Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial.

Abstract

Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8weeks and 6.5months follow-up. Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016. Thirty-two eligible services (provided face-to-face client sessions to ≥50 clients/year) in Australia were randomized to control (usual care; n=15) or intervention (n=17) groups by an independent blinded biostatistician. Eligible participants (≥ 16years, current smoker) completed surveys at the service at baseline (n=896) and telephone follow-up surveys (conducted by blinded assessors) at 8weeks (n=471; 53%) and 6.5months (n=427; 48%). Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent. At 8weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR)=1.72, 95% confidence interval (CI)=0.5-5.7, P=0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8weeks [incidence rate ratio (IRR)=0.88, 95% CI=0.8-0.95, P=0.001] but were similar at 6.5 months (IRR=0.96, 95% CI=0.9-1.02, P=0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use. Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.