title: Smoking and its treatment in addiction services: clients' and staff behaviour and attitudes.
abstract: BACKGROUND
  High smoking prevalence has been observed among those misusing other substances. This study aimed to establish smoking behaviours and attitudes towards nicotine dependence treatment among clients and staff in substance abuse treatment settings.
  
  
  METHODS
  Cross-sectional questionnaire survey of staff and clients in a convenience sample of seven community and residential addiction services in, or with links to, Europe's largest provider of mental health care, the South London and Maudsley NHS Foundation Trust. Survey items assessed smoking behaviour, motivation to quit, receipt of and attitudes towards nicotine dependence treatment.
  
  
  RESULTS
  Eighty five percent (n = 163) and 97% (n = 145) response rates of clients and staff were achieved. A high smoking prevalence was observed in clients (88%) and staff (45%); of current smokers, nearly all clients were daily smokers, while 42% of staff were occasional smokers. Despite 79% of clients who smoked expressing a desire to quit and 46% interested in receiving advice, only 15% had been offered support to stop smoking during their current treatment episode with 56% reported never having been offered support. Staff rated smoking treatment significantly less important than treatment of other substances (p < 0.001), and only 29% of staff thought it should be addressed early in a client's primary addiction treatment, compared with 48% of clients.
  
  
  CONCLUSIONS
  A large unmet clinical need is evident with a widespread failure to deliver smoking cessation interventions to an extraordinarily high prevalence population of smokers in addiction services. This is despite the majority of smokers reporting motivation to quit. Staff smoking and attitudes may be a contributory factor in these findings.
authors.forename: Camilla
authors.initials: C
authors.lastname: Cookson
authors.forename: John
authors.initials: J
authors.lastname: Strang
authors.forename: Elena
authors.initials: E
authors.lastname: Ratschen
authors.forename: Gay
authors.initials: G
authors.lastname: Sutherland
authors.forename: Emily
authors.initials: E
authors.lastname: Finch
authors.affiliation: National Addiction Centre, Institute of Psychiatry, King's College London, Addiction Sciences Building, 4, Windsor Walk, Denmark Hill, London SE5 8AF, UK. ann.mcneill@kcl.ac.uk.
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000523:psychology*; D016320:Substance Abuse Treatment Centers; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000517:prevention & control / Q000523:psychology; D016896:Treatment Outcome