Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA.
Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA.
Int J Environ Res Public Health. 2023 Mar 24;20(7):5260. doi: 10.3390/ijerph20075260.
People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers' misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients' substance-use recovery, although research indicates that it enhances support for recovery and relapse prevention. A total of 86 treatment providers employed in SUTS (i.e., 9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs), 6 substance-use treatment programs in LMHAs, and 55 stand-alone substance-use treatment centers) in Texas, USA, answered survey questions about their (1) thoughts about treating tobacco during substance-use treatment, and (2) delivery of the 5A's tobacco-use intervention (Ask, Advise, Assess, Assist, Arrange). Twenty-six providers and leaders were interviewed about attitudes toward tobacco-free workplace policies and tobacco dependence and the relative importance of treating tobacco (vs. other substance-use disorders) at their center. Providers who did not believe tobacco use should be addressed as soon as clients begin treatment (i.e., endorsed responses of after 1 year, it depends on the client, or never) had lower odds of Asking clients about their tobacco use (OR = 0.195), Advising clients to quit smoking (OR = 0.176), and Assessing interest in quitting smoking (OR = 0.322). Qualitative results revealed barriers including beliefs that clients need to smoke to relieve the stress of substance-use recovery, are disinterested in quitting, fears that concurrent treatment would jeopardize substance use, and limited resources; additional training and education resources was the key facilitator theme. The results demonstrate a critical need to eliminate barriers to tobacco-treatment provision for clients in SUTS through education to correct misperceptions, specialized training to equip providers with knowledge and skills, and resources to build center capacity. Integrating evidence-based smoking interventions into routine care is key to support the recovery efforts of clients in SUTS.
与普通人群相比，患有物质使用障碍的人吸烟率更高，但在物质使用治疗环境 (SUTS) 中很少接受烟草依赖治疗。在 SUTS 中提供基于证据的干预措施的一个障碍是提供者的误解，即同时治疗烟草使用和非尼古丁物质使用会危及客户的物质使用康复，但研究表明，这会增强对康复和预防复发的支持。美国德克萨斯州的 86 名 SUTS 治疗提供者（即 9 个联邦合格的健康中心、16 个地方心理健康管理局、6 个地方心理健康管理局的物质使用治疗项目和 55 个独立的物质使用治疗中心）回答了关于他们的调查问题：(1) 在物质使用治疗期间治疗烟草的想法，以及 (2) 实施 5A 烟草使用干预措施（询问、建议、评估、协助、安排）。26 名提供者和领导者接受了有关其中心的禁烟工作场所政策和烟草依赖态度以及治疗烟草（与其他物质使用障碍相比）的相对重要性的访谈。不认为应尽快在客户开始治疗时解决烟草使用问题的提供者（即，他们认可在治疗 1 年后、视客户而定或从不处理的观点），询问客户有关其烟草使用情况的可能性较低（OR = 0.195），建议客户戒烟（OR = 0.176），评估客户戒烟兴趣（OR = 0.322）。定性结果揭示了一些障碍，包括认为客户需要吸烟来缓解物质使用康复的压力，对戒烟不感兴趣，担心同时治疗会危及物质使用，以及资源有限；额外的培训和教育资源是关键的促进主题。结果表明，迫切需要通过教育纠正误解、提供专门培训以增强提供者的知识和技能以及提供资源来建设中心能力，为 SUTS 中的客户提供烟草治疗服务，消除提供烟草治疗服务的障碍。将基于证据的吸烟干预措施纳入常规护理是支持 SUTS 中客户康复努力的关键。
