Published by Haight Ashbury Publications

 

Smoking, Mental Disorders and Substance Abuse Treatment

Table of Contents (scroll down to view abstracts) Volume 39, Number 4 December 2007 View sample article

Editors’ Introduction: Smoking, Mental Disorders and Substance Abuse Treatment  — Joseph Guydish, Ph.D. &  Janice Tsoh, Ph.D.

Staff Smoking and Other Barriers to Nicotine Dependence Intervention in Addiction Treatment Settings: A Review   — Joseph Guydish, Ph.D.; Emma Passalacqua, B.A.; Barbara Tajima, Ed.M. & Sarah Turcotte Manser, M.A.

Addressing Smoking in Community Drug Abuse Treatment Programs: Practical and Policy Considerations   — Gregory S. Brigham, Ph.D.; Grant Schroeder, M.S. & Eric Schindler, Ph.D.

Smoking Among Adolescents in Substance Abuse Treatment: A Study of Programs, Policy, and Prevalence  — JongSerl Chun, Ph.D.; Joseph Guydish, Ph.D. & Ya-Fen Chan, Ph.D.

Addressing Tobacco Use Through Organizational Change: A Case Study of an Addiction Treatment Organization  —Douglas M. Ziedonis, M.D., MPH.; Lucy Zammarelli, M.A.; Gregory Seward, M.S.H.C.A.; Karen Oliver; Joseph Guydish, Ph.D.; Marie Hobart, M.D. & Bruce Meltzer, M.D.

Organizational Change in a Perinatal Treatment Setting: Integration of Clinical Practice and Policies on Tobacco and Smoking Cessation  — Martha A. Jessup R.N., Ph.D., C.N.S.     View this article

Substance Abuse Counselor Certification in California: How is Nicotine Addiction Addressed?  —Keiko Kurita, M.B.A. & Joseph Guydish, Ph.D.

Gender Differences in Immediate Antecedents of Ad Lib Cigarette Smoking in Smokers with and without Posttraumatic Stress Disorder: A Preliminary Report  —Michelle F. Dennis, B.A.; Carolina P. Clancy, Ph.D. & Jean C. Beckham, Ph.D.

A Comparison of Smoking Cessation Treatments for Persons with Schizophrenia and Other Serious Mental Illnesses  — Sandra M. Gallagher, Ph.D.; Patricia E. Penn, Ph.D.; Eric Schindler, Ph.D. & Wendy Layne, M.A.

Negative Affect, Emotional Acceptance, and Smoking Cessation — Timothy P. Carmody, Ph.D.; Cassandra Vieten, Ph.D. & John A. Astin, Ph.D.

INDEX —Volume 39 (1-4) 2007

COVER ART  — Yellow and Blue Abstract by Michael Wilson

Abstracts

Staff Smoking and Other Barriers to Nicotine Dependence Intervention in Addiction Treatment Settings: A Review — Joseph Guydish, Ph.D.; Emma Passalacqua, B.A.; Barbara Tajima, Ed.M.  & Sarah Turcotte Manser, M.A. Abstract—The aims of this review were to assess smoking prevalence among drug abuse treatment staff and summarize the range of barriers to provision of nicotine dependence intervention to clients receiving addictions treatment. A systematic literature search was conducted to identify publications reporting on workforce smoking prevalence, attitudes toward smoking, and perceived barriers to providing smoking cessation treatment in drug abuse treatment settings. Twenty papers met study inclusion criteria. Staff smoking prevalence estimates in the literature ranged from 14% to 40%. The most frequently reported barriers to providing nicotine dependence intervention in addiction treatment settings were lack of staff knowledge or training in this area, that smoking cessation concurrent with other drug or alcohol treatment may create a risk to sobriety, and staff are themselves smokers. Staff smoking is not uniformly elevated in the drug abuse treatment workforce. Smoking prevalence may be lower where staff are more educated or professionally trained, and may be higher in community-based drug treatment programs. Barriers to treating nicotine dependence may be addressed through staff training, policy development, and by supporting staff to quit smoking. State departments of alcohol and drug programs, and national and professional organizations, can also support treatment of nicotine dependence in drug abuse treatment settings. Keywords—drug abuse treatment, nicotine dependence, smoking, staff, workforce

Smoking Among Adolescents in Substance Abuse Treatment: A Study of Programs, Policy, and Prevalence — JongSerl Chun, Ph.D.; Joseph Guydish, Ph.D. & Ya-Fen Chan, Ph.D. Abstract—The study was designed to: (1) to identify smoking policies and interventions in adolescent residential treatment settings; (2) to examine the prevalence of smoking among adolescents in these settings; and (3) to assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interventions, we conducted phone interviews with one key informant at each program (N = 12). To describe client smoking behaviors, we conducted a secondary data analysis of baseline data for adolescents (N = 912) entering ART programs. All sites had no smoking indoors and 75% of the site had tobacco-free grounds for adolescents. Forty-two percent provided their youth with nicotine replacement therapy, and 42% provided counseling for smoking cessation. Also, 33% did not allow staff smoking on and off campus. The prevalence of any smoking in the past month was 66%, and 22% of current smokers were daily smokers at admission. Where smoking was allowed on grounds, adolescents more often reported recent smoking. Smoking behavior is prevalent among adolescents in residential drug treatment, and should be addressed in all such programs through policy implementation and client-level smoking cessation intervention. Keywords—adolescent, drug abuse treatment, residential treatment, smoking

Smoking Among Adolescents in Substance Abuse Treatment: A Study of Programs, Policy, and Prevalence — JongSerl Chun, Ph.D.; Joseph Guydish, Ph.D. & Ya-Fen Chan, Ph.D. ABSTRACT—The study was designed to: (1) to identify smoking policies and interventions in adolescent residential treatment settings; (2) to examine the prevalence of smoking among adolescents in these settings; and (3) to assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interventions, we conducted phone interviews with one key informant at each program (N = 12). To describe client smoking behaviors, we conducted a secondary data analysis of baseline data for adolescents (N = 912) entering ART programs. All sites had no smoking indoors and 75% of the site had tobacco-free grounds for adolescents. Forty-two percent provided their youth with nicotine replacement therapy, and 42% provided counseling for smoking cessation. Also, 33% did not allow staff smoking on and off campus. The prevalence of any smoking in the past month was 66%, and 22% of current smokers were daily smokers at admission. Where smoking was allowed on grounds, adolescents more often reported recent smoking. Smoking behavior is prevalent among adolescents in residential drug treatment, and should be addressed in all such programs through policy implementation and client-level smoking cessation intervention. KEYWORDS—adolescent, drug abuse treatment, residential treatment, smoking

Addressing Tobacco Use Through Organizational Change: A Case Study of an Addiction Treatment Organization —Douglas M. Ziedonis, M.D., MPH.; Lucy Zammarelli, M.A.; Gregory Seward, M.S.H.C.A.;  Karen Oliver; Joseph Guydish, Ph.D.; Marie Hobart, M.D. & Bruce Meltzer, M.D. Abstract—Compared to the general population, persons entering addiction treatment are three to four times more likely to be tobacco dependent and even addiction treatment staff members are two to three times more likely to be tobacco dependent. In these settings, tobacco use continues to be the norm; however addiction treatment programs are increasingly aware of the need to assess for and treat tobacco dependence. The problem is a cultural issue that is so ingrained that assumptions about tobacco use and dependence in addiction treatment are rarely questioned. Denial, minimization, and rationalization are common barriers to recovery from other addictions; now is the time to recognize how tobacco use and dependence must be similarly approached. This article describes the Addressing Tobacco through Organizational Change (ATTOC) model which has successfully helped many addiction treatment programs to more effectively address tobacco use. The article will review the six core strategies used to implement the ATTOC intervention, the 12-Step approach guiding the model, and describe a case study where the intervention was implemented in one clinic setting. Other treatment programs may use the experience and lessons learned from using the ATTOC organizational change model to better address tobacco use in the context of drug abuse treatment. Keywords—drug abuse treatment, nicotine dependence, organizational change, smoking, tobacco

Organizational Change in a Perinatal Treatment Setting: Integration of Clinical Practice and Policies on Tobacco and Smoking Cessation — Martha A. Jessup R.N., Ph.D., C.N.S. Abstract—Perinatal smoking presents serious health risks to the fetus, mother, and child. Despite extensive evidence of risk and high rates of smoking among in-treatment perinatal women substance abusers, tobacco-related practice and policy change has not been widely transferred for application in drug abuse treatment programs for pregnant and parenting women. This qualitative study investigated the process of change and the resultant adoption of clinical policy and treatment innovation in a residential drug abuse treatment program that converted from tobacco-tolerant to tobacco-free with provision of smoking cessation services. Informed by the Organizational Readiness for Change Model, staff interviews and data analysis were conducted to examine program characteristics affecting adoption. An organizational climate of openness to change and the program’s clarity of mission, expressed in perinatal-specific motivators for change, influenced the adoption of tobacco-related clinical practice and policy. Re-allocation of time, previously occupied by smoking behaviors, allowed for added promotion of maternal-child interaction and positive role-modeling for children. Keywords—organizational change, perinatal substance abuse, smoking cessation, tobacco policy

Substance Abuse Counselor Certification in California: How is Nicotine Addiction Addressed? —Keiko Kurita, M.B.A. & Joseph Guydish, Ph.D. Abstract—Persons entering substance abuse treatment smoke at rates three to four times that of the general population, but programs providing substance abuse treatment rarely address comorbid nicotine addiction. With California’s recent adoption of a regulation requiring alcohol and other drug (AOD) counselors to be certified, this study explored the degree to which nicotine addiction education was required or recommended to obtain certification by examining pertinent documentation and Web sites. Findings reveal two main points. First, the text of the California AOD Counselor Certification regulation and supporting documents make no mention of cigarettes, nicotine, smoking, or tobacco, and thus do not mandate or recommend they be addressed in the counselor certification process. Second, although nicotine or tobacco were not mentioned in regulatory or supporting documents, four of the 10 certifying organizations mentioned nicotine at least once in handbooks, program books, continuing education topics, or other materials available online. One certifying organization offered specialization in smoking and nicotine addiction as separate tracks within its certification training program. While systematic inclusion of smoking and nicotine addiction in counselor training offers one strategy to address smoking in substance abuse treatment settings, these topics are not addressed in regulations or supporting documents governing the certification of California AOD counselors. Keywords—counselor certification, counselor training, health education, health professionals, substance abuse, tobacco

Gender Differences in Immediate Antecedents of Ad Lib Cigarette Smoking in Smokers with and without Posttraumatic Stress Disorder: A Preliminary Report —Michelle F. Dennis, B.A.; Carolina P. Clancy, Ph.D. & Jean C. Beckham, Ph.D. Abstract—Using ambulatory methods for monitoring, this study investigated gender differences regarding the association between smoking and situational cues in 63 smokers with posttraumatic stress disorder (PTSD) and 32 smokers without PTSD. Smokers were instructed to complete a diary entry each time an ambulatory blood pressure monitor took a reading and each time they prepared to smoke. Generalized estimating equations contrasted 682 smoking and 444 nonsmoking situations by group status. For all smokers, ad lib smoking was strongly related to craving. For women with PTSD, ad lib smoking was strongly related to total PTSD symptoms, PTSD reexperiencing symptoms, and PTSD hyperarousal symptoms. For men with PTSD, ad lib smoking was significantly related to negative affect, PTSD reexperiencing symptoms, restlessness, and worry. No other mood antecedents were significant for women or men smokers without PTSD. These results are consistent with previous studies documenting gender differences in smoking behavior, and underscore the importance of examining gender differences in psychiatric samples. Keywords—ad lib, smoking, antecedents, gender, posttraumatic stress disorder

A Comparison of Smoking Cessation Treatments for Persons with Schizophrenia and Other Serious Mental Illnesses — Sandra M. Gallagher, Ph.D.; Patricia E. Penn, Ph.D.; Eric Schindler, Ph.D. & Wendy Layne, M.A. Abstract—Adults with any DSM-IV diagnosed mental illness smoke nearly half of the cigarettes consumed in the U.S. (Lasser et al. 2000). This study compared two smoking cessation interventions for persons with schizophrenia or other serious mental illness because national data suggests that: (1) they smoke at two to three times the rate of the general population; (2) cessation interventions for this population are understudied; (3) most cessation studies exclude persons with serious mental illness; and (4) cessation results in public health care savings and disposable income savings for clients. This study included a large number of persons with serious mental illness (N = 181) who were randomly assigned to one of three groups: contingent reinforcement (CR), CR plus nicotine patch (21 mg, CR+NRT) for 16 weeks, and a minimal intervention, self-quit control group. These participants were followed for 36 weeks. CR was accomplished with escalating financial compensation for achieving and maintaining abstinence as verified by expired carbon monoxide (CO). Quit rates, as measured by expired CO, were higher and discordant with saliva cotinine quit rates. Cotinine showed lower quit rates and small differences between intervention and control participants at weeks 20 and 36. There was, however, evidence of reduced smoking and importantly, no evidence of psychiatric exacerbation. Keywords—cessation, schizophrenia, serious mental illness, smoking

Negative Affect, Emotional Acceptance, and Smoking Cessation — Timothy P. Carmody, Ph.D.; Cassandra Vieten, Ph.D. & John A. Astin, Ph.D. Abstract—This article describes recent theoretical developments and empirical findings regarding the role of negative affect (NA) and emotion regulation in nicotine dependence and smoking cessation. It begins with a review of affect-based models of addiction that address conditioning, affect motivational, and neurobiological mechanisms and then describes the role of NA and emotion regulation in the initiation and maintenance of cigarette smoking. Next, the role of emotion regulation, coping skill deficits, depression, and anxiety sensitivity in explaining the relationship between NA and smoking relapse are discussed. We then review recent models of affect regulation, including emotional intelligence, reappraisal and suppression, and emotional acceptance, and describe implications for substance abuse and smoking cessation interventions. Finally, we point out the need for further investigations of the moderating role of individual differences in response to NA in the maintenance of nicotine dependence, and controlled randomized trials testing the efficacy of acceptance-based interventions in facilitating smoking cessation and relapse prevention. Keywords—acceptance, distress tolerance, emotion regulation, interoceptive exposure, mindfulness, nicotine dependence