‘The lesser of two evils’: A qualitative study of staff and client experiences and beliefs about addressing tobacco in addiction treatment settings

Abstract

Client and staff perceptions and attitudes about the treatment of tobacco, particularly those relating telephone support and nicotine replacement therapy, provided information, which will inform the design of smoking cessation programs for addiction treatment populations. [Wilson AJ, Bonevski B., Dunlop A., Shakeshaft A, Tzelepis F., Walsberger S., Farrell M., Kelly PJ, Guillaumier A. 'The lesser of two evils': A qualitative study of staff and client experiences and beliefs about addressing tobacco in addiction treatment settings. Drug Alcohol Rev 2015].

Potential sources of cessation support for high smoking prevalence groups: a qualitative study

“…However, some interviewees, particularly those accessing mental health CSOs, had been advised by their doctors that they should not quit smoking because their other health conditions should be prioritised. This experience reflects findings previously reported in the literature that people living with a mental illness and/or affected by alcohol and other drug use are sometimes dissuaded from quitting 16,17 . To reduce health inequities, it is important to address tobacco use among populations with high smoking rates; the findings of the present study suggest that doctors could benefit from receiving additional support, education about current smoking cessation guidelines and training to enable them to better support these groups.…”

“…These smokers may face unique barriers to using cessation support. For example, health professionals have been found less likely to provide people living with a mental illness or alcohol and other drug dependence with cessation support due to the belief that: i) cessation can be detrimental to clients’ mental health; ii) other aspects of treatment are prioritised; and/or iii) their clients do not want to quit 16,17 . These perceptions exist despite evidence that smoking cessation does not significantly affect substance use treatment outcomes or symptoms of mental illness and, in some cases, can improve both 18,19 .…”

“…The limited previous research with high smoking prevalence groups has tended to focus on general barriers to quitting 17,21 . Prior work does not appear to have investigated the factors influencing the acceptability of various sources of cessation support, and this information is needed to develop strategies to increase the acceptability and attractiveness of support options.…”

“…For example, health professionals have been found less likely to provide people living with a mental illness or alcohol and other drug dependence with cessation support due to the belief that: i) cessation can be detrimental to clients' mental health; ii) other aspects of treatment are prioritised; and/ or iii) their clients do not want to quit. 16,17 These perceptions exist despite evidence that smoking cessation does not significantly affect substance use treatment outcomes or symptoms of mental illness and, in some cases, can improve both. 18,19 Other barriers to receiving cessation support among smokers experiencing disadvantage include limited access to healthcare due to a lack of transportation, being stigmatised due to living with a mental illness and/or alcohol and other drug dependence, and doubts about the usefulness of quit support.…”

“…[20][21][22] The limited previous research with high smoking prevalence groups has tended to focus on general barriers to quitting. 17,21 Prior work does not appear to have investigated the factors influencing the acceptability of various sources of cessation support, and this information is needed to develop strategies to increase the acceptability and attractiveness of support options. To address this knowledge deficit, the present study focused on attitudes to sources of cessation support among three priority groups: people experiencing homelessness; mental illness; and/or alcohol and other drug dependence.…”