Addressing Tobacco through Organizational Change

Professor in Residence

Tobacco 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 tests 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 participate in a 6 month intervention designed to support organizational changes in tobacco policies, staff -level changes in smoking knowledge, attitudes and practices, and client-level changes in exposure to and utilization of tobacco dependence services. At each measurement point (pre-intervention, post-intervention, and follow-up), a longitudinal sample of 50 agency staff and a cross-sectional sample of 50 agency clients complete surveys concerning tobacco-related knowledge, attitudes and practices they use (staff) or services they receive (clients). This work shifts the focus of tobacco dependence intervention from the individual level to the organizational level, and tests the effectiveness of an organizational change intervention. 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.