Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster‐randomized controlled trial

Abstract

Aim Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7‐day point prevalence abstinence (PPA) at 8 weeks follow‐up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow‐up. Design Cluster‐randomized controlled trial, with AOD service as unit of randomization, conducted January 2015–March 2016. Setting Thirty‐two eligible services (provided face‐to‐face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician. Participants Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow‐up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%). Intervention Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. Measurements Primary outcome was biochemically verified 7‐day PPA at 8‐week follow‐up. Secondary outcomes included verified and self‐reported prolonged abstinence, self‐reported 7‐day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention‐to‐treat analyses were performed, assuming missing participants were not abstinent. Findings At 8 weeks, the findings in verified 7‐day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5–5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8–0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9–1.02, P = 0.240) follow‐up. At both follow‐ups the intervention group reported higher rates of NRT use. Conclusions Integrating smoking cessation treatment into addiction services did not significantly improve short‐term abstinence from smoking.

Supporting smoking cessation and preventing relapse following a stay in a smoke‐free setting: a meta‐analysis and investigation of effective behaviour change techniques

“…1). Twenty‐three studies [10,37–58] were RCTs (intervention n = 6593, control n = 5801). Three studies [59–61] were trials, but adopted a non‐randomized design (intervention n = 845, control n = 394).…”

“…Post-discharge interventions were included in the majority of the trials (n = 23), with the exception of three [38,39,45] and five cohort studies [9,61,63,66,67]. Telephone calls were used in 14 studies [10,41,42,48,[50][51][52][54][55][56]58,60,61,67], ranging from one to 14 calls at time-points between 1 day and 9 months post-discharge.…”

Pre-Implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California

“…Organizational change interventions have been associated with increased favorable attitudes toward treating tobacco use disorder in SUD treatment programs, use of NRT medications, client receipt of services from their programs or counselors, and a reduction client smoking prevalence and cigarettes smoked per day. 36,37 Furthermore, funding streams continue to serve as a barrier to the availability of smoking cessation services in SUD treatment programs. 34 Smoking cessation covered services have expanded with the expansion of Medicaid under the Affordable Care Act (ACA).…”

Alcohol and other drug health‐care providers and their client's perceptions of e‐cigarette use, safety and harm reduction

“…This study is part of a cluster randomised controlled trial, the Tackling Nicotine Together project. The trial protocol [14] and primary outcomes [15] are reported elsewhere. Briefly, AOD health‐care providers were recruited from 32 participating trial services and completed an online survey 6 months pre‐intervention implementation (August to September 2014) and 18 months post‐intervention implementation (October 2016).…”