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The Need for Improving Access to Integrated Health Services and the Elimination of Tobacco Culture Within Substance Use Dependency Treatment
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The literature reviewing comorbid physical and behavioral health disorders indicates a need for examining access and treatment strategies for improving health outcomes. Via umbrella review, this dissertation demonstrates that there was substantial variation between and within models regarding treatment type, length, frequency, exposure time, delivery and setting, technology employed, type and number of healthcare providers, targeted health outcome, and interactions between intervention components of integrated care models employed within the United States (US). Overall, collaborative care appeared to have the greatest efficacy in improving health outcomes, although evidence was mostly limited to depression and depression-related symptoms. Additionally, this dissertation reviewed access to integrated care services within different types of substance use dependency treatment (SUDt) facilities across the US between 2014 and 2017. There was significant variability between type and number of integrated care services offered at each type of SUDt facility. Overall, there were higher rates of facilities not offering any service compared to offering one or more services across all survey years, with nearly half not offering any integrated care service at all and little noticeable change over time. Finally, this dissertation used access to nicotine addiction support services (NASS) as a proxy indicator for organization tobacco culture by demonstrating: 1) a protobacco use culture does exist within SUDt, 2) facilities that not ban tobacco use are less likely to offer NASS, and 3) the likelihood of facilities having a campus-wide tobacco ban increases with the number of NASS offered at those facilities. This dissertation also provides evidence-based recommendations such as removing organization-level obstacles, providing open and thorough two-way communication with staff, standardizing tobacco addiction therapy as part of SUDt, denormalizing tobacco use within the organization, and both focusing on and providing the necessary resources for staff to promote an effective transition to a tobacco-free culture.
SubjectSubstance use treatment
Hercules, Gregory William (2019). The Need for Improving Access to Integrated Health Services and the Elimination of Tobacco Culture Within Substance Use Dependency Treatment. Doctoral dissertation, Texas A&M University. Available electronically from