Systematic design of patient and staff smoking cessation processes at state operated substance abuse facilities in North Carolina

The paper describes the approach and results from an innovative implementation science project to help residents and staff at three inpatient Alcohol and Drug Treatment Centers(ADATC) in North Carolina accomplish and sustain a smoke-free lifestyle. 81% of individuals served by these facilities reported tobacco use. North Carolina is establishing regulations for state mental health facilities to become smoke free campuses in 2013. Integration of smoking cessation programs into addiction treatment faces three barriers: (a) substance abuse treatment professionals do not consider smoking cessation important;(b) no time to integrate smoking cessation activities into addiction treatment programs and(c)not enough staff with smoking cessation counseling skills. The first barrier is no longer an option due to the impending regulations. Our approach addresses the remaining two barriers and consists of three steps. First, we train health care providers in ALL three ADATCs on smoking cessation interventions. Next, we train selected staff in ONE facility in process design and continuous quality improvement. Finally, we work with a team of clinicians and administrators in the target facility to develop and test processes to integrate smoking cessation into existing addiction treatment protocols without reducing the quality. The effectiveness of this approach is assessed by comparing this facility's achievement of Joint Commission smoking cessation metrics with one of the other facilities acting as a control site. The output of this project is an “implementation guide” that will be used to systematically implement smoking cessation program in other alcohol and drug treatment facilities in North Carolina and beyond.