In July 2008, the New York State Office of Alcoholism and Substance Abuse Services (OASAS) implemented a tobacco-free mandate for all state-funded or certified substance abuse treatment facilities. The main intentions of the regulation were to: reduce addiction, illness and death caused by tobacco products; to increase smoking cessation services; and to provide a healthier environment for staff, patients, and visitors at the treatment facilities.
The regulation states that:
- All tobacco products are prohibited in facilities, on grounds, or in vehicles owned or operated by the treatment facility.
- Organizations shall determine and establish written policies and procedures related to the tobacco-free environment.
- Staff is prohibited from using tobacco while at work, during their work hours.
- All patients, staff, and visitors must be informed of the tobacco-free policy, including by posted notices.
- Patients, family members, and other visitors are prohibited from bringing tobacco products and paraphernalia to the facility.
- The organization should establish treatment services for patients who use tobacco.
A study, funded by the National Institute on Drug Abuse (NIDA) and published in the Journal of Substance Abuse Treatment, measured substance abuse clinicians’ perceptions regarding the implementation success of the regulation. The authors Lillian T. de Tormes Eby, PhD, and Tanja C. Laschober, PhD, collected repeated cross-sectional data approximately four months before the regulation was implemented, 10-12 months post-regulation and then again 20-24 months post-regulation.
The study explored “implementation extensiveness,” which basically serves as a checklist to say, “Here are the things OASAS said you need to do, which of these things have you implemented?” explains Eby. Much research takes data from the program administrator’s perspective, but the researchers chose not to follow that pattern in this study. All of the data were collected from the clinicians, which the she says is important for two reasons:
- The program administrators may or may not know what’s really happening on site on a day-to-day basis.
- The program administrators might not always be as truthful as they should be when reporting data because they have an intensified vested interest in presenting their program in a favorable light.
According to Eby, one of the major implications is that not only was there success in the regulation, as over time, the policy was implemented in general as expected, but it also ignited changes in clinical practice behaviors to support tobacco cessation. For example, instead of counselors just saying, “Yes, it’s in the handbook,” or “No, we don’t allow people to smoke here,” clinicians reported that they’re practicing behaviors that were recommended by the Surgeon General’s report and evidence-based practices to further help patients with this issue.
Because perceptions of implementation extensiveness and clinical practice behaviors increased over time, this suggests that the OASAS regulation is being implemented and sustained. Findings also suggest that the mandatory regulation can promote a tobacco-free environment and clinical practice behaviors. The authors say that this may seem obvious because the regulation was mandatory, but many times mandatory regulations fizzle out shortly after implementation, so there’s hope in this case that the smoke-free environments and cessation programs are here to stay.
Laschober says that in general, people typically are reluctant to follow such strict mandates, so the fact that the policy worked to a certain extent, and that clinicians began to change behaviors is very positive.
“The cloud to that silver lining is that there’s still work to be done,” Eby says. Although some treatment programs showed signs of sustainability, many weren’t doing much at all, and it was rare to see a treatment program in full compliance, even while under these strict regulatory guidelines, she explains.
Why are they not following these guidelines and what are the barriers to implementing tobacco treatment and drug abuse treatment? Eby says other research they have conducted addresses this issue by looking at correlates and much of the answers have to do with management practices and how the policy was actually implemented in the treatment programs. She says, “Organizations can really affect how clinicians respond to this and there is certainly a lot of variability in that based on this study alone.”
Eby wonders if perhaps the regulation required an amount of work that either was or appeared to be unrealistic to implement. She also notes that such a strict regulation may take more time to be fully implemented. “This is not unusual or totally unexpected if one looks at the slow pace of adoption and implementation of evidence-based practices/innovations in SUD treatment in general. Most innovations are very slow to be adopted and implemented,” she explains.
Differences in organizational characteristics
Of the treatment programs studied, there were differences based on organizational characteristics. For example,