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INTRODUCTION: Despite steadily declining rates of tobacco use in the United States, individuals suffering from substance use disorders (SUD) and other mental illnesses continue to use tobacco at alarmingly high rates, resulting in increased mortality. Given the synergistic consequences to those who suffer from both tobacco use disorders (TUD) and other SUD, embedding tobacco treatment into structured SUD programs using an opt-out approach may yield a greater impact. The current study compares clinical outcomes (i.e., quit attempts and prescription of tobacco cessation medications) for an opt-out versus opt-in approach to tobacco treatment. METHODS: Tobacco use information was collected prior to and after implementation of an opt-out, eight-session, tobacco group treatment intervention. Patient self-report and medical chart review were utilized to identify individuals who began a tobacco cessation medication during treatment as well as those who reported quitting tobacco, defined as sustained tobacco abstinence for at least seven days. The analysis includes a total of N = 332 Veterans who enrolled in the Intensive Outpatient Program (IOP). RESULTS: Those enrolled in the opt-out tobacco treatment group reported a significantly higher rate of quitting tobacco (24.57%) than those in the opt-in group (2.55%; p <.001). Likewise, the opt-out group was prescribed tobacco cessation medications at a significantly higher rate than the opt-in group (55.00% compared to 14.65%; p <.001). CONCLUSIONS: An opt-out treatment approach to TUD in SUD treatment settings produced improved outcomes, including significantly more patients engaged in TUD treatment and a higher overall rate of SUD treatment completion. IMPLICATIONS: Given the disproportionately high rate of tobacco use among those seeking treatment for SUD, enhanced tobacco cessation interventions could result in both improved tobacco as well as other substance use outcomes. The implementation of an opt-out tobacco treatment intervention embedded into SUD programming is supported by our findings of reduced tobacco use among patients.
RESUMO
BACKGROUND: Research has demonstrated that the combination of pharmacotherapy and psychological interventions in alcohol use disorder (AUD) treatment is superior to either alone. Despite this, medications remain highly underutilized in many outpatient treatment facilities. Pharmacists can serve as an excellent resource to aid in improving access to medications. METHODS: This study was a prospective, longitudinal evaluation of a pharmacist's role in a substance use disorder (SUD) clinic, specifically an intensive outpatient program (IOP). The primary objective was to determine if the addition of a clinical pharmacy specialist (CPS) as a bridge until next available provider appointment would improve access to AUD pharmacotherapy for patients in the IOP. RESULTS: A total of 43 patients were enrolled in the IOP during the study. Of these, 27 patients presented with a primary diagnosis of AUD, and only eight were receiving AUD pharmacotherapy at the start of the program. During this intervention, 11 patients expressed interest in initiating a medication for AUD while in the IOP. The average wait time for a medication evaluation appointment with the CPS was 1.4 days. By comparison, the average wait time for an addiction psychiatrist was approximately 44 days. Each patient was seen for an average of two 30-minute visits, including an initial medication evaluation and one follow-up. Upon completion of CPS services, patients were referred almost equally to an established non-addiction recovery services (ARS) mental health provider (36%), an ARS psychiatrist (36%), or a primary care provider (28%). CONCLUSION: Our study highlights the role that pharmacists can play in improving access to evidence-based AUD pharmacotherapy, as well as in providing medication education to patients and providers. Long-term prospective research and pharmacoeconomic analysis are needed to determine the sustainability of this service, both at our facility and in other similar practice settings.
