University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, USA.
Int J Drug Policy. 2012 May;23(3):220-8. doi: 10.1016/j.drugpo.2011.11.006. Epub 2012 Jan 26.
Most clients in drug treatment smoke cigarettes, but few facilities provide treatment for tobacco dependence. We identify subjective experiences and social processes that may influence facility adoption of tobacco treatment policies and practices.
Cross-sectional, semi-structured interviews were conducted with staff, directors and clients of 8 drug treatment facilities in the Midwestern U.S. We assembled a purposive sample stratified by ownership, methadone provision, and treatment service provision. We conducted in-person interviews with clinic directors and 54 staff and clients and employed a mixed-method analytic approach.
Facility policies and philosophy related to tobacco differed from those regarding alcohol and other drugs. Participants suggested facilities may not treat tobacco dependence because it does not create legal and social problems that force clients into treatment. Tobacco dependence treatment falls outside of a core function of drug treatment, which is to help clients fix legal problems caused by their drug use. Moreover, proactively treating clients for tobacco dependence creates strong ambivalence amongst staff and directors. On the one hand, staff smoking would violate core principles of drug treatment (i.e., the importance of staff abstinence from drugs of abuse); on the other, staff who smoke feel their personal rights and jobs are threatened. This situation creates strong incentives for staff to resist adoption of tobacco dependence treatment. Unlike other studies, the fear of jeopardising clients' abstinence from other drugs did not emerge as a downside for treating tobacco dependence.
International and national trends will probably increase the pressure to treat tobacco dependence during drug treatment. However, the U.S. context of drug treatment, as a patchwork, under-funded industry with high employee turnover, may undermine true adoption. At present, many facility staff resolve their ambivalence by reporting they "offer" treatment, but actually providing none. To facilitate dissemination of service provision, it may be useful to identify incentives for U.S. facilities that are closely aligned with the criminal justice system, help facilities define policies and treatment roles for staff who smoke, and better define the role of facilities in preventing morbidity and mortality.
大多数戒毒所的客户都吸烟，但很少有机构提供烟草依赖治疗。我们确定了可能影响设施采用烟草治疗政策和实践的主观经验和社会过程。
对美国中西部 8 个戒毒所的工作人员、主管和客户进行了横断面、半结构式访谈。我们按照所有制、美沙酮供应和治疗服务供应进行了分层，以确定有目的的样本。我们对诊所主任和 54 名工作人员和客户进行了面对面访谈，并采用了混合方法分析方法。
与酒精和其他药物相比，设施的烟草政策和理念有所不同。参与者认为，戒毒所可能不会治疗烟草依赖，因为它不会产生迫使客户接受治疗的法律和社会问题。烟草依赖治疗不属于戒毒治疗的核心功能，其核心功能是帮助客户解决因吸毒而产生的法律问题。此外，主动为客户治疗烟草依赖会在工作人员和主管中引起强烈的矛盾心理。一方面，工作人员吸烟会违反戒毒治疗的核心原则（即工作人员戒除滥用药物的重要性）；另一方面，吸烟的工作人员则感到自己的个人权利和工作受到威胁。这种情况为工作人员抵制采用烟草依赖治疗创造了强烈的动机。与其他研究不同的是，担心危及客户对其他药物的戒除，并没有成为治疗烟草依赖的一个不利因素。
国际和国家的趋势可能会增加在戒毒治疗中治疗烟草依赖的压力。然而，美国的戒毒治疗环境是一个拼凑而成的、资金不足的行业，员工流动率高，这可能会破坏真正的采用。目前，许多戒毒所工作人员通过报告他们“提供”治疗，但实际上并未提供任何治疗来缓解他们的矛盾心理。为了促进服务提供的传播，确定与刑事司法系统密切相关的美国戒毒所的激励因素，帮助戒毒所为吸烟的工作人员制定政策和治疗角色，以及更好地定义戒毒所在预防发病率和死亡率方面的作用，可能会有所帮助。
