Management of tobacco use in residential addiction services: professional and patient perspectives
P. Caravaca, F. CalvoIntroduction
In residential resources for substance use disorders (SUD), tobacco use is widely tolerated despite its health impact and the evidence showing that cessation does not worsen SUD course or psychiatric symptoms.
Objectives
To describe tobacco management in therapeutic communities and reintegration housing.
To quantify prevalence, dependence, and motivation to quit.
To identify gaps between evidence and clinical practice.
Methods
Qualitative design with a descriptive quantitative component. Two questionnaires (professionals/patients) and focus groups were conducted in 2 therapeutic communities and 3 reintegration apartments (Catalonia, Sep–Nov 2024). Sample: 29 professionals and 53 patients. Instruments: sociodemographic variables, smoking status, Fagerström Test for Nicotine Dependence, Adams & Biener’s (1992) Willingness to Quit Scale, and the Stages of Change Assessment (Becoña & Lorenzo, 2004).
Results
Professionals (n=29): 69% had no training in tobacco management; 20.7% were smokers. All centers allowed smoking; 72.4% agreed with this policy. Among smoking staff, 48.3% reported smoking with patients; 62.1% preferred to postpone cessation.
Patients (n=53): 87.8% were daily smokers; 51.1% had high dependence; 65.1% were in precontemplation. While 71.5% agreed with allowing smoking, 58.1% perceived insufficient support to quit; only 11.6% had attempted cessation during treatment.
Qualitative themes: (a) tobacco as an emotional regulator and “substitute” for other drugs; (b) ambiguous professional modeling (smoking together); (c) discontinuity of “smoke-free” settings after inpatient detoxification; (d) belief that cessation increases relapse risk despite evidence to the contrary.
Conclusions
A policy–practice gap persists: high prevalence and tacit validation of tobacco coexist in settings promoting integral health. Systematic integration of tobacco treatment (psychological and pharmacological), team training, and continuity of smoke-free environments could improve both SUD and mental health outcomes. Institutional policies must align with evidence and reconsider professional modeling.
Disclosure of Interest
None Declared