Evaluating a Tobacco-free Policy Intervention in Residential Substance Use Disorder Programs.

Introduction: Individuals in treatment for substance use disorders (SUD) use tobacco at much higher rates than the general population. Qualitative research can help identify successful implementation approaches for tobacco-free policy interventions in SUD treatment, but qualitative post-intervention evaluation studies are limited.

Methods: Directors of sixteen residential SUD treatment programs participated in a multi-year tobacco-free policy intervention. Semi-structured interviews (n = 32) were conducted at 12- and 18 months post-intervention. Interview transcripts were analyzed thematically to determine implementation barriers and supports.

Results: Supports for tobacco-free policies included a broader wellness context, alternatives to smoking, community partnerships, gradual change, and patient inclusion. Barriers were patient cessation challenges, staff resistance, and insufficient capacity.

Conclusion: Implementation of tobacco-free policies in residential SUD treatment programs is feasible but requires significant planning and support. Single state agencies and other substance use treatment authorities should allocate more resources to support implementation of tobacco-free policies in SUD treatment.