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Tobacco-Free Policies May Reduce Completion Rates at Substance Abuse Treatment Centers

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Instituting tobacco-free policies at substance abuse treatment centers may discourage participants from completing the program, a study of an Ohio program for women suggests. The study found that when such a policy was implemented, both smokers and nonsmokers were more likely to stop treatment early.

Science Daily reports that the researchers said this drop in treatment completion does not mean treatment centers shouldn’t try implementing tobacco-free policies. But their findings show how difficult it can be to introduce a new policy.

“Even a well-planned and evidence-informed programming change to tobacco-free programming has the potential for significant impact on the treatment climate and negative treatment outcome,” they wrote in the Journal of Social Work Practice in the Addictions.

The study found that after the center’s implementation of a tobacco-free policy, the number of women who completed a program at the center dropped 28 percent, from 70 percent in the 18 months before the ban, to 42 percent within the first three months after the ban took effect.

While 20 percent of smokers and 7 percent of nonsmokers checked out of the center early when smoking was allowed, early checkouts increased to 42 percent of smokers and 22 percent of nonsmokers after the ban was implemented.

Thomas Gregoire, co-author of the study and Associate Professor of Social Work at Ohio State University, said that many treatment facilities allow patients to smoke because officials feel that trying to get someone to stop smoking, in addition to treating their other substance abuse issues, would be too complicated and would be likely to fail. Some centers may also fear that banning smoking would be bad for business, he said. However he added that past research has shown that treating patients for tobacco addiction along with other substance abuse issues is most likely best for patients.

7 Responses to this article

  1. Avatar of RA
    RA / May 10, 2011 at 12:39 pm

    In creating a TF policy for a treatment center it would be much better if the treatment center in addition could provide no cost or low cost tobacco treatment. Maybe the dropout rate would not be so high. In NYS this works.

  2. Avatar of Jesper Kristensen
    Jesper Kristensen / May 9, 2011 at 2:10 pm

    …and why not treat obesity, bad eating habits, biting your nails and everything else?

    Or maybe the high-brow apostles of clean, wholesome living should, just for once, try to focus on the most important issues facing the “inmates”?

    Besides, as one other poster said, there’s this new, wonderful thing called the electronic cigarette. It works.

  3. Avatar of Jim Sharp
    Jim Sharp / May 6, 2011 at 8:15 pm

    This was not our experience in New York State. While there were initial increases in the number of people dropping out, as staff became better at addressing the resistances to nicotine cessation as well as better at treating nicotine withdrawal and cravings with both counseling and medication, within 6 months completion rates had returned to their prior rates. One program (the Van Dyke Addiction Treatment Center) revamped their program to be “person-centered” and achieved record completion rates of 85 to 90% despite having a zero tolerance for violations of its tobacco-free policy (see Sharp, Schwartz, Nightingale & Novak (2003), Targeting nicotine addiction in a substance abuse program, Science & Practice Perspectives, Vol 2, No. 1)

  4. Avatar of Dee
    Dee / May 6, 2011 at 4:46 pm

    As Steve notes, it seems there must be other considerations not apparently addressed in the study. Join Together did not provide the specific numbers – rather than only percentages – so that a small study of some 200 post-policy-change women might seem to take on greater weight.
    The study documents available without charge offer almost no information whatsoever to indicate the reason(s) for the increased non-completion rate, saying only, “General climate and the sense of dissatisfaction in the treatment agency at the time of the initial implementation could pose as a possible explanation for the higher rate of staff-initiated discharges,”
    What (else) was happening at the time of initial implementation to cause the “climate and the sense of dissatisfaction”? What was the specific policy implemented, and were any additional program changes initiated to address the foreseeable effects of the new policy?
    What is the value of this study, when it is impossible for readers to assess whether there might be any “causality” at all, rather than mere coincidence, between the nonsmoking policy and the change in completion rates?
    Who funded this unhelpful study?

  5. maxwood / May 6, 2011 at 2:53 pm

    “Treating patients for tobacco addiction along with other substance abuse issues is most likely best for patients.” That need not require a total ban– compared with what is being spent to provide the other services, the cost of an e-cigarette (and cartridges) is not great. Where are researchers exploring this option?

  6. Avatar of Steve
    Steve / May 6, 2011 at 1:51 pm

    It is interesting that both smokers and non-smokers had increases in early check out. I wonder if the study took into consideration the staff who were smokers that had to change behavior when this policy was implimented. I work in a medical detox that has been tobbaco free since 2000. Looking at the stats prior to the implementation of our non smoking policy and after it’s implementation show no significant difference. The yearly average is usually around 33% of all patients leaving prior to completion. Most of our patients are indigent and are smokers.

  7. Avatar of Dick Dillon
    Dick Dillon / May 6, 2011 at 1:44 pm

    Most definitely treating smoking addiction along with other drug addictions is the best for the patient overall, but the work that has to go into this co-treatment runs into the brick wall of policies designed to reduce funding, lengths of stay and other benefits that is so prevalent today. The addictions treatment field has been under consistent pressures to lower costs and shorten treatment episodes since managed care came on the scene in the 1980s; now programs are being asked to address additional issues, like smoking, while these reduction forces continue. There comes a point in time when you just can’t complete open heart surgery in 20 minutes (to use a medical analogy). We may have reached that point.

    No sensible person would suggest that smoking cessation is not a good and desirable health practice, but every system has it’s limitations. Perhaps if the funders (both government and private) acknowledged the additional challenge of dealing with smoking AND alcoholism (as one example) by increasing unit payments and/or lengths of stay, a viable solution could be reached. If not, well maybe its time to admit we are asking too much.

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