Pre-implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California

Abstract

Background

Across the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs.

Methods

We conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts.

Findings

Themes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors’ strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services.

Conclusion

To support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.

Keywords:

• Policy implementation
• Substance use treatment
• Health disparities
• smoking cessation

Declaration of interest

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that there are no known potential competing interests.

Data availability statement

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. We confirm we had full access to all of the data in this study and we take responsibility for the integrity of the data and the accuracy of the data analysis.

Additional information

Funding

This work was supported by the California Tobacco Control Program (18-10025), by the California Tobacco Related Disease Research Program (TRDRP 27IR-0040, 28CP-0038), and by the National Institute on Drug Abuse, Award Number T32DA007250. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The abovementioned funding sources played no role in the design of the study, data collection, analysis, and interpretation of data; and they did not play a role in writing the manuscript.