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药物滥用状况的个体中，吸烟的患病率非常高，在70%-95%之间（Burling & Ziff, 1988； Fiore等，2000；Kozlowski等，1986；McCarthy等，2002）。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，低收入人群不仅更有可能吸烟，而且戒烟资源可能不如高收入人群那么容易获得（Novotny & Giovino, 1998； MMRW， 2007年11月9日；Barbeau等人，2004；Honjo等人，2006）。因此，药物滥用治疗是一个以证据为基础的吸烟治疗（ebt）可能最有机会惠及低收入吸烟者的环境。同时治疗患者吸烟和其他药物是很重要的，因为研究表明，尼古丁成瘾可能会引起大脑化学和结构的变化，从而引发对药物和酒精的渴望，减少长期清醒的机会（Britt & McGehee, 2008; Yeh et al., 2007）。拟议的项目追求与了解在药物滥用治疗环境中采用、实施和可持续性（或相反地停止）电子烟治疗相关的两个目标。第一个目的是纵向检查那些寻求同时发生的药物滥用治疗的吸烟者的电子烟瘾治疗的可获得性，并探索治疗方案中服务可获得性随时间变化的预测因素。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。第二个目标也使用纵向设计来检查基于证据的临床实践行为，辅导员参与与客户。这一点很重要，因为实施ebt的是个人，而不是组织或治疗方案（Fixsen et al., 1995）。综合实施科学、公共卫生、组织变革、药物滥用治疗和卫生服务提供的理论和研究，研究了四类调节变量，以了解咨询师为什么和在什么条件下可能让客户参与戒烟努力。

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.