation extensiveness based on hospital-based status, profit status, and level of care offered, although the pattern of effects differed some over the three time-points under investigation.

Using data from a nationwide study, we annually track a cohort of 598 substance use disorder counselors over a 4-wave period to (1) document the cumulative rates of voluntary turnover and (2) examine how counselor perceptions of the organizational environment (procedural justice, distributive justice, perceived organizational support, job satisfaction) and clinical supervisor leadership effectiveness (relationship quality, in-role performance, extra-role performance) predict voluntary turnover over time. Survey data were collected from counselors in year 1 and actual turnover data were collected from organizational records in year 2, 3, and 4. Findings reveal that 25% of the original counselors turned over by year 2, 39% by year 3, and 47% by year 4. Counselors with more favorable perceptions of the organizational environment are between 13.8% – 22.8% less likely to turn over than those with less favorable perceptions. None of the leadership effectiveness variables are significant.

Study Background Despite efforts to promote the use of tobacco cessation services (TCS), implementation extensiveness remains limited. This study investigated three factors (cognitive, behavioral, environmental) identified by social cognitive theory as predictors of substance use disorder counselors’ likelihood of use versus non-use of tobacco cessation (TC) 5 A's (ask patients about tobacco use, advise to quit, assess willingness to quit, assist in quitting, arrange for follow-up contact), counseling, and pharmacotherapy with their patients who smoke cigarettes. Methods Data were collected in 2010 from 942 counselors working in 257 treatment programs that offered TCS. Cognitive factors included perceived job competence and TC attitudes. Behavioral factors encompassed TC-related skills and general training. External factors consisted of TC financial resource availability and coworker TC attitudes. Data were analyzed using logistic regression models with nested data. Results Approximately 86% of counselors used the 5 A's, 76% used counseling, and 53% used pharmacotherapy. When counselors had greater TC-related skills and greater general training they were more likely to implement the 5 A's. Implementation of counseling was more likely when counselors had more positive attitudes toward TC treatment, greater general training, greater financial resource availability, and when coworkers had more positive attitudes toward TC treatment. Implementation of pharmacotherapy was more likely when counselors had more positive attitudes toward TC treatment, greater general training, and greater financial resource availability. Conclusion Findings indicate that interventions to promote TCS implementation should consider all three factors simultaneously as suggested by social cognitive theory.

Objectives This study investigated three organizational factors (i.e., counseling staff clinical skills, absence of treatment program obstacles, policy-related incentives) as predictors of tobacco cessation pharmacotherapy (TCP) adoption (comprised of the nine available TCP) in addiction treatment programs using the innovation implementation effectiveness framework. Methods Data were obtained in 2010 from a random sample of 1006 addiction treatment program administrators located across the U.S. using structured telephone interviews. Results According to program administrator reports, TCP is adopted in approximately 30% of treatment programs. Negative binomial regression results show that fewer treatment program obstacles and more policy-related incentives are related to greater adoption of TCP. Counter to prediction, clinical skills are unrelated to TCP adoption. Conclusions Our findings suggest that organizational factors, based on established theoretical frameworks, merit further examination as facilitators of the adoption of diverse TCP in addiction treatment programs.