title: Addressing Tobacco Through Organizational Change (ATTOC) in residential addiction treatment settings.
abstract: BACKGROUND
  Smoking prevalence among persons in addiction treatment is 3-4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence.
  
  
  METHODS
  The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked.
  
  
  RESULTS
  From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163)=7.15, p=0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123)=3.66, p=0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235)=10.58, p=0.0013) and clients received more tobacco-related services from their program (F(1, 235)=92.86, p<0.0001) and from their counselors (F(1, 235)=61.59, p<0.0001). Most changes remained at follow-up.
  
  
  CONCLUSIONS
  The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.
authors: University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94118, United States. Joseph.Guydish@ucsf.edu
authors: Joseph
authors: J
authors: Guydish
authors: Douglas
authors: D
authors: Ziedonis
authors: Barbara
authors: B
authors: Tajima
authors: Greg
authors: G
authors: Seward
authors: Emma
authors: E
authors: Passalacqua
authors: Mable
authors: M
authors: Chan
authors: Kevin
authors: K
authors: Delucchi
authors: Lucy
authors: L
authors: Zammarelli
authors: Michael
authors: M
authors: Levy
authors: Monika
authors: M
authors: Kolodziej
authors: Greg
authors: G
authors: Brigham
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D012114:Residential Treatment; D020377:Self Efficacy; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000628:therapy*