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Abstract
Background: Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. Objective: To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related IMB factors in this population. Methods: Current or former smokers in methadone treatment (n = 35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. Results: Commonly known IMB factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with emotions, finding social support, and pharmacotherapy adherence (behavioral skills). IMB factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). IMB strengths and deficits varied by individual. Conclusions: Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population.
THE AUTHORS
Nina A. Cooperman, Psy.D., is Assistant Professor of Psychiatry in the Division of Addiction Psychiatry at Rutgers Robert Wood Johnson Medical School. She also has a faculty appointment at the Cancer Institute of New Jersey. She is the recipient of a NIDA K23 Patient-Oriented Career Development Award to develop a smoking cessation intervention for methadone maintained smokers. Dr. Cooperman has been Principal or Co-investigator on several NIH and privately funded studies, including projects investigating adherence to antiretroviral medications among HIV-infected drug users, smoking cessation interventions in the emergency department, and HIV risk behavior among women in Mumbai, India.
Kimber P. Richter, Ph.D., M.P.H., is Professor, Preventive Medicine and Public Health at the University of Kansas Medical Center. Dr. Richter conducts research in treating tobacco dependence in rural areas, hospitals, and substance abuse treatment. Recent studies include testing video counseling for smoking cessation among rural smokers, and testing alternative methods for linking hospitalized smokers with tobacco quitlines postdischarge.
Steven L. Bernstein, M.D., is Professor and Vice Chair for Academic Affairs in the Department of Emergency Medicine at Yale. His work focuses on the implementation of tobacco dependence treatment in various clinical settings, including the hospital emergency department. His work has been supported by the National Cancer Institute, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the American Legacy Foundation. Dr. Bernstein has served in an advisory capacity developing tobacco policies and measures for several national groups.
Marc L. Steinberg, Ph.D., is Associate Professor of Psychiatry and Associate Director, Division of Addiction Psychiatry at Rutgers Robert Wood Johnson Medical School. His work has focused on tobacco dependence and predictors of initiation of quit attempts and treatments to facilitate quit attempts. He is also interested in smoking among those with low socioeconomic status, mental illness, or substance use disorders. Dr. Steinberg's work has been supported by funding from the National Institute on Drug Abuse (NIDA), the American Legacy Foundation, NJ Department of Health and Senior Services, and a Global Research Award on Nicotine Dependence (GRAND).
Jill M. Williams, M.D., is Professor of Psychiatry and Director of the Division of Addiction Psychiatry at Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ. The focus of Dr. Williams work has been in addressing tobacco in individuals with mental illness or other addictions. Dr Williams has developed training curricula for behavioral health professionals and manualized treatments for treating tobacco in mental health settings. Dr. Williams has received research funding from sources including the National Institutes on Drug Abuse (NIDA), National Institute of Mental Health (NIMH), and American Legacy Foundation.
Glossary
Methadone: A synthetic opioid that is used to treat pain and opioid dependence.
Information-Motivation-Behavioral Skills (IMB) Model: A theoretical model which asserts that health-related IMB factors are all necessary for health behavior change.
Focus group: A method of qualitative research where a group of people are asked about their experiences, thoughts, feelings, and opinions.
Theoretical Saturation: When no new domains, concepts, or dimensions are being discovered, and researchers begin to record similar comments/themes in response to interview questions.
Content Analysis: The analysis of text, with either a quantitative or qualitative approach.
Deductive Approach: A research method that is used to test an existing theory or hypothesis.
Inductive Approach: A research method that is used to generate new theories.
Inter-Observer Agreement: The degree of concordance between observer ratings.
Declaration of Interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
This work was funded by the National Institute on Drug Abuse (K23DA025049).