Enhancing systems-level tobacco interventions in substance abuse treatment programs

Substance abuse treatment program (SATP) patients are four times more likely to smoke than non-substance users, and also suffer high rates of tobacco-related disease and mortality. In 2008, regulations mandated smoke-free policies in all New York State SATPs, including a smoke-free environment, smoking cessation training for staff, and identification and treatment of all smokers. However, multiple national surveys continue to demonstrate low levels of tobacco cessation treatment in SATPs. Among the barriers to provision of cessation services in SATPs is limited staff capacity to address tobacco use. The proposed project will address this need by building capacity for multi-disciplinary tobacco cessation treatment at both provider and system levels in a large multi-site SATP serving approximately 4000 opioid dependent drug users.

The goals of the proposed project are to increase identification of tobacco use in SATP patients, to provide evidence-based smoking cessation treatment to all SATP patients who smoke, and to improve cessation rates among smokers with co-occurring substance use disorders. The project addresses both provider- and healthcare system-level approaches to tobacco use among smokers with comorbid substance abuse disorders. It achieves this by leveraging the infrastructure of the Einstein-Montefiore Division of Substance Abuse, which has a strong track record of delivering integrated primary medical care and substance abuse treatment to economically disadvantaged, racial/ethnic minority patients. In addition, the proposal focuses on a special population disproportionately burdened by smoking, goes beyond educating health professionals to address system change, and assesses not only smoking cessation treatment practices, but also smoking cessation outcomes.