Addressing Tobacco Through Organizational Change (ATTOC) in residential addiction treatment settings

Abstract

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.

Building Tobacco Cessation Capacity in Homeless Shelters: A Pilot Study

“…These results are in contrast to a previous study that did not find improvements in the S-KAP knowledge scale among staff in substance use recovery programs who had participated in more intensive cessation training than ours [6]. Unlike staff in recovery programs who may have a high baseline knowledge on addiction, staff in homeless shelters may benefit from brief interventions to increase knowledge around tobacco use and addiction among homeless clients.…”

“…These interventions have included training staff to provide motivational interviewing, training to increase knowledge of existing resources for smoking cessation, provision of nicotine replacement therapy, and performance improvement strategies [6,7]. These interventions have shown to increase knowledge and willingness among staff to address tobacco use among clients disproportionately affected by tobacco use [6,7].…”

“…Yet studies have demonstrated the feasibility of implementing tobacco dependence capacity building interventions in these settings [6,7]. These interventions have included training staff to provide motivational interviewing, training to increase knowledge of existing resources for smoking cessation, provision of nicotine replacement therapy, and performance improvement strategies [6,7].…”

“…However, no interventions have targeted system-level changes. System-level interventions that target social norms and build cessation capacity within organizations serving homeless adults may promote change in organizational culture around tobacco use [6,7], and may reduce tobacco use behaviors among homeless adults.…”

Tobacco Use and Its Treatment Among Young People in Mental Health Settings: A Qualitative Analysis

“…To increase clinician prioritization and delivery of tobacco treatment, recent research in adult drug treatment programs supports the evidence of organizational interventions consisting of staff training, consultation, policy development, leadership support, and access to cessation medication (Guydish et al, 2012). An emphasis on tobacco treatment's broader possible effects for enhancing sobriety and mental wellness may be particularly helpful (Prochaska, Delucchi, & Hall, 2004;Prochaska et al, 2008).…”