Smoking Cessation Interventions and Program Availability for Drug and Alcohol Add

说明(由申请人提供)：在寻求治疗同时发生的药物滥用情况的个人中，吸烟率非常高，在70%-95%之间(Burling&Ziff，1988；Fiore等人，2000；Kozlowski等人，1986；McCarthy等人，2002)。然而，许多药物治疗机构并不鼓励在治疗期间戒烟，尽管患者经常表现出戒烟的兴趣。研究发现，不仅低收入者更有可能吸烟，而且戒烟资源可能不像高收入者那样容易获得(Novotny&Giovino，1998；MMRW，2007年11月9日；Barbeau等人，2004；Honjo等人，2006)。因此，物质滥用治疗是一种基于证据的吸烟治疗(EBTS)可能最有可能接触到低收入吸烟者的背景。与其他药物同时治疗吸烟患者很重要，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，从而可能引发对毒品和酒精的渴望，从而减少长期戒酒的机会(Britt&McGehee，2008年；Yeh等人，2007年)。拟议的项目追求两个目标，即在药物滥用治疗的情况下，了解用于吸烟的EBTS的采纳、实施和可持续性(或相反，停止使用)。第一个目标是纵向检查那些寻求治疗共生物质滥用的人中吸烟的EBTS的可用性，并探索治疗计划中服务可用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为低收入客户提供服务的百分比、组织和政策因素以及劳动力特征。第二个目标还使用纵向设计来检查咨询师与客户进行的循证临床实践行为。这一点很重要，因为实施EBTS的是个人，而不是组织或治疗方案(Fixsen等人，1995年)。结合实施科学、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，考察了四类调节变量，以了解为什么以及在什么条件下，咨询师可能会让来访者与来访者进行戒烟努力。 与公共健康相关：吸烟与健康相关的风险使其成为一个主要的公共卫生问题，特别是考虑到最近的研究表明，尼古丁的成瘾特性类似于鸦片类药物。由于社会经济地位和种族/族裔的原因，吸烟行为和吸烟治疗在健康方面也存在差异。许多低收入者也得不到高质量的医疗服务(沃内克等人，2008年)，在药物滥用治疗方面人数过多。通过在药物滥用治疗的背景下重点关注吸烟循证治疗的可用性、实施和可持续性，拟议的应用具有明显的公共卫生(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.