The Implementation of Smoking Cessation Counseling in Substance Abuse Treatment

Abstract

Research on the implementation of smoking cessation counseling within substance abuse treatment organizations is limited. This study examines associations among counselors’ implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization- and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors’ knowledge of the Public Health Service’ s clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors’ knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations.

Sustainment of Smoking Cessation Programs in Substance Use Disorder Treatment Organizations

“…However, greater implementation of counseling is achieved when formal programs were in place (Knudsen et al, 2012). Unfortunately, we could not collect additional counselor data at follow-up, which precluded analyses of program discontinuation and the implementation behaviors of individual counselors.…”

“…However, smoking cessation has historically been viewed by the treatment system as a low priority, with providers often considering tobacco to be less harmful than patients' other substance use (McCool, Richter, & Choi, Advance Access publication November 6, 2012November 6, 2005Ziedonis, Guydish, Williams, Steinberg, & Foulds, 2006) or fearing that smoking cessation would promote SUD relapse (Prochaska, 2010). Counselors generally receive little training about smoking cessation and report limited knowledge about the PHS guideline Knudsen, Studts, & Studts, 2012;Rothrauff & Eby, 2011), posing additional barriers. Although smoking cessation programs are rarely available, cross-sectional studies have shown that they are more likely to be offered when organizational cultures value smoking cessation (Fuller et al, 2007) and provide training to staff Richter, Choi, McCool, Harris, & Ahluwalia, 2004).…”

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

“…A similar relationship between knowledge and implementation of behavioral interventions was found in a sample of counselors working in adolescent-only SUD programs (67). Counselors' knowledge of the PHS practice guideline was positively correlated with implementation of the 5 As and counseling sessions dedicated to smoking cessation (23,62). Organizational investments in training counselors can yield benefits in terms of implementation.…”

“…Much like organizational studies of adoption, counselors were most likely to ask about smoking, but then diminishing percentages of counselors engaged in advising patients to quit, assessing willingness to quit, and using motivational interventions to increase willingness to quit (23). When asked how routinely they delivered counseling sessions dedicated to smoking cessation, the mean was 0.9 (where 0 = never and 5 = very often), representing very low implementation (62). Low implementation has also been documented among staff working in perinatal SUD treatment (63), despite staff acknowledgement of the dangers of smoking to mothers and their children (64).…”

Cigarette Smoking and Quit Attempts Among Injection Drug Users in Tijuana, Mexico

“…Despite these recommendations, a 2006-2008 national survey of drug and alcohol treatment centers in the United States found that only 17.6% had incorporated a formal smoking cessation treatment program (Knudsen, Studts, & Studts, 2012). This proportion is likely to be much lower in low-and middle-income countries, where resources for services to drug users are extremely scarce, leaving IDUs and other drug users with limited access to smoking cessation treatment.…”