title: Tobacco dependence diagnosis and treatment in Veterans Health Administration residential substance use disorder treatment programs.
abstract: OBJECTIVE
  To explore tobacco dependence (TD) diagnosis and treatment utilization, and identify predictors of nicotine replacement therapy (NRT) among veterans with substance use disorders (SUDs) enrolled in Veterans Health Administration (VHA) SUD residential treatment programs (SRTPs).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  VHA SRTPs, which treat veterans with SUD and multiple severe psychosocial deficits, from 1 October 2009 to 31 September 2010.
  
  
  METHODS
  Identified tobacco users among veterans with SUD treated in SRTPs during fiscal year 2010 (FY10).
  
  
  METHODS
  Rates of documented TD diagnosis and pharmacotherapy were assessed nationally, regionally and by facility. Patient-level predictors of NRT were examined using a mixed-effects logistic regression model with facility as a random effect.
  
  
  RESULTS
  A total of 12 097 of the 15 320 veterans in SRTPs in FY10 (79%) were identified as probable tobacco users. Among these, 33% had a documented TD diagnosis, 34% were treated with pharmacotherapy and only 11% were both diagnosed and treated for TD while in SRTP. NRT was more common among patients with a current documented TD diagnosis, recent history of TD treatment, comorbid mental health disorder, age 55 years or younger and identified as white.
  
  
  CONCLUSIONS
  Most veterans in Veterans Health Administration substance use disorders residential treatment programs appear to use tobacco, yet only one in 10 receives a documented ICD-9 TD diagnosis and pharmacotherapy while in a substance use disorders residential treatment program.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road, Menlo Park, CA 94025,USA. elizabeth.gifford@va.gov
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Gifford
authors.forename: Sara
authors.initials: S
authors.lastname: Tavakoli
authors.forename: Ruey
authors.initials: R
authors.lastname: Wang
authors.forename: Hildi J
authors.initials: HJ
authors.lastname: Hagedorn
authors.forename: Kim W
authors.initials: KW
authors.lastname: Hamlett-Berry
mesh_terms: D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D016642:Bupropion / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D012114:Residential Treatment; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D014481:United States; D058014:Veterans Health
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion