The implementation of tobacco-related brief interventions in substance abuse treatment: a national study of counselors.

Most individuals receiving substance abuse treatment also use tobacco, which suggests that smoking cessation is an important clinical target for most clients. Few studies have measured the extent to which addiction treatment counselors address clients' tobacco use. In this study, we examined counselors' implementation of brief interventions that are consistent with the U.S. Public Health Service's (PHS) clinical practice guideline, Treating Tobacco Use and Dependence, when counselors are engaging new clients in treatment. We hypothesized that counselors' implementation of tobacco-related brief interventions is associated with organizational and counselor-level factors. Data were collected from 2,067 counselors via mailed surveys. Implementation of recommended brief interventions during intake was significantly lower among counselors reporting greater barriers to smoking cessation services within their organizational context. Perceived managerial support for smoking cessation services was positively associated with implementation. Counselors with greater knowledge of the PHS guideline and who believed in the positive impact of smoking cessation interventions on sobriety reported greater implementation. Relative to counselors who have never been tobacco users, current tobacco users reported significantly lower implementation of these brief interventions. These findings suggest that attempts to increase the implementation of best practices in substance abuse treatment may require attention to organizational contexts and the individuals responsible for implementation.