Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study

Abstract

People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers’ misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients’ substance-use recovery, although research indicates that it enhances support for recovery and relapse prevention. A total of 86 treatment providers employed in SUTS (i.e., 9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs), 6 substance-use treatment programs in LMHAs, and 55 stand-alone substance-use treatment centers) in Texas, USA, answered survey questions about their (1) thoughts about treating tobacco during substance-use treatment, and (2) delivery of the 5A’s tobacco-use intervention (Ask, Advise, Assess, Assist, Arrange). Twenty-six providers and leaders were interviewed about attitudes toward tobacco-free workplace policies and tobacco dependence and the relative importance of treating tobacco (vs. other substance-use disorders) at their center. Providers who did not believe tobacco use should be addressed as soon as clients begin treatment (i.e., endorsed responses of after 1 year, it depends on the client, or never) had lower odds of Asking clients about their tobacco use (OR = 0.195), Advising clients to quit smoking (OR = 0.176), and Assessing interest in quitting smoking (OR = 0.322). Qualitative results revealed barriers including beliefs that clients need to smoke to relieve the stress of substance-use recovery, are disinterested in quitting, fears that concurrent treatment would jeopardize substance use, and limited resources; additional training and education resources was the key facilitator theme. The results demonstrate a critical need to eliminate barriers to tobacco-treatment provision for clients in SUTS through education to correct misperceptions, specialized training to equip providers with knowledge and skills, and resources to build center capacity. Integrating evidence-based smoking interventions into routine care is key to support the recovery efforts of clients in SUTS.

Implementing a tobacco-free workplace program at a substance use treatment center: a case study

“…However, we also encountered attitudes indicating that staff, including clinicians, were doubtful about their clients’ interest in quitting and ability to do so. Given their expertise and supportive roles as addiction treatment specialists, clinicians’ attitudes can greatly affect those of their clients; moreover, clinicians’ beliefs and attitudes are often cited as one of the major barriers to effectively implementing tobacco-free programs within substance use treatment settings [ 4 , 22 , 25 , 57 ]. Training given as a part of the program implementation provided staff with information on evidence-based tobacco cessation practices and addressed some of these attitudes to better prepare staff to provide cessation care to their clients.…”

“…Our use of “staff” here refers to both clinical employees, those providing direct services to clients, and nonclinical employees. Moreover, despite evidence to the contrary, staff may believe that treating tobacco use and substance use disorders simultaneously will jeopardize substance use treatment and recovery [ 25 ]. Together, these barriers and others may contribute to the known translational lag whereby any type of evidence-based practice takes a long time (e.g., up to 17 years) to be implemented into practice to reach the intended population and ensure the improvement of clients’ health [ 26 , 27 ].…”

Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study

“…The University of Houston Institutional Review Board (IRB) concluded that this project did not meet the definition of human subjects research under 45 CFR 46.102 (I) (i.e., a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge); therefore, no IRB review/approval was necessary. Detailed recruitment procedures are described elsewhere ( Siddiqi et al, 2022 , Taing et al, 2022 , Jafry et al, 2022 , Britton et al, 2023 , Britton et al, 2023 ).…”