Staff Knowledge, Attitudes, and Practices regarding Nicotine Dependence Differ by Setting

Abstract

This study examined smoking-related knowledge, beliefs, self-efficacy, smoking cessation practices, and barriers to providing smoking cessation services in a workforce sample. The 11 participating clinics (N=335 staff) included substance abuse treatment and HIV care clinics categorized into three types: Veterans Affairs Medical Center (VAMC) clinics, hospital-based clinics, and community-based clinics. Staff in both VAMC and hospital-based settings shared characteristics that may predict smoking-related knowledge, beliefs, and practices (higher education level, low smoking rates, fewer staff in recovery, and location in hospital-affiliated environments where there was greater emphasis on physical health). However, staff in VAMC settings outperformed those in both hospital-based and community-based clinic settings on measures of smoking-related knowledge, beliefs, self-efficacy, and practices. Well-developed procedures to support VAMC clinicians in addressing smoking may account for these findings. Findings suggest that both reductions in staff smoking, and development and implementation of smoking policy are needed to support staff in better addressing nicotine dependence in community-based treatment settings.

Softening up on the hardening hypothesis

“…Adoption by smokers has been low even in jurisdictions where barriers such as cost have been removed 9. The view by many practitioners that tobacco use is a relatively low therapeutic priority is another barrier; should the patient suffer from comorbidities, smoking cessation often takes a back seat to other presenting problems, although it often negatively affects the outcome 11. Moreover, nicotine replacement therapy (NRT) is recommended for use in fixed doses, with appropriate guidelines for combination therapy lacking.…”

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

“…Such barriers have been identified among SUD providers outside VHA, and can include staff smoking, lack of training and the mistaken belief that smoking cessation will impede SUD recovery [19][20][21][22][23]66]. Some VHA-specific implementation barriers also may exist.…”

“…The risk of coronary death is four times greater for people with alcohol use disorders (AUD) who smoke than for non-smokers with AUD, for example, and tobacco-dependent drug users are four times more likely to die prematurely than those who do not use tobacco [17,18]. Historically, however, SUD treatment providers have not considered tobacco use an important focus of treatment [19]. A number of barriers to integrating TD treatment into addiction treatment have been identified, including lack of staff training on TD treatment [19][20][21] and beliefs that smoking cessation will impede recovery from other SUDs [19,22,23].…”

“…Historically, however, SUD treatment providers have not considered tobacco use an important focus of treatment [19]. A number of barriers to integrating TD treatment into addiction treatment have been identified, including lack of staff training on TD treatment [19][20][21] and beliefs that smoking cessation will impede recovery from other SUDs [19,22,23]. These barriers are of concern as considerable evidence indicates that TD treatment is appropriate and efficacious for patients in SUD recovery [24][25][26][27][28][29][30][31][32].…”

Implementation of smoking cessation treatment in substance use disorder treatment settings: a review

“…This perspective on implementation necessitates shifting the unit of analysis from the organization to individual counselors. Surveys of counselors have repeatedly found very low implementation (59)(60)(61). A national survey of more than 2,100 counselors examined implementation of brief interventions (i.e., 5 As) and counseling sessions dedicated to smoking cessation.…”