Implementation of a Smoking Cessation Treatment Study at Substance Abuse Rehabilitation Programs: Smoking Behavior and Treatment Feasibility Across Varied Community-based Outpatient Programs

Abstract

Cigarette smoking is widely prevalent among individuals in treatment for drug or alcohol dependence; however, the treatment of nicotine addiction in this population has numerous obstacles at both programmatic and patient levels. Despite these difficulties, recent studies have demonstrated moderate success in implementing smoking cessation treatment in drug rehabilitation programs. The National Drug Abuse Treatment Clinical Trials Network sponsored a smoking cessation study in 13 community-based outpatient substance abuse rehabilitation programs across the country. The study evaluated the effectiveness of smoking cessation treatment provided as an adjunct to substance abuse treatment-as-usual. This report summarizes the practical and clinical experiences encountered at each of the study sites with regard to implementing the smoking cessation treatment intervention. Smoking behavior of the treatment clientele was assessed by anonymous survey at each site. In addition, sites were systematically characterized by using program review and assessment tools completed by the respective staff and program directors at the site. Survey and recruitment data indicated that cigarette smoking is more prevalent and that smoking cessation treatment is more feasible, in methadone maintenance treatment programs. Other factors associated with smoking behavior and with the recruitment of drug- and alcohol-dependent individuals into the smoking cessation treatment study are described.

Smoking cessation treatment in community-based substance abuse rehabilitation programs

“…More outpatient programs originally signed up for the study but dropped out when recruitment proved infeasible (see Reid et al, 2007). The group treatment format, although favored by providers for its low cost of delivery, appeared to be one of the key barriers to enrollment because it did not suit patients' needs for flexibility of scheduling and may also have figured in the limited counseling adherence rates (Reid et al, 2007). The present design did not separate the contributions of the cognitive-behavioral/mood management counseling versus the nicotine replacement to smoking abstinence rates and reductions in smoking.…”

Smoking Cessation Treatment among Patients in Community-Based Substance Abuse Rehabilitation Programs: Exploring Predictors of Outcome as Clues Toward Treatment Improvement

“…The need for more effective interventions for smoking is especially pronounced among drug- and alcohol-dependent patients, the majority of whom smoke (70–90%) (7,8,9,10), and among whom smoking is associated with greater levels of substance abuse (7,10,11), nicotine dependence (12,13,14), medical problems (15,16), and mortality (17), and low abstinence rates (10% to 20%) in response to smoking cessation interventions (18,19,20,21,22,23,24,25,26,27,28). …”

Tobacco Cessation Interventions for Underserved Women

“…As previously noted, the majority of women with mental illness or substance use disorders smoke; therefore, integrated approaches are required. Although it is a common belief among clinicians and others that people in treatment for mental health or substance use issues cannot quit smoking or would be at greater health risk if they tried to do so (Prochaska, 2010), evidence suggests that people in treatment for substance use, particularly women, are interested in quitting smoking (Poole, Greaves, & Cormier, 2003;Reid et al, 2007). Integrated treatments, including smoking cessation interventions provided concurrently during addictions treatment (Prochaska, Delucchi, & Hall, 2004) and mental health services (McFall et al, 2010;Prochaska, 2010), have been shown to enhance the effectiveness of treatment.…”