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Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program.
J Subst Abuse Treat. 2019 12; 107:44-49.JS

Abstract

BACKGROUND

Recent estimates are that 30% of military veterans use tobacco or recreational nicotine products, and rates significantly increase for veterans with co-occurring substance use disorder (SUD). Despite emerging literature that indicate better outcomes when SUD and tobacco use disorder (TUD) are treated simultaneously (in parallel), most SUD programs fail to address tobacco use. This can prove catastrophic, as perhaps the most likely cause of death lifetime for patients admitted to a SUD treatment program is tobacco/nicotine-related. Studies suggest that residential SUD treatment programs can improve the screening, diagnosis, documentation, and treatment of TUD. Perceived barriers among staff include fear of causing patients to leave early. There are few studies evaluating the accuracy of these perceived barriers to programmatic and patient-level outcomes in the residential SUD treatment setting when TUD services are provided along with a nicotine/tobacco-free therapeutic milieu.

OBJECTIVE

In the fall of 2015, a SUD treatment program at a large midwestern Veteran. Affairs Medical Center fully implemented a tobacco-free residential unit. The current study investigates the programmatic and patient-level outcomes among cohorts treated before versus after the tobacco-free policy was implemented.

PARTICIPANTS & PROCEDURES

This study utilized archival data and all participants were enrolled in the residential program with 117 veterans enrolled pre and 92 post tobacco-free policy. The final sample consisted of 194 males (92.8%), 14 females (6.7%), and 1 transgendered (0.5%) with a mean age of 47.80 (SD = 12.65). Most of the participants were Caucasian (69.4%) and divorced (43.1%). The majority (167, 79.9%) reported current tobacco use, with cigarettes (118, 56.5%) being the most frequently reported type. In addition, 17.59 (SD = 6.51) years old is the average start age of tobacco use.

RESULTS

Veterans in the pre-policy cohort did not differ from post-policy cohort on age, gender, ethnicity, and marital status. Preliminary results related to programmatic outcomes indicate improved rates of TUD diagnosis during intake (28.4% to 75.0%). Similar rates were observed in veterans who reported tobacco quit goal during treatment planning (37.4% to 56.8%). However, while there were no significant differences in the total rates of infractions; tobacco-related infractions significantly increased from one to eight. Finally, there were no significant differences in the number of against medical advice discharges or irregular discharges. Examination of patient-level outcomes revealed similar rates of veterans enrolling in the program as it relates to rates of current tobacco use, admission expired breath carbon monoxide (CO) measured in parts per million (ppm), longest period of tobacco abstinence, and self-reported primary preferred substance/drug. Of note, there were also no differences in reported importance and confidence of quitting tobacco. Rates of veterans prescribed nicotine replacement therapy during residential stay more than doubled.

CONCLUSIONS

Our data suggest that implementing a tobacco-free policy within a residential SUD treatment program would not deter veterans from staying engaged in the program as evident by similar rates of irregular and AMA discharges. In addition, the prevalence of Veterans wishing to quit tobacco was higher in the post-policy cohort, as was NRT utilization, and without the addition of staff. Specific treatment recommendations will be discussed along with other implications.

Authors+Show Affiliations

Veterans Affairs Medical Center, Cincinnati, OH, United States of America. Electronic address: Octaviana.HemmyAsamsama@va.gov.Veterans Affairs Medical Center, Dayton/Middletown, OH, United States of America; Center for Interventions, Treatment, and Addictions Research, Departments of Psychiatry & Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States of America.University of Virginia, Charlottesville, VA, United States of America.Veterans Affairs Medical Center, Indianapolis/Ft. Wayne, IN, United States of America.Veterans Affairs Medical Center, Cincinnati, OH, United States of America.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

31757264

Citation

Hemmy Asamsama, Octaviana, et al. "Impact of Implementing a Tobacco and Recreational Nicotine-free Policy and Enhanced Treatments On Programmatic and Patient-level Outcomes Within a Residential Substance Use Disorder Treatment Program." Journal of Substance Abuse Treatment, vol. 107, 2019, pp. 44-49.
Hemmy Asamsama O, Miller SC, Silvestri MM, et al. Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program. J Subst Abuse Treat. 2019;107:44-49.
Hemmy Asamsama, O., Miller, S. C., Silvestri, M. M., Bonanno, C., & Krondilou, K. (2019). Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program. Journal of Substance Abuse Treatment, 107, 44-49. https://doi.org/10.1016/j.jsat.2019.09.004
Hemmy Asamsama O, et al. Impact of Implementing a Tobacco and Recreational Nicotine-free Policy and Enhanced Treatments On Programmatic and Patient-level Outcomes Within a Residential Substance Use Disorder Treatment Program. J Subst Abuse Treat. 2019;107:44-49. PubMed PMID: 31757264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program. AU - Hemmy Asamsama,Octaviana, AU - Miller,Shannon C, AU - Silvestri,Mark M, AU - Bonanno,Christina, AU - Krondilou,Kostendena, Y1 - 2019/10/05/ PY - 2019/04/29/received PY - 2019/08/18/revised PY - 2019/09/09/accepted PY - 2019/11/24/entrez PY - 2019/11/24/pubmed PY - 2020/9/1/medline KW - Residential substance use KW - Tobacco free KW - Veterans SP - 44 EP - 49 JF - Journal of substance abuse treatment JO - J Subst Abuse Treat VL - 107 N2 - BACKGROUND: Recent estimates are that 30% of military veterans use tobacco or recreational nicotine products, and rates significantly increase for veterans with co-occurring substance use disorder (SUD). Despite emerging literature that indicate better outcomes when SUD and tobacco use disorder (TUD) are treated simultaneously (in parallel), most SUD programs fail to address tobacco use. This can prove catastrophic, as perhaps the most likely cause of death lifetime for patients admitted to a SUD treatment program is tobacco/nicotine-related. Studies suggest that residential SUD treatment programs can improve the screening, diagnosis, documentation, and treatment of TUD. Perceived barriers among staff include fear of causing patients to leave early. There are few studies evaluating the accuracy of these perceived barriers to programmatic and patient-level outcomes in the residential SUD treatment setting when TUD services are provided along with a nicotine/tobacco-free therapeutic milieu. OBJECTIVE: In the fall of 2015, a SUD treatment program at a large midwestern Veteran. Affairs Medical Center fully implemented a tobacco-free residential unit. The current study investigates the programmatic and patient-level outcomes among cohorts treated before versus after the tobacco-free policy was implemented. PARTICIPANTS & PROCEDURES: This study utilized archival data and all participants were enrolled in the residential program with 117 veterans enrolled pre and 92 post tobacco-free policy. The final sample consisted of 194 males (92.8%), 14 females (6.7%), and 1 transgendered (0.5%) with a mean age of 47.80 (SD = 12.65). Most of the participants were Caucasian (69.4%) and divorced (43.1%). The majority (167, 79.9%) reported current tobacco use, with cigarettes (118, 56.5%) being the most frequently reported type. In addition, 17.59 (SD = 6.51) years old is the average start age of tobacco use. RESULTS: Veterans in the pre-policy cohort did not differ from post-policy cohort on age, gender, ethnicity, and marital status. Preliminary results related to programmatic outcomes indicate improved rates of TUD diagnosis during intake (28.4% to 75.0%). Similar rates were observed in veterans who reported tobacco quit goal during treatment planning (37.4% to 56.8%). However, while there were no significant differences in the total rates of infractions; tobacco-related infractions significantly increased from one to eight. Finally, there were no significant differences in the number of against medical advice discharges or irregular discharges. Examination of patient-level outcomes revealed similar rates of veterans enrolling in the program as it relates to rates of current tobacco use, admission expired breath carbon monoxide (CO) measured in parts per million (ppm), longest period of tobacco abstinence, and self-reported primary preferred substance/drug. Of note, there were also no differences in reported importance and confidence of quitting tobacco. Rates of veterans prescribed nicotine replacement therapy during residential stay more than doubled. CONCLUSIONS: Our data suggest that implementing a tobacco-free policy within a residential SUD treatment program would not deter veterans from staying engaged in the program as evident by similar rates of irregular and AMA discharges. In addition, the prevalence of Veterans wishing to quit tobacco was higher in the post-policy cohort, as was NRT utilization, and without the addition of staff. Specific treatment recommendations will be discussed along with other implications. SN - 1873-6483 UR - https://www.unboundmedicine.com/medline/citation/31757264/Impact_of_implementing_a_tobacco_and_recreational_nicotine_free_policy_and_enhanced_treatments_on_programmatic_and_patient_level_outcomes_within_a_residential_substance_use_disorder_treatment_program_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0740-5472(19)30258-2 DB - PRIME DP - Unbound Medicine ER -