Barriers and Facilitators to Tobacco Cessation in a Nationwide Sample of Addiction Treatment Programs

Abstract

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.

Outcome of tobacco cessation in workplace and clinic settings: A comparative study

“…[3233] Tobacco cessation barriers include poor knowledge, lack of advice and support, lack of motivation, as well as intrapersonal, social, cultural, and financial factors. [34] Most of these barriers may be reduced or eliminated by multiple interventions carried out in our study such as pre-awareness session, focus group discussion, one-on-one counseling, and pharmacotherapy resulting in low dropout rate and adherence to the tobacco cessation program. Literature on tobacco cessation in workplace settings is mostly from western countries.…”

Smoking-related outcomes and associations with tobacco-free policy in addiction treatment, 2015–2016

“…Following the site visit, the director of each program was interviewed by phone concerning tobacco-related policies and services. Additional details concerning client surveys and director interviews are reported elsewhere (Guydish et al, 2016b; Pagano et al, 2016b). Study procedures were approved by the University of California, San Francisco, Institutional Review Board.…”

“…Following each site visit the program director was interviewed concerning tobacco policies in their clinic, and interviews were transcribed (Pagano et al, 2016b). After the first director interview, two raters independently read the interviews to assess whether a clinic did (1) or did not (0) have a tobacco-free grounds policy, defined as a ban on indoor and outdoor smoking with no designated smoking areas.…”

Perceived barriers to smoking cessation among adults with substance use disorders

“…The belief that smoking cessation will interfere with efforts to attain or maintain sobriety is common among those with alcohol use disorder (Gulliver, Kamholz, & Helstrom, 2006; Martin, Rohsenow, MacKinnon, Abrams, & Monti, 2006). Moreover, beliefs that smoking cessation will interfere with SUD treatment may be reinforced by similar beliefs among some clinicians (Bobo, Slade, & Hoffman, 1995; Pagano, Tajima, & Guydish, 2016; Richter, 2006; Sheals, Tombor, McNeill, & Shahab, 2016), as well as limited availability of smoking cessation services in SUD treatment settings (Currie, Nesbitt, Wood, & Lawson, 2003; Knudsen, in press; Knudsen, Muilenburg, & Eby, 2013; Knudsen, Studts, Boyd, & Roman, 2010; Nahvi, Blackstock, Sohler, Thompson, & Cunningham, 2014). Thus, individuals presenting to SUD treatment have particularly poor smoking cessation rates and are vulnerable to a broader array of potential barriers to smoking cessation relative to those without SUDs, highlighting the importance of understanding barriers to smoking cessation in this population.…”