Smoking cessation for clients in chemical dependence treatment. A demonstration project.

A demonstration project was conducted to examine the factors that facilitate implementation of nicotine dependence treatment in a chemical dependence (cd) program. The project included: (a) staff education; (b) staff training to conduct nicotine dependence treatment groups; (c) voluntary smoking cessation treatment for smoking staff; and (d) smoking cessation treatment for client volunteers in outpatient and residential cd programs. A 12-week, cognitive/behavioral group program with nicotine patches was conducted separately for staff and client volunteers. Forty-two of approximately 70 staff returned smoking questionnaires, 10 of whom reported current smoking. Four staff members began treatment, in addition to four staff from a second treatment agency. There were three of eight staff (37.5%) who reported ongoing abstinence at the end of the 12-week program. There were 83 cd clients (approximately 20% of smoking clients) who volunteered to participate in smoking cessation treatment. Forty clients began treatment, 3 (7.5%) of whom were abstinent from smoking at the conclusion of the 12-week program. Staff smoking, lack of clinic resources devoted to the project, and voluntary client participation, which was adjunctive to other treatment components, were impediments to implementation and success. Success was greatest in a clinical setting in which smoking cessation treatment was staff supported and integrated with cd treatment. We recommend that (a) smoking cd staff be offered nicotine dependence treatment, (b) nicotine dependence treatment become a standard, integrated component of cd treatment, and (c) initiation of smoking cessation be individualized according to clients' needs and circumstances.