Pre-implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California

Background: Across the United States, substance use disorder (SUD) treatment programs vary in terms of their tobacco-related policies and cessation services offered to clients. Guided by the Consolidated Framework for Implementation Research (CFIR), the current study identified key factors that may influence the implementation of tobacco related cessation policies and services in residential SUD programs. Methods: We conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts.Findings: Guided by the CFIR constructs, themes that arose as facilitators for implementation included the relative advantage of the intervention compared with current practice, external policies/incentives to support tobacco related policy, program directors strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise and, lack of reimbursement for smoking cessation services.Conclusion: The CFIR provided a valuable framework for evaluating factors that may influence implementation of tobacco policies and services in SUD treatment. In order to support successful implementation, residential SUD programs (staff and clients) require extensive education on the effectiveness of tobacco cessation efforts on health outcomes and publicly funded SUD treatment programs should receive support through expanded reimbursement for tobacco cessation services.