Tobacco dependence diagnosis and treatment in <scp>V</scp>eterans Health Administration residential substance use disorder treatment programs

Gifford, Elizabeth J.; Tavakoli, Sara; Wang, Ruey; Hagedorn, Hildi; Hamlett-Berry, Kim

doi:10.1111/add.12105

Cited by 12 publications

(4 citation statements)

References 55 publications

(71 reference statements)

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“…However, the Guideline recommendation has not led to significant changes in clinical practice. Addiction treatment programs rarely provide tobacco treatment (Fuller et al, 2007; Gifford, Tavakoli, Wang, Hagedorn, & Hamlett-Berry, 2013; Hunt, Cupertino, Garretta, Friedman, & Richter, 2012; Knudsen, Studts, Boyd, & Roman, 2010). An analysis of the reasons for failure to treat tobacco use in addiction programs (Prochaska, 2010) focused on provider beliefs including assumptions that tobacco is less harmful than other drugs, and that continued tobacco use supports abstinence from other substances.…”

mentioning

confidence: 99%

Concurrent alcohol and tobacco treatment: Effect on daily process measures of alcohol relapse risk.

Cooney¹,

Litt²,

Sevarino³

et al. 2015

Journal of Consulting and Clinical Psychology

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Objective The aim of this study was to compare the effects of alcohol treatment along with concurrent smoking treatment or delayed smoking treatment on process measures related to alcohol relapse risk. Method Alcohol dependent smokers (N = 151) who were enrolled in an intensive outpatient alcohol treatment program and were interested in smoking cessation were randomized to a concurrent smoking cessation (CSC) intervention or to a waiting list for delayed smoking cessation (DSC) intervention scheduled to begin three months later. Daily assessments of relapse process measures were obtained using an Interactive Voice Response (IVR) system for 12 weeks after the onset of smoking treatment in the CSC condition, and before beginning smoking treatment in the DSC condition. Smoking outcomes were assessed at 2 and 13 weeks after starting treatment. Results Seven-day CO-verified smoking abstinence in the CSC condition was 50.5% at 2 weeks and 19.0% at 13 weeks compared to 2.2% abstinence at two weeks and 0% abstinence at 13 weeks for those in the DSC condition. Drinking outcomes were not significantly different for CSC vs. DSC treatment conditions. On daily IVR assessments, CSC participants had significantly lower positive alcohol outcome expectancies relative to DSC participants. Multilevel modeling (MLM) analyses of within-person effects across the 12 weeks of daily monitoring showed that daily smoking abstinence was significantly associated with same day reports of lower alcohol consumption, lower urge to drink, lower negative affect, lower positive alcohol outcome expectancies, greater alcohol abstinence self-efficacy, greater alcohol abstinence readiness to change, and greater perceived self-control demands. Conclusions; Analyses of process measures provide support for recommending smoking intervention concurrent with intensive outpatient alcohol treatment. Public Health Significance Statement Study results support conveying a message to alcohol dependent smokers that smoking abstinence is accompanied by favorable changes in alcohol use, craving, mood, confidence, and motivation.

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mentioning

confidence: 99%

Concurrent alcohol and tobacco treatment: Effect on daily process measures of alcohol relapse risk.

Cooney¹,

Litt²,

Sevarino³

et al. 2015

Journal of Consulting and Clinical Psychology

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“…We lacked any data regarding the prevalence of current smoking, which might have added to the generalizability of study findings. Only a third of the current smokers enrolled in VHA residential addiction treatment programs are reported to have a documented TUD diagnosis (Gifford et al, 2013) while about 50% of smokers in general population have tobacco dependence (or TUD). (Grant et al, 2004) These rates may be even higher among veterans (Wagner et al, 2007) and those with smoking-related chronic disease (Darville and Hahn, 2014; Kalman et al, 2005; Westmaas et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Tobacco Use Disorder Among Patients With Smoking-related Chronic Medical Disease: Association With Comorbid Substance Use Disorders

Manhapra

Rosenheck

2017

Journal of Addiction Medicine

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INTRODUCTION Very little is known of the behavioral vulnerabilities of patients diagnosed with smoking-related chronic medical illness who continue to smoke, potentially worsening morbidity and mortality risks. This study explores the association of tobacco use disorder (TUD) among those with smoking-related chronic medical illnesses with other substance use disorders (SUD) and risk factors. METHODS Among veterans with smoking-related chronic medical illnesses identified from the National Veterans Health Administration (VHA) administrative records from Fiscal Year 2012, we compared the characteristics of those with a diagnosis of TUD (ICD 9 code 305.xx; n=519,918), and those without such a diagnosis (n=2,691,840). Using multiple logistic regression, we further explored the independent association of factors associated with TUD. RESULTS SUD prevalence was markedly higher among those with TUD (24.9% Vs 5.44%), including alcohol use disorder (AUD: 20.4% Vs. 4.3%) and drug use disorder (DUD: 13.5% Vs. 2.6%) compared to non-smokers. On multiple logistic regression analyses, AUD (OR = 2.94, 95% CI 2.90–2.97) and DUD (OR=1.97, 95% CI 1.94–1.99) were independently associated with current TUD diagnosis. Having any single SUD was associated with considerably high odds of having TUD (OR 3.32; 95% CI 3.29–2.36), and having multiple SUDs with even further increased risk (OR 4.09, 95% CI 4.02–4.16). CONCLUSIONS A substantial proportion of people with tobacco use disorder diagnosis despite concurrent smoking-related medical illnesses are also likely to have other comorbid substance use disorders complicating efforts at smoking cessation, and requiring a broader approach than standard nicotine dependence interventions.

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“…Data from the 2004-2006 NSDUH found that female veterans were twice as likely as male veterans to experience past-year severe psychological distress (14.5 vs. 6.5 percent; SAMHSA, 2007), and Weiner et al (2011) found that the association between a psychiatric diagnosis and suicide was greater for female than male veterans. Female veterans in the VA SUD outpatient treatment setting also had high prevalences of comorbid mental disorders, with 47.6% also having PTSD, 38.7% serious mental illness, and 31.9% major depressive disorder (Gifford et al, 2011). In addition, females who served in OIF/OEF and used large quantities of alcohol and drugs screened positive for PTSD more than those not using substances, and comparison of women screening positive versus negative for PTSD found only alcohol use predicting the PTSD status (Nunnink et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Suicide and substance use among female veterans: A need for research

Chapman

2014

Drug and Alcohol Dependence

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Background The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. Methods Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. Results Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. Conclusion Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.

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Tobacco dependence diagnosis and treatment in Veterans Health Administration residential substance use disorder treatment programs

Abstract: Most veterans in Veterans Health Administration substance use disorders residential treatment programs appear to use tobacco, yet only one in 10 receives a documented ICD-9 TD diagnosis and pharmacotherapy while in a substance use disorders residential treatment program.

Cited by 12 publications

References 55 publications

Concurrent alcohol and tobacco treatment: Effect on daily process measures of alcohol relapse risk.

Concurrent alcohol and tobacco treatment: Effect on daily process measures of alcohol relapse risk.

Tobacco Use Disorder Among Patients With Smoking-related Chronic Medical Disease: Association With Comorbid Substance Use Disorders

Suicide and substance use among female veterans: A need for research

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