Availability of nicotine replacement therapy in substance use disorder treatment: longitudinal patterns of adoption, sustainability, and discontinuation

Abstract

Background: There is growing recognition regarding the clinical importance of integrating smoking cessation services, such as nicotine replacement therapy (NRT), within programs that treat substance use disorders (SUDs) since the majority of individuals receiving treatment also smoke. Previous research has not examined the organizational characteristics associated with NRT availability over time in SUD treatment programs.

Method: Using longitudinal data collected from administrators of 868 SUD treatment programs over a four-year period, the availability of NRT in the forms of the nicotine patch or nicotine gum was measured. Associations between organizational covariates and NRT adoption were estimated using multinomial logistic regression.

Results: The rate of NRT availability significantly decreased over time from 38.0% of SUD programs at baseline to 33.8% at follow-up. The multinomial logistic regression model indicated programs that sustained adoption of NRT over time were more medically oriented, as measured by location in a hospital setting and access to physicians, and were less likely to offer outpatient services. Sustained and recent adopters of NRT were more likely to offer other smoking cessation interventions at follow- up than NRT discontinuers or NRT non-adopters.

Conclusions: These findings suggest that patients' access to NRT varies across different types of treatment organizations. Future research should continue to measure the availability of NRT and other smoking cessation interventions in SUD treatment since these services may help patients to quit smoking and reduce the likelihood of SUD relapse.