A qualitative examination of the positive and negative consequences associated with going tobacco-free in substance abuse treatment: The NY State experience.

In 2008, the New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS) required all state-funded or state-certified addiction treatment programs to be 100% tobacco-free. The regulation prohibits the use or possession of all tobacco products by patients, employees, volunteers, and visitors. Addiction treatment centers are also required to screen patients for tobacco use and incorporate tobacco cessation into treatment programming. This study, funded by a grant from the National Institute on Drug Abuse (NIDA) in response to a program announcement focusing on health services research on practice improvement utilizing community treatment programs (CTPs) within the National Drug Abuse Treatment Clinical Trials Network (CTN), examined the perceived effectiveness of this regulation from the perspective of counselors and clinical supervisors.

Qualitative data were collected from 261 counselors and 80 clinical supervisors working in 50 free-standing substance abuse treatment programs throughout New York, including 10 CTPs from the former Long Island and New York Nodes of the CTN (now combined into the Greater New York Node). Questions asked about the perceived positive and negative consequences of the OASAS regulation approximately 1 year after its implementation.

Conclusions: The findings indicate mixed reactions to the regulation. The most commonly reported positive outcomes were positive behavior change (e.g., less smoking) and increased awareness about the consequences of smoking. The most commonly reported negative consequences were reinforcing addict behaviors among patients (e.g., lying, “dealing” cigarettes) and enforcement problems. These findings have implications for the implementation of tobacco-free regulations in substance abuse treatment programs; equipped with the knowledge presented here, treatment centers may more effectively plan for change and proactively identify potential barriers and solutions to overcome them.