Organizational Change and Nicotine Dependence Treatment

尼古丁依赖仍然是世界上最可预防的发病和死亡原因。 美国的接受药物滥用治疗的人吸烟率是其他人的3-4倍，工作人员在公共场所吸烟率是其他人的3-4倍。 受资助项目的吸烟率是普通人群的两倍。虽然疾病的负担和 尼古丁成瘾的相关经济成本在药物治疗人群中升高， 项目很少解决尼古丁成瘾的问题。虽然治疗方案越来越认识到这一点， 矛盾的是，几乎没有模型可以指导他们进行尼古丁依赖干预。本研究将 测试通过组织变革解决烟草问题手册（ATTOC）的有效性 促进药物滥用和尼古丁依赖治疗相结合的干预措施。在多 基线设计与每个程序作为自己的控制，三个住宅处理方案将 参与为期6个月的干预，旨在支持尼古丁政策的组织变革，工作人员- 尼古丁知识、态度、实践水平的变化，以及暴露于 尼古丁依赖治疗。在每个测量点（干预前，干预后， 和后续行动），50名机构工作人员的纵向样本将完成有关尼古丁相关的调查， 知识，态度和做法，以及50个机构客户的横截面样本将参加 电话调查他们接受过的尼古丁相关服务。这项工作的重点转移到 尼古丁依赖干预从个人层面到组织层面，并测试 旨在解决尼古丁依赖的组织变革干预的有效性。的 调查小组将UMDNJ干预开发团队的优势与UCSF的优势结合起来 组织变革研究小组，在一个背景下，干预和研究程序 已被试点。该研究将在NIDA CTN平台上进行， 公认的和研究经验丰富的治疗诊所。短期目标是测试 ATTOC干预解决正在接受治疗的吸毒者的尼古丁依赖问题。长 长期目标是开发和传播可以广泛应用的组织变革技术， 超越尼古丁依赖，支持采用循证实践的计划。

Nicotine dependence continues to be the single most preventable cause of morbidity and mortality in the United States. Persons entering drug abuse treatment smoke at 3-4 times the rate, and staff in publicly funded programs smoke at twice the rate, of the general population. Although the burden of illness and associated economic costs of nicotine addiction are elevated in the drug treatment population, treatment programs rarely address comorbid nicotine addiction. While treatment programs increasingly recognize this paradox, there are few models available to guide them in nicotine dependence intervention. This study will test the effectiveness of the manualized Addressing Tobacco through Organizational Change (ATTOC) intervention in facilitating the integration of drug abuse and nicotine dependence treatments. In a multiple baseline design with each program acting as its own control, three residential treatment programs will participate in a 6 month intervention designed to support organizational changes in nicotine policies, staff - level changes in nicotine knowledge, attitudes, practices, and client-level changes in exposure to and utilization of nicotine dependence treatment. At each measurement point (pre-intervention, post-intervention, and follow-up), a longitudinal sample of 50 agency staff will complete surveys concerning nicotine-related knowledge, attitudes and practices, and a cross-sectional sample of 50 agency clients will participate in phone surveys concerning nicotine-related services they have received. This work shifts the focus of nicotine dependence intervention from the person level to the organizational level, and tests the effectiveness of an organizational change intervention designed to address nicotine dependence. The investigative team unites the strengths of the UMDNJ intervention development team with those of the UCSF organizational change study team, in a context where both the intervention and the research procedures have been piloted. The study will be conducted on the NIDA CTN platform with the participation of nationally recognized and research-experienced treatment clinics. The short term goal is to test the effectiveness of the ATTOC intervention in addressing nicotine dependence among drug using persons in treatment. The long term goal,is to develop and disseminate organizational change technologies that can be applied broadly, beyond nicotine dependence, to support programs in adopting evidence based practices.