How is Tobacco Use Addressed at US Substance Use Disorder Treatment Facilities? The Importance of Financial Support for Tobacco Cessation Treatment

Persons in substance use disorders (SUD) treatment report a high prevalence of tobacco use. Often neglected in SUD treatment, some recent state-level policies mandated screening and offering tobacco use treatment or referral. We interviewed 85 providers from 68 SUD treatment facilities across 20 US states, assessed providers' estimates of tobacco use prevalence in their facilities, their perceptions on types of nicotine-containing products used by their service users, tobacco policies that were implemented at their facilities, and whether treatment (counseling or pharmacologic treatment) was offered. Prevalence estimates replicate prior findings; however, the variability of the types of nicotine-containing products used was greater than what has been reported in prior studies (cigarettes, e-cigarettes, and modern oral nicotine products). According to providers, 44 (64.7%) of the facilities offered tobacco cessation treatment, and 49 (72.1%) offered FDA-approved pharmacologic adjuncts. Treatment centers in our sample in states mandating assessment/treatment of tobacco use were relatively less likely to offer tobacco cessation treatment (52.8% vs. 78.1%), whereas facilities that accepted insurance as a payment option were more likely to provide these services (77.6% vs. 31.6%). These data suggest that policy mandates may be less effective than financial incentives at promoting tobacco use cessation in SUD facilities.