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In 2011, 5,737 substance abuse treatment facilities—less than half (42 percent) of all such facilities nationwide—offered tobacco cessation services (Figure 1). Specifically, 34 percent of all facilities offered tobacco cessation counseling, 21 percent offered nicotine replacement medication, and 16 percent offered non-nicotine tobacco cessation medication.
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Cessation Services | Percent |
---|---|
Any Tobacco Cessation Service | 42% |
Specific Tobacco Cessation Service(s) | |
Smoking Cessation Counseling | 34% |
Nicotine Replacement Pharmacotherapy | 21% |
Non-nicotine Tobacco Cessation Pharmacotherapy | 16% |
Source: SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS), 2011. |
The proportions of substance abuse treatment facilities offering tobacco cessation services differed by Census region, and there were several notable differences at the State level as well (Figure 2). Over half of facilities located in the Northeast (58 percent) offered tobacco cessation services compared with 40 percent of facilities in the West, 38 percent of facilities in the South, and 34 percent of facilities in the Midwest. The higher percentage of facilities offering tobacco cessation services in the Northeast were primarily driven by two States. Specifically, 83 percent of facilities in New York offered tobacco cessation services, and 73 percent of those in Massachusetts did. Arkansas and Wyoming also had high percentages of treatment facilities offering tobacco cessation services; the proportions in these States were about double that of their respective regional averages (80 percent in Arkansas vs. 38 percent in the South, and 72 percent in Wyoming vs. 40 percent in the West).
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Census Region | Percent |
---|---|
MIDWEST REGION | 34% |
Illinois | 29% |
Indiana | 44% |
Iowa | 31% |
Kansas | 29% |
Michigan | 32% |
Minnesota | 32% |
Missouri | 35% |
Nebraska | 33% |
North Dakota | 34% |
Ohio | 36% |
South Dakota | 41% |
Wisconsin | 44% |
NORTHEAST REGION | 58% |
Connecticut | 48% |
Maine | 36% |
Massachusetts | 73% |
New Hampshire | 41% |
New Jersey | 42% |
New York | 83% |
Pennsylvania | 35% |
Rhode Island | 42% |
Vermont | 67% |
SOUTH REGION | 38% |
Alabama | 23% |
Arkansas | 80% |
Delaware | 51% |
District of Columbia | 31% |
Florida | 39% |
Georgia | 33% |
Kentucky | 28% |
Louisiana | 39% |
Maryland | 38% |
Mississippi | 32% |
North Carolina | 40% |
Oklahoma | 47% |
South Carolina | 49% |
Tennessee | 34% |
Texas | 44% |
Virginia | 38% |
West Virginia | 27% |
WEST REGION | 40% |
Alaska | 49% |
Arizona | 34% |
California | 36% |
Colorado | 34% |
Hawaii | 57% |
Idaho | 32% |
Montana | 32% |
Nevada | 34% |
New Mexico | 40% |
Oregon | 55% |
Utah | 59% |
Washington | 46% |
Wyoming | 72% |
Source: SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS), 2011. |
A larger proportion of substance abuse treatment facilities operated by Federal Government agencies offered tobacco cessation services than that of all other facilities. Specifically, 80 percent of facilities operated by the Federal Government offered tobacco cessation services, compared with just over half (51 percent) of those operated by State governments and more than one third (34 percent) of those operated by private for-profit organizations (Figure 3).
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Facility Operation | Percent |
---|---|
Federal Government | 80% |
State Government | 51% |
Local Government | 45% |
Private Non-profit | 44% |
Tribal Government | 41% |
Private For Profit | 34% |
Source: SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS), 2011. |
The majority (81 percent) of substance abuse treatment facilities with a primary general health care focus (usually facilities located within hospitals) offered tobacco cessation services (Figure 4). These facilities offered tobacco cessation services at a higher rate than those with a primary focus on both substance abuse and mental health services (46 percent), mental health services only (42 percent), or substance abuse services only (39 percent).
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Primary Therapeutic Focus | Percent |
---|---|
General Health Care | 81% |
Mix of Substance Abuse & Mental Health Services | 46% |
Mental Health Services | 42% |
Substance Abuse Services | 39% |
Other | 37% |
Source: SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS), 2011. |
The 2011 N-SSATS survey included questions about a facility's smoking policy. About one third (34 percent) of substance abuse treatment facilities reported that they prohibited smoking on site (i.e., did not allow smoking anywhere), 54 percent reported that they permitted smoking outside only, and 10 percent reported they permitted smoking outside and in designated areas only. The remainder reported some other policy or had an invalid or missing response to this question.
A larger percentage of substance abuse treatment facilities (44 percent) that offered tobacco cessation services prohibited smoking anywhere compared with facilities that did not offer these services (27 percent) (Figure 5). Less than half of facilities that offered tobacco cessation services (45 percent) permitted smoking outdoors but not indoors—this was a lower percentage than for facilities that did not offer tobacco cessation services (62 percent).
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Smoking Policies | Any Tobacco Cessation Service |
No Tobacco Cessation Service |
---|---|---|
Not Permitted Anywhere | 44% | 27% |
Permitted Outdoors Only | 45% | 62% |
Permitted Outdoors and Designated Indoor Areas | 10% | 11% |
Source: SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS), 2011. |
The 2011 N-SSATS asked about screening for tobacco use during assessment and/or as a pretreatment service. Half (50 percent) of substance abuse treatment facilities reported that they screened for tobacco use (Figure 6), more than one third (38 percent) reported that they did not screen, and the remainder (12 percent) had either an invalid or missing response to this question. Nearly three fourths (72 percent) of substance abuse treatment facilities that offered any type of tobacco cessation service provided screening for tobacco use, compared to 34 percent of facilities that did not offer tobacco cessation services.
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Tobacco Cessation Services | Percent |
---|---|
All Facilities | 50% |
Any Tobacco Cessation Service | 72% |
No Tobacco Cessation Service | 34% |
Source: SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS), 2011. |
Tobacco cessation services provide important benefits that can improve the short- and long-term health of clients in substance abuse treatment and can enhance drug and alcohol treatment outcomes.6,7 Yet this report shows that less than half of treatment facilities nationwide provide tobacco cessation services. Notably, the Census regions with the heaviest rates of smoking and tobacco-related mortality and morbidity—the Midwest and South—are the regions in which facilities are least likely to offer tobacco cessation services.1 Compared with other regions, the Northeast has more treatment facilities that offer tobacco cessation services, are operated by the Federal Government, or have a primary general health care focus (Table 1). Many of these findings are expected given the policies that typically prohibit tobacco use in hospitals, other health care facilities, and Federal and some State government facilities. New York, for example, prohibits smoking in State-owned substance abuse treatment facilities and requires that all treatment centers help their patients to quit smoking.9
Substance abuse treatment facilities offering tobacco cessation services were MORE likely than facilities that did not offer services to be or to report: |
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Substance abuse treatment facilities offering tobacco cessation services were LESS likely than facilities that did not offer services to be or to report: |
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* The differences shown in this table have Cohen's h effect size > 0.20, indicating that they are considered to be meaningful. Source: SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS), 2011. |
Treatment programs that do not screen for tobacco use or offer tobacco cessation services should be encouraged to implement these services as an important, complementary adjunct to substance abuse treatment and to meet an important public health need. To that end, the Substance Abuse and Mental Health Services Administration (SAMHSA) has developed resources for implementing tobacco use cessation during substance abuse treatment.
Please see the following documents that are available on the SAMHSA website:
The U.S. Preventive Services Task Force has also developed general counseling recommendations to prevent tobacco use and tobacco-caused disease for adults and pregnant women (see http://www.uspreventiveservicestaskforce.org/uspstf09/tobacco/tobaccors2.htm). Clinicians who work in treatment programs without formal tobacco cessation programs or services may refer interested clients to 1-800-QUIT-NOW or http://www.smokefree.gov.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. The National Survey of Substance Abuse Treatment Services (N-SSATS) is an annual survey designed to collect information from all facilities in the United States, both public and private, that provide substance abuse treatment. N-SSATS provides the mechanism for quantifying the dynamic character and composition of the United States substance abuse treatment delivery system. The objectives of N-SSATS are to collect multipurpose data that can be used to assist SAMHSA and State and local governments in assessing the nature and extent of services provided and in forecasting treatment resource requirements, to update SAMHSA's Inventory of Behavioral Health Services (I-BHS), to analyze general treatment services trends, and to generate the Substance Abuse Treatment Facility Locator [http://findtreatment.samhsa.gov/]. N-SSATS is one component of the Behavioral Health Services Information System (BHSIS), maintained by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA. N-SSATS collects three types of information from facilities: (1) characteristics of individual facilities such as services offered and types of treatment provided, primary focus of the facility, and payment options; (2) client count information such as counts of clients served by service type and number of beds designated for treatment; and (3) general information such as licensure, certification, or accreditation and facility website availability. In 2011, N-SSATS collected information from 13,720 facilities from all 50 States, the District of Columbia, Puerto Rico, the Federated States of Micronesia, Guam, Palau, and the Virgin Islands. Information and data for this report are based on data reported to N-SSATS for the survey reference date March 31, 2011. The N-SSATS Report is prepared by the Center for Behavioral Health Statistics and Quality, SAMHSA; Synectics for Management Decisions, Inc., Arlington, VA; and RTI International, Research Triangle Park, NC. Latest N-SSATS reports: Latest N-SSATS public use files and variable definitions: Other substance abuse reports: |