Commitment and capacity for providing evidence-based tobacco treatment in US drug treatment facilities

ABSTRACT

Background: Although people with mental illness, including substance use disorders, consume 44% of cigarettes in the United States, few facilities provide tobacco treatment. This study assesses staff- and facility-level drivers of tobacco treatment in substance use treatment. Methods: Surveys were administered to 405 clinic directors selected from a comprehensive inventory of 3800 US outpatient facilities. The main outcome was the validated 7-item Index of Tobacco Treatment Quality. Other measures included the validated Tobacco Treatment Commitment Scale and indicators of facility resources for providing tobacco treatment. Results: Stepwise model selection was used to determine the relationship between capacity/resources and treatment quality. The final model retained 7 items and had good fit (adjusted R² = 0.43). Four capacities significantly predicted treatment quality. Structural equation modeling (SEM) was used to test the impact of staff commitment on treatment quality; the model had good fit and the relationship was significant (comparative fit index [CFI] = 0.951, root mean square error of approximation [RMSEA] = 0.054). Adding the 7 capacity/resources maintained similar model fit (CFI = 0.922, RMSEA = 0.053). Staff commitment was slightly strengthened in this model, with a rise in parameter estimate from 0.449 to 0.560. All resource/capacity items were also significant predictors of treatment quality; the strongest was receiving training in how to provide tobacco treatment (0.360), followed by dedicated staff time (0.279) and having a policy that requires staff to offer treatment (0.272). Conclusions: Staff commitment to providing tobacco treatment was the strongest predictor of tobacco treatment quality, followed by resources for providing treatment. Interventions to change staff attitudes and improve resources for tobacco treatment have the strongest potential for improving quality of care.

KEYWORDS:

• Health services
• substance use disorder
• tobacco use disorder

Acknowledgments

The authors would like to acknowledge Terri Tapp and Meredith Benson for their diligent work on data collection. Also, the authors are very grateful for expert input on survey items from Erna L. Boone, DrPH, RRT, FAARC; Ann Gademsky; Sheila Weix, MSN, RN, CARN; William J. Pannepinto, MSW; Jill M. Williams, MD; Marc L. Steinberg, PhD; Gregory Seward, MSHCA, LADC-I, CTTS-M; Timothy Grollmes, MPA, MTTS; Nina A. Cooperman PsyD; and Shadi Nahvi, MD, MS. The authors declare they have no conflicts of interest.

Funding

Grant R21DA020489 from the National Institute on Drug Abuse (NIDA) funded this project. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. NIDA had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Author contributions

K.P.R. led the design, data collection, and analyses for this study. J.J., P.C., B.J.G., Y.J., J.M., P.D.F. assisted with data collection and analyses. All authors contributed to writing drafts of the manuscript, and all have approved the final manuscript.