Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres...
-
Upload
lester-denis-sharp -
Category
Documents
-
view
216 -
download
0
Transcript of Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres...
![Page 1: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/1.jpg)
Changing organisational systems to address tobacco dependence in drug
and alcohol treatment centres
Billie Bonevski
Cancer Institute NSW
Research Fellow
University of Newcastle, Australia
![Page 2: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/2.jpg)
The team• University of Newcastle: Amanda Wilson, Flora Tzelepis, Chris Paul, Jamie
Bryant, Andrew Searle
• Hunter New England Health: Adrian Dunlop
• National Drug and Alcohol Research Centre (NDARC): Anthony Shakeshaft, Michael Farrell, Richard Mattick
• Cancer Council NSW: Scott Walsberger, Phil Hull, Jon O’Brien
• University of Wollongong: Pete Kelly
• London: John Strang, Ann McNeill
• US: Judith Prochaska
2
![Page 3: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/3.jpg)
Overview
Part 1 – Myth Busting
Part 2 – What is current practice
Part 3 – What can we do
Part 4 – How do we do it
3
![Page 4: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/4.jpg)
Why address smoking amongst drug and alcohol (D&A) treatment clients?
4
![Page 5: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/5.jpg)
Myth No 1:
“Tobacco is not a health priority for this population. Other drugs are more important/deadly/more harmful”
5
![Page 6: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/6.jpg)
Hospital admissions in Canada 6
Single et al, 2000
![Page 7: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/7.jpg)
Annual drug-related deaths in the US 7
Centre for Disease Control, 2008, 2004, 2007
![Page 8: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/8.jpg)
Tobacco-related deaths within Australia compared with other causes
Begg et al., 2007
8
Begg et al, 2007
![Page 9: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/9.jpg)
Drug related deaths in Australia (2004/05)
Begg et al., 2007
9
Collins DJ, Lapsley HM. DoHA; 2008.
![Page 10: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/10.jpg)
Smoking rates in D&A treatment populations
10
![Page 11: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/11.jpg)
Myth No 2:
“Tobacco smoking is a necessary self-medication”
11
![Page 12: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/12.jpg)
Tobacco is part of the problem not the solution
• Perpetuated by the tobacco industry
• Mental illness
• Stress, coping, stabilise mood etc
• Nicotine reward system
12
![Page 13: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/13.jpg)
Nicotine dependence
Physiological addiction Behavioural habit
Triggers the release of dopamine Frequency and immediacy of reinforcement firmly cements a behavioural cluster
Positive affect – brain reward system
1 pack/day = 200/day hand to mouth rituals
De-activation leads to withdrawal (cravings)
Social acceptability increases range and number of triggers
Limited effect on lifestyle
13
![Page 14: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/14.jpg)
Myth No 3:
“Addicts are not interested in quitting smoking”
14
![Page 15: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/15.jpg)
Australian D&A clients are interested to quit
• N = 228 smokers in residential D&A treatment
• 75% had tried quitting in the past
• 67% were ‘seriously thinking about quitting’
Kelly et al, 2012
15
![Page 16: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/16.jpg)
Methadone maintained clients interest in quitting • N = 103 OTP clients in two clinics in Australia
• 84% current smokers
• 56% previous quit attempt
• 38% thinking of quitting ‘next 6 months’
• Would like help with quitting – 36% said Yes and 31% were Unsure
• 80% were heavy nicotine dependence
16
Bowman et al 2011
![Page 17: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/17.jpg)
Myth No 4:
“Drug and alcohol clients are unable to quit smoking”
17
![Page 18: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/18.jpg)
Smoking cessation offered during D&A treatment is effective
18
A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery.Prochaska, Judith; Delucchi, Kevin; Hall, Sharon
Journal of Consulting & Clinical Psychology. 72(6):1144-1156, December 2004.
Significant two-fold increase in the likelihood of smoking abstinence among intervention versus control participants
![Page 19: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/19.jpg)
Myth No 5:
“Addressing smoking compromises other treatment outcomes”
19
![Page 20: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/20.jpg)
Alcohol and illicit drug abstinence following smoking cessation intervention
20
A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery.Prochaska, Judith; Delucchi, Kevin; Hall, Sharon
Journal of Consulting & Clinical Psychology. 72(6):1144-1156, December 2004.
Significant increase of 25% in the likelihood of abstinence from drugs and alcohol among participants receiving a smoking cessation intervention relative to participants in the control condition.
![Page 21: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/21.jpg)
How is smoking currently treated within the drug and alcohol sector?
21
![Page 22: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/22.jpg)
Clinically recommended
• Tobacco dependence is:
‘a chronic disease with remission and relapse’
“Nicotine dependence warrants medical treatment as does any drug dependence disorder or chronic disease”
Fiore et al, U.S. Dept of Health and Human Services, June 2000
22
![Page 23: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/23.jpg)
23
![Page 24: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/24.jpg)
Is smoking cessation care provided to D&A treatment clients?
• National survey of D&A agencies (n =260 agencies: 213 managers and/or 204 other staff)
– 23-25% said they had a written smoke-free policy
– 80-83% indicated delivery of smoking support was left to the discretion of individual staff - ie, not routinely and systematically provided
24
Walsh et al, 2006
![Page 25: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/25.jpg)
D&A treatment centres smoking cessation care practices
Statement % of clients receiving
Smoking status recorded 65
Recommendation to quit 36
Counselling on behavioural methods 26
Attempt to negotiate quit date 17
Recommendation to use NRT 20
Referral to stop smoking group 16
Follow-up discussion 27
Bonevski et al., 2012, under review
25
Walsh et al, 2006
![Page 26: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/26.jpg)
Barriers to the provision of smoking cessation care in D&A setting• Staff smoking status1
• Lack of training1,2,3
• Resistance to smoke-free policies1,3
• Limited resources, eg, cost of NRT1
• Lack of coordinated staff approach (no system!)2
• Lack of staff time2
• Lack of confidence2,3
• Pessimism regarding effectiveness of smoking cessation interventions2
• Misperceptions – eg, “tobacco is not a real drug”, “its too difficult to address tobacco and other dependencies”, “clients don’t want to quit”1,2,3
26
1 Zeidonis, Guydish, 2006; 2 Walsh, Bowman et al 2005; 3 Baca et al, 2008
![Page 27: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/27.jpg)
Attitudes of managers and staff toward smoking interventions (strongly agree/agree) Walsh et al 2006
27
%
Provision of smoking cessation interventions should be an integral function of this agency
65
Smoking clients of this agency should receive smoking cessation interventions tailored to their readiness to quit
86
Smoking cessation counselling is as important as counselling about other drugs for clients of this agency
53
Increasing restrictions on smoking and greater provision ofsmoking interventions would have very little impact on client attendance at this agency
47
Most drug and alcohol clients who smoke are not interested in doing anything about their smoking
64
Clients of this agency usually have enough other problems without worrying about smoking
58
Occasionally it is useful for staff to smoke with a client in an effort to build rapport/trust
15
![Page 28: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/28.jpg)
What can we do - Menu of support
Brief Advice 5As (ASK, ADVISE, ASSESS, ASSIST, ARRANGE)
Motivational Interviewing
Behavioural Counselling
Pharmacotherapy (NRT gum, patches, inhaler, lozenges), buproprion
Quitline
Follow-up
Referral to other stop smoking services
28
Heavily addicted!! Best to throw everything at them!
![Page 29: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/29.jpg)
How to integrate this into usual care provision in drug and alcohol services?
29
![Page 30: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/30.jpg)
What is a systems based strategy?
Six Core Components
1.Implement a system of identifying and recording smoking status
2.Equip staff with education, resources and feedback
3.Dedicate staff to tobacco dependence treatment
4.Organisational policies
5.Provide tobacco dependence treatments as part of service (pharmaco and behavioural)
6.Defined duties of care
30
(Fiore et al, Zeidonis et al)
![Page 31: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/31.jpg)
How technology can be used
• Touchscreen computers– Highly acceptable to clients– Accurate
– Assesses smoking status, nicotine
dependence, quit attempts– Print-out for client files– Education for staff and clients– Ongoing monitoring and improvement
31
Shakeshaft et al, 1999, Bonevski et al, 2010, Bryant et al 2012
![Page 32: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/32.jpg)
Advantages of a systems based strategy
• Integration of smoking cessation support provision in routine care
• Aim to build capacity of the organisation to address smoking
• De-normalisation of smoking within the setting• Based on systems - sustainable model in the
long term
32
![Page 33: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/33.jpg)
Is it effective at reducing smoking?
• Pilot studies have found
– Improves staff attitudes score regarding smoking
– Increases distribution of NRT
– Increases provision of behavioural cessation support
• The potential is evident
• Well designed trials needed
33
Guydish, 2010, 2012; Zeidonis 2007
![Page 34: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/34.jpg)
Trial of system change intervention in drug and alcohol setting (NHMRC:2013-16)
34
30 Drug & Alcohol Treatment Centres in
QLD, NSW & Vic randomised to:
15 Drug & Alcohol centres in intervention group:•Touchscreen survey and print out•Staff training•Organisational policies•NRT•Follow-up
15 Drug & Alcohol centres in control group: usual care
Outcomes at 6 months:•Cessation•Quit attempts•Smoking care provision
![Page 35: Changing organisational systems to address tobacco dependence in drug and alcohol treatment centres Billie Bonevski Cancer Institute NSW Research Fellow.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649d985503460f94a827bf/html5/thumbnails/35.jpg)
CRICOS Provider 00109J | www.newcastle.edu.au
THANK YOU
Funding:•Cancer Council NSW•Cancer Institute NSW•NHMRC•University of Newcastle•HMRI
Contact me on:[email protected] ph: 02 40335710
35