Smoking Cessation Interventions and Program Availability for Drug and Alcohol Add

描述（由申请人提供）：在寻求治疗同时发生的物质滥用状况的个体中，吸烟的流行率非常高，在70%-95%之间（Burling & Ziff，1988; Fiore等人，2000; Kozlowski等人，1986; McCarthy等人，2002年）。然而，许多药物治疗机构不鼓励在治疗期间戒烟，即使患者经常表现出戒烟的兴趣。研究发现，不仅低收入人群更有可能吸烟，而且戒烟的资源可能不如高收入人群容易获得（Novotny & Giovino，1998; MMRW，2007年11月9日; Barbeau等人，2004; Honjo等人，2006年）。因此，物质滥用治疗是一个环境，其中吸烟的循证治疗（EBT）可能有最好的机会达到低收入吸烟者。与其他药物同时治疗患者吸烟是重要的，因为研究表明尼古丁成瘾可能导致脑化学和结构的变化，这可能引发药物和酒精渴望，降低长期清醒的机会（布里特&麦基希，2008; Yeh等人，2007年）。拟议的项目追求两个目标，了解通过，实施和可持续性（或相反地停止）的EBT吸烟药物滥用治疗的情况。第一个目标是纵向检查EBT的可用性，为那些寻求治疗的共同发生的药物滥用，并探讨了服务的可用性随着时间的推移，在治疗方案的变化的预测。预测因素的关键类别包括治疗中心服务的低收入客户的百分比，组织和政策因素以及劳动力特征。第二个目的也使用纵向设计，以检验基于证据的临床实践行为，咨询师从事与客户。这是重要的，因为个人实施EBT而不是组织或治疗计划（Fixsen等人，1995年）。从实施科学，公共卫生，组织变革，药物滥用治疗和卫生服务提供四个类别的调节变量的整合理论和研究进行了检查，以了解为什么和在什么条件下，辅导员有可能从事客户与客户的戒烟努力。 公共卫生相关性：吸烟与健康有关的风险使其成为一个重大的公共卫生问题，特别是鉴于最近的研究表明，尼古丁的成瘾特性与阿片类药物相似。在吸烟行为和吸烟治疗方面也存在健康差异，这是社会经济地位和种族/民族的函数。许多低收入人群也无法获得高质量的医疗服务（Warnecke等人，2008年），并在药物滥用治疗环境中过度代表。通过关注物质滥用治疗背景下吸烟循证治疗的可用性、实施和可持续性，拟议的申请具有明确的公共卫生（包括公共卫生政策）相关性。

DESCRIPTION (provided by applicant): The prevalence of smoking among individuals seeking treatment for a co-occurring substance abuse condition is very high, between 70%-95% (Burling & Ziff, 1988; Fiore et al., 2000; Kozlowski et al., 1986; McCarthy et al., 2002). However, many drug treatment facilities do not encourage smoking cessation during treatment, even though patients are often show interest in quitting smoking. Research finds that not only are low income people more likely to smoke, but the resources for smoking cessation may not be as accessible as those who have higher income (Novotny & Giovino, 1998; MMRW, November 9, 2007; Barbeau et al., 2004; Honjo et al., 2006). Therefore, substance abuse treatment is a context where evidence-based treatments (EBTs) for smoking might have the best chance of reaching low-income smokers. Treating patient smoking concurrent with other drugs is important since research demonstrates that addiction to nicotine may cause changes in brain chemistry and structure which could trigger drug and alcohol cravings, decreasing the chance of prolonged sobriety (Britt & McGehee, 2008; Yeh et al., 2007). The proposed project pursues two objectives related to understanding the adoption, implementation, and sustainability (or conversely discontinuation) of EBTs for smoking in substance abuse treatment contexts. The first aim examines longitudinally the availability of EBTs for smoking among those seeking treatment for co-occurring substance abuse and explores the predictors of changes in service availability over time in treatment programs. Key categories of predictors include the percentage of low-income clients served by the treatment center, organizational and policy factors, and workforce characteristics. The second aim also uses a longitudinal design to examine the evidence-based clinical practice behaviors that counselors engage in with clients. This is important because individuals implement EBTs not organizations or treatment programs (Fixsen et al., 1995). Integrating theory and research from implementation science, public health, organizational change, substance abuse treatment, and health services delivery four categories of moderator variables are examined to understand why and under what conditions counselors are likely to engage clients in smoking cessation efforts with clients. PUBLIC HEALTH RELEVANCE: The health-related risks of smoking make it a major public health concern, particularly in light of recent research suggesting that the addictive properties of nicotine are similar to that of opiates. There are also health disparities in both smoking behavior and smoking treatment as a function of socio-economic status and race/ethnicity. Many low-income people also lack access to high quality medical care (Warnecke et al., 2008) and are over-represented in substance abuse treatment contexts. By focusing on the availability, implementation, and sustainability of evidence-based treatments for smoking in the context of substance abuse treatment the proposed application has clear public health (including public health policy) relevance.