Modifiable health risk behaviours and attitudes towards behaviour change of clients attending community‐based substance use treatment services

Abstract

Introduction and AimsHealth risk behaviours, such as smoking, nutrition and physical inactivity, are significant contributors to chronic disease for people with substance use disorders. This study reports the prevalence of these behaviours amongst substance use treatment clients, their attitudes towards modifying such behaviours and the acceptability of receiving support to do so. Client characteristics associated with risk status and interest in modifying behaviours were examined.Design and MethodsA cross‐sectional survey was undertaken with clients of 15 community substance use treatment services within in New South Wales, Australia. Data for the study were collected via computer assisted telephone interviews.ResultsOf those contactable and eligible, 386 (71%) clients completed the survey. Clients reported a high prevalence of smoking (80%), insufficient fruit and/or vegetable consumption (89%) and insufficient physical activity (31%). Overall, 51–69% of clients reported considering modifying their health risk behaviours and 88–97% thought it was acceptable to be provided preventive care to address such behaviours. Younger clients were more likely to smoke (18–34 years (odds ratio [OR] = 4.6 [95% confidence interval [CI] = 1.9, 11.3]); 35–54 years (OR = 2.6 [95% CI = 1.2, 5.7])) and be interested in increasing vegetable consumption (18–34 years (OR = 4.4 [95% CI = 1.3, 14.8]); 35–54 years (OR = 8.0 [95% CI = 2.5, 25.4])) than older clients (≥55 years).Discussion and ConclusionsThere is a high prevalence of health risk behaviours amongst clients of community substance use treatment services. However, contrary to commonly cited barriers to care provision, clients are interested in modifying their risk behaviours and report that receiving preventive care to address these behaviours is acceptable. [Tremain D, Freund M, Wolfenden L, Wye P, Bowman J, Dunlop A, Gillham K, Bartlem K, McElwaine K, Gow B, Wiggers J. Modifiable health risk behaviours and attitudes towards behaviour change of clients attending community‐based substance use treatment services. Drug Alcohol Rev 2017;36:369–377.]

Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention

“…The greatest intervention effect was indicated for insufficient fruit and/or vegetable consumption for both client and clinician report and suggests clinicians can be assisted to provide preventive care addressing such risks within community substance use treatment settings. The importance of a strategy to address insufficient fruit and/or vegetable consumption is emphasised by the significant health burden associated with such risks, 60 61 the high prevalence of such risks within substance use treatment clients 56 and the low levels of care being provided at baseline.…”

“…Only 39% of clinicians reported their clients were interested in modifying their health behaviours. However, research indicates that substance use service clients are interested in quitting smoking (67%–69%), 14 56 increasing fruit and/or vegetable consumption (55%) 56 and increasing physical activity (67%–81%). 14 56 In addition, over a half of clinicians (56%) believed that clients would change all their health risk behaviours due to the care provided.…”

“…Assuming a baseline prevalence of care of 23%, 29 it was estimated the study would have 80% power to detect an increase in assessment of 15% from baseline to follow-up (α=0.01). Using the least prevalent health risk behaviour (physical activity; 31% 56 ) and an assumed prevalence of care at baseline of 25%, 29 the study was estimated to have 80% power to detect an increase of 27% in the provision of brief advice and offer of referral.…”

Substance use treatment clinician attitudes to care for chronic disease health risk behaviours and associations of attitudes with care provision

“…People who use substances have a markedly higher prevalence of health risk behaviours, such as smoking, insufficient fruit and vegetable consumption and insufficient physical activity . Substance use treatment services provide an opportunity to address these risk behaviours, as treatment is often delivered by multidisciplinary clinical teams with skills in behaviour change and may incorporate multiple episodes of treatment and regular monitoring of progress .…”

How can we help African American substance users stop smoking? client and agency perspectives

“…Cigarette smoking is widespread among persons in substance use disorder (SUD) treatment programs, with rates two to four times higher than those in the general population, underscoring the need for evidence-based smoking cessation strategies and tobacco-free standards in these programs (Cupertino et al, 2013;Hall & Prochaska, 2009). Persons in SUD programs are interested in smoking cessation (Tremain et al, 2016) and not fearful of the implications of quitting for sobriety (Richter, Hunt, Cupertino, Garrett, & Friedmann, 2012). Smoking cessation interventions do not dissuade smokers from entering SUD treatment, do not increase the number of patients leaving early (Williams et al, 2005),nor undermine treatment goals.Smoking cessation is associated with better alcohol and drug abstinence rates (McClure et al, 2015;McKelvey, Thrul, & Ramo, 2017;Prochaska, Delucchi, & Hall, 2004;Stuyt, 2015) and decreased recidivism to heroin use (Hser, McCarthy, & Anglin, 1994).Short-term smoking cessation rates in this population may be comparable to those in the general population (Hall & Prochaska, 2009;Prochaska et al, 2004).Despite mixed findings (Friend & Pagano, 2004) and small sample sizes, short-term smoking cessation studies in this population report reduced smoking at the end of cessation treatment with relapse common (Prochaska et al, 2004).…”