Qualitative evaluation of perceptions of smoking cessation among clients at an alcohol and other drug treatment program.

Background: Smoking is highly prevalent in the substance use population and trials of smoking cessation among patients actively receiving treatment for substance use disorder have yielded modest quit rates. However, smoking cessation is not routinely provided due to the ungrounded belief it will interfere with recovery from the primary substance use problem.

Objectives: The objective of this qualitative study was to determine the perceptions of smoking cessation in a substance use population. Specifically, we aimed to 1) identify the motivations for and barriers to cessation for clients in treatment for substance use disorder; 2) explore the attitudes of clients towards cessation efforts while actively receiving treatment for substance use disorder; 3) identify sources of social support during cessation; and 4) describe the culture of cessation at the site.

Methods: Semi-structured, one-on-one, in-person interviews were conducted with clients at Salvation Army Harbor Light Center, a 90-day residential alcohol and other drug treatment facility in Pittsburgh, PA. All current and past smokers were invited to participate. Participants were asked to complete a brief demographic survey. Enrollment continued until thematic saturation was achieved. Interviews were transcribed verbatim and transcripts were verified. Codes were developed and themes were identified using Grounded Theory.

Results: Sixteen interviews were conducted over a period of 6 months. Most participants were white men (68.8%) with a primary drug of choice of alcohol (75%). Thematic analysis from interviews identified 9 themes relating to the environment at the site, specific strategies and challenges related to substance use, and generalized factors impacting their confidence in success.

Conclusions: Clients at Harbor Light face several unique barriers to quitting that are consistent with findings in the literature. Program administrators may consider adopting policies that promote cultural changes to encourage smoking cessation in the recovery community. This data will help to tailor smoking cessation services to the needs of the population.