Abstract:
New Zealanders with a substance abuse issue are at high risk for smoking-related morbidity and mortality. Yet, most of New Zealand's substance abuse treatment services do not provide smoking cessation (SC) treatment. A mixed-method, before and after study was conducted at an outpatient, community-based, substance abuse treatment service in Auckland, to explore whether providing SC treatment would be feasible and/or effective as part of routine clinical practice in this setting. Clinicians (n=16) from the service's counselling and methadone services received two training sessions on SC, and were asked to implement their training with their tobacco-smoking clients. The participating clients (n= 16) received SC treatment (cessation support plus nicotine replacement therapy (NRT)) as an adjunct to their usual substance abuse treatment over five weeks. SC treatment consisted of trialling five different NRT products (Habitrol® 21 milligram (mg) patch, Habitrol® 4 mg gum, Habitrol® 2 mg lozenge, Nicorette® 10 mg inhaler, and Nicorette(j!) 2 mg microtab) for one week after clients' target quit-dates, then choosing one or two NRT products to use for the remaining four weeks of the study. Self-reported, continuous abstinence rates were 18.8% amongst the participating clients at the end of the intervention period, though zero had achieved seven-day point prevalen,ce abstinence. Fourteen (87.5%) clients chose to use combination therapy, with the patch and inhaler combination being most popular. Four (25.0%) clients experienced an adverse change in their health during the study. However, the relationship between these events and the study medication cannot be determined. At the end of the study, the majority (87.5%, n=14) of clinicians reported that they thought SC treatment should become part of routine clinical practice in this setting, and a number of themes were presented on how that treatment could be provided feasibly. Several themes were also identified regarding the training provided, future training needs, SC treatment provision, and the impacts of providing SC treatment. This study supports the effectiveness of SC treatment in this setting, and provides suggestions on how to supply treatment in a way that is feasible and effective for both the clinicians and their clients. However, further research is still required.