University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94118, United States.
Drug Alcohol Depend. 2012 Feb 1;121(1-2):30-7. doi: 10.1016/j.drugalcdep.2011.08.003. Epub 2011 Sep 8.
Smoking prevalence among persons in addiction treatment is 3-4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence.
The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked.
From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163)=7.15, p=0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123)=3.66, p=0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235)=10.58, p=0.0013) and clients received more tobacco-related services from their program (F(1, 235)=92.86, p<0.0001) and from their counselors (F(1, 235)=61.59, p<0.0001). Most changes remained at follow-up.
The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.
接受戒毒治疗的人群中，吸烟率比普通人群高 3-4 倍。然而，治疗项目往往报告存在组织障碍，难以提供与烟草相关的服务。本研究评估了为期六个月的组织变革干预措施“通过组织变革解决烟草问题”（ATTOC）的效果，以改善项目解决烟草依赖问题的方式。
该 ATTOC 干预措施在三个住院治疗项目中实施，包括咨询、员工培训、政策制定、领导支持和尼古丁替代疗法（NRT）药物的使用。项目工作人员和客户在干预前、干预后和 6 个月随访时接受调查。员工调查衡量了对吸烟危害的认识、对治疗吸烟的态度和障碍、顾问提供此类服务的自我效能，以及用于解决烟草问题的做法。客户调查衡量了知识、态度和接受的与烟草相关的服务。跟踪了 NRT 的使用情况。
从干预前到干预后，工作人员对治疗烟草依赖的信念变得更加有利（F(1, 163)=7.15, p=0.008），NRT 的使用增加，烟草相关做法呈非显著趋势增加（F(1, 123)=3.66, p=0.058）。客户对治疗烟草依赖的态度变得更加有利（F(1, 235)=10.58, p=0.0013），并且客户从其项目（F(1, 235)=92.86, p<0.0001）和顾问（F(1, 235)=61.59, p<0.0001）处获得了更多与烟草相关的服务。大多数变化在随访时仍然存在。
ATTOC 干预措施可以帮助改变治疗系统文化，增加戒毒治疗项目中的烟草服务。
