Preparing a Residential Substance Use Treatment Program to Be Smoke Free: A Quality Improvement Project

Substance use disorders (SUD) are associated with a two- to fourfold increase in rates of tobacco use. Clients with comorbid SUD and tobacco dependence are more likely to die of tobacco-related causes, and smoking cessation is associated with a reduced risk of returning to substance use. Therefore, smoking cessation care should be an integral part of SUD treatment. However, many organizations do not follow recommendations for integrating tobacco cessation practices into their SUD treatment models. A large residential SUD treatment program in the southeastern United States with a tobacco use rate over 70% implemented a quality improvement project to improve smoking cessation care in preparation for a statewide policy prohibiting tobacco products. The project involved enhanced smoking cessation screening and intervention using the 5As approach and implementing a multiweek smoking cessation course composed of combination nicotine replacement therapy (NRT), counseling, and peer support. The project was implemented in collaboration with state and local tobacco control boards and an academic-practice partnership. Tobacco use counseling rates improved from 31.8% preimplementation to 71.4% postimplementation. The smoking cessation classes had high rates of retention and were associated with nearly 43% of clients quitting tobacco use for at least 7 days during the implementation period and 14% remaining tobacco free 60 days after course completion. The enhanced screening, counseling, and smoking cessation course reduced smoking rates in anticipation of a statewide tobacco ban.