Addressing Tobacco Through Organizational Change (ATTOC) in Residential Addiction Treatment Settings

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Tobacco Use Disorder; Tobacco Use Cessation; Smoking Cessation; Residential Treatment


Health Services Research | Mental and Social Health | Psychiatric and Mental Health | Psychiatry | Psychiatry and Psychology


BACKGROUND: Smoking prevalence among persons in addiction treatment is 3-4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence.

METHODS: The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked.

RESULTS: From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163)=7.15, p=0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123)=3.66, p=0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235)=10.58, p=0.0013) and clients received more tobacco-related services from their program (F(1, 235)=92.86, p<0.0001) and from their counselors (F(1, 235)=61.59, p<0.0001). Most changes remained at follow-up.

CONCLUSIONS: The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.

DOI of Published Version



Drug Alcohol Depend. 2012 Feb 1;121(1-2):30-7. Epub 2011 Sep 8. Link to article on publisher's site

Journal/Book/Conference Title

Drug and alcohol dependence

Related Resources

Link to Article in PubMed