The Protected Addiction: Exploring Staff Beliefs toward Integrating Tobacco Dependence into Substance Abuse Treatment Services

Article excerpt

ABSTRACT

Survey research was used to explore the beliefs of 963 staff members regarding the myths to treating tobacco dependence and the integration of tobacco dependence into substance abuse treatment programs. The staff represented a mixture of residential, outpatient, and prevention-based gender-specific (women only) treatment centers throughout Ohio. The study found the following: a high percentage of staff believed in the conventional myths associated with the treatment of tobacco in chemically dependent persons; current smokers were reluctant to support all substance abuse treatment facilities in becoming tobacco-free, yet did support treating tobacco dependence in their facilities; and former and never smokers supported tobacco-free policies for their and all treatment facilities. Education and support for staff in treating tobacco dependence is recommended.

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Tobacco use among chemically dependent persons is high with prevalence rates estimated at 70-90% compared to 21% in the current adult population in the United States (Batel, Pessione, Maitre, & Reuff, 1995; Centers for Disease Control and Prevention [CDC], 2007; Kalman, Morissete, & George, 2005; Richter, Ahluwalia, Mosier, Nazir, & Ahluwalia, 2002; Sharp, Schwartz, Nigthingale, & Novak, 2003). Despite such a high percentage of tobacco users among chemically dependent persons, substance abuse programs are slow to integrate tobacco dependence into existing treatment services (Fuller et al., 2007; Ziedonis, Guydish, Williams, Steinberg, & Foulds, 2006). This reluctance is often fueled by prevailing myths concerning concurrent treatment of alcohol, tobacco and other drugs as detrimental to treatment outcomes (Gulliver, Kamholz, & Helstrom, 2006). Substance abuse treatment staff are estimated to use tobacco at rates of 30-40% (Bemstein & Stoduto, 1999; Friend & Levy, 2004; Fuller et al., 2007). Staff resistance to the integration of tobacco into existing treatment services may be rooted in myth and dogma as well as in its own tobacco use. Substance abuse treatment facilities must address these underlying issues in order to gain staff support and cooperation for the integration and treatment of tobacco dependence. This study explores staff: (a) beliefs about existing myths around treating tobacco dependence; and (b) beliefs toward integrating tobacco dependence into its substance abuse treatment programs.

LITERATURE REVIEW

Treating Tobacco Dependence: Prevailing Myths

Treatment for tobacco is often ignored or omitted within the standard substance abuse treatment model, which is fueled by several myths designed to discredit the needs for and benefits of addressing this addiction (Fuller et al., 2007; Ziedonis et al., 2006). The prevailing myths commonly discussed include the following: (a) Chemically dependent clients do not want to quit using tobacco (Kalman, 1998; Kodl, Fu, & Joseph, 2006); (b) concurrent treatment will bring detrimental consequences to recovery outcomes (Bowman & Walsh, 2003; Joseph, Willenbring, Nugent, & Nelson, 2004; Kalman, 1998); (c) tobacco is more benign than other substances (Gulliver et al., 2006); and (d) addressing tobacco dependence would be too stressful for the client (Ziedonis et al., 2006). Studies on the treatment of tobacco dependence refute such myths and create stronger evidence for the treatment of tobacco dependence with chemically dependent individuals.

Numerous studies have found that clients receiving substance abuse treatment desire to quit using tobacco and are interested in receiving treatment for their tobacco dependence either during or after substance abuse treatment (Bernstein & Stoduto, 1999; Bobo, Lando, Walker, & McIlvain, 1996; Burling, Burling, & Latini, 2001; Clarke, Stein, McGarry, & Gogineni, 2001; Ellingstad, Sobell, Sobell, Cleland, & Agrawal, 1999; Joseph, Lexau, Willenbring, Nugent, & Nelson, 2004; Zullino, Besson, & Schnyder, 2000). …