Organizational Change and Nicotine Dependence Treatment

尼古丁依赖仍然是老年人发病和死亡的唯一最可预防的原因。 美国。接受药物滥用治疗的人吸烟率是吸烟率的3-4倍，工作人员在公共场合 受资助的项目吸烟率是普通人群的两倍。尽管疾病和疾病的负担 尼古丁成瘾的相关经济成本在药物治疗人群中上升，治疗 节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，在尼古丁依赖干预中，几乎没有可用的模型来指导他们。这项研究将 测试通过组织变革手动解决烟草问题(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。在多个 基线设计，每个方案作为自己的对照，三个住宅处理方案将 参与旨在支持组织改变尼古丁政策的6个月干预措施，员工- 尼古丁知识、态度、做法的水平变化，以及接触和接触尼古丁的客户水平变化 尼古丁依赖治疗的利用。在每个测量点(干预前、干预后、 和后续)，一个由50名机构工作人员组成的纵向样本将完成与尼古丁相关的调查 知识、态度和实践，以及50家机构客户的横截面样本将参与 关于他们接受的尼古丁相关服务的电话调查。这项工作将重点转移到 从个人层面到组织层面的尼古丁依赖干预，并测试了 旨在解决尼古丁依赖的组织变革干预的有效性。这个 调查团队将UMDNJ干预开发团队的优势与加州大学旧金山分校的优势结合起来 组织变革研究团队，在干预和研究程序都有的背景下 已经试行过了。这项研究将在NIDA CTN平台上进行，国家参与 公认的、有研究经验的治疗诊所。短期目标是测试 ATTOC干预治疗中吸毒者对尼古丁的依赖。《长河》 学期目标是开发和传播可广泛应用的组织变革技术， 除尼古丁依赖外，支持采用循证做法的方案。

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.