Smoking Cessation Services in Adolescent Substance Abuse Treatment: Opportunities Missed?
Knudsen, Hannah K., Journal of Drug Issues
The majority of adolescents receiving substance abuse treatment also use tobacco, yet there are few data regarding the adoption of tobacco use assessment and smoking cessation services by adolescent treatment programs. Using data from a national sample of adolescent-only treatment programs (n = 154), this research measures the adoption of aspects of assessment and treatment from the Public Health Service's (2000) guideline, Treating Tobacco Use and Dependence. When adoption of four intake/assessment practices was measured, adoption appeared high, but only 45% of programs had adopted all four practices. About 43% of programs offered some type of smoking cessation services. However, there was no association between adoption of intake procedures and the odds of availability of smoking cessation services, suggesting a lack of connection between the identification of treatment needs and the availability of services. The lack of smoking cessation services may represent a missed opportunity for early intervention with this population.
While there is growing interest in the treatment of nicotine dependence as part of addiction treatment (Reid et al., 2007), little attention has been focused directly on the needs of adolescents with substance abuse disorders (SUDs) despite indications that tobacco use is a significant health issue for this population. As in adults (Kaiman et al., 2001; Richter, Ahluwalia, Mosier, Nazier, & Ahluwalia, 2002; Williams & Ziedonis, 2004), the rate of smoking among adolescents with SUDs is far greater than among those without such disorders (Bowman & Walsh, 2003; Myers, 1999; Myers, Doran, & Brown, 2007). For example, about 61% of adolescents receiving substance abuse treatment report smoking more than 1 0 cigarettes per day (Myers & Brown, 1 994); only about 6% of twelfth graders report this level of daily consumption (Johnston, O'Malley, Bachman, & Schulenberg, 2007). In a study of adolescents receiving substance abuse treatment, a majority had attempted to quit using tobacco in the previous year (Myers & MacPherson, 2004), suggesting that they may have considerable interest in smoking cessation. Despite the public health significance of reducing smoking among adolescents with SUDs, there is currently little research on the availability of smoking cessation services within adolescent treatment programs (Chun, Guydish, & Chan, 2007; Myers & Kelly, 2006).
CLINICAL PRACTICE GUIDELINES FOR SMOKING CESSATION
In 2000, the US Public Health Service (PHS) released a clinical practice guideline consisting of several key elements for identifying and treating tobacco users (The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives , 2000). A revised version of the guideline was released in 2008 after the completion of data collection, so the present study focuses on the 2000 PHS guideline. The 2000 PHS guideline recommended asking all patients about their tobacco use and advising users to stop using tobacco products (Fiore et al., 2000). It indicated that clinicians should assess whether the patient wanted to attempt to quit and use brief interventions to increase motivation in those unwilling to make a quit attempt. For those willing to make a quit attempt, services should be arranged, including formal psycho-social counseling and pharmacotherapies. These recommendations have been retained in the 2008 update. Medications approved by the Food and Drug Administration (FDA) at the time of the 2000 PHS guideline included nicotine replacement therapy (NRT) and sustained-release bupropion hydrochloride (e.g., Zyban®), which is an atypical antidepressant. Varenicline (e.g., Chantix®) became available after the publication of the 2000 PHS guideline, and is now recommended for treating adult tobacco users in the updated guideline (Fiore et al., 2008). For adults, the combination of counseling with medication improves the odds of successful cessation (Fiore et al. …