Joseph Guydish’s research while affiliated with University of California, San Francisco and other places

Introduction: Individuals in treatment for substance use disorders (SUD) use tobacco at much higher rates than the general population. Qualitative research can help identify successful implementation approaches for tobacco-free policy interventions in SUD treatment, but qualitative post-intervention evaluation studies are limited. Methods: Directors of sixteen residential SUD treatment programs participated in a multi-year tobacco-free policy intervention. Semi-structured interviews ( n = 32) were conducted at 12- and 18 months post-intervention. Interview transcripts were analyzed thematically to determine implementation barriers and supports. Results: Supports for tobacco-free policies included a broader wellness context, alternatives to smoking, community partnerships, gradual change, and patient inclusion. Barriers were patient cessation challenges, staff resistance, and insufficient capacity. Conclusion: Implementation of tobacco-free policies in residential SUD treatment programs is feasible but requires significant planning and support. Single state agencies and other substance use treatment authorities should allocate more resources to support implementation of tobacco-free policies in SUD treatment.

Background Approximately 1 in 6 cannabis users develop a cannabis use disorder (CUD) and the odds increase to 1 in 2 for daily users. Objective The Dual use of Cannabis and Tobacco Monitoreing through a Gamified Web app (DuCATA_GAM-CaT) project aims to identify cannabis-tobacco patterns of use and withdrawal symptoms among individuals with CUD who are attending substance abuse programs. Methods The project uses a mixed methods approach consisting of 3 studies. First, a participatory qualitative study involves focus groups comprising individuals with CUD, clinicians, project researchers, and an expert gamification company to co-design a gamified web app. Second, a longitudinal prospective study to follow up individuals over 6 weeks with CUD attending substance abuse programs . Participants report their cannabis-tobacco usage patterns, type and frequency of tobacco use, nicotine dependence, withdrawal symptoms, psychoemotional factors, and motivation to quit both substances. Predictive analysis techniques are used to analyze clinical, demographic, psychological, and environmental data to predict the probability of achieving abstinence. Third, homogeneous focus groups to explore participants’ experiences during their CUD treatment. Results By June 2024, the project had completed the first study, defining eligible cannabis user profiles, developed the initial web app prototype, and initiated recruitment across 10 centers, with 74 participants enrolled, aiming to reach 150 participants in total. Conclusions All participants are required to provide informed consent, and their information is kept confidential and anonymized following confidentiality rules. The research team is committed to disseminating the results obtained to professional and patient groups, as well as informing public health agents, to positively influence political and social decision makers and design programmers. Additionally, we aim to prioritize the publication of the results in high-impact journals specialized in drug abuse, public health, and health care services research. Trial Registration ClinicalTrials.gov NCT05512091; https://clinicaltrials.gov/study/NCT05512091 International Registered Report Identifier (IRRID) DERR1-10.2196/58335

UNSTRUCTURED Background. Approximately one in six cannabis users develops a cannabis use disorder (CUD) and the odds increasing to one in two among daily users. The DuCATA project aims to identify cannabis-tobacco withdrawal symptoms among individuals with CUD who are attending substance abuse programs (SAP). Methods. The DuCATA project employs a mixed-methods approach consisting of three studies. First, a participatory qualitative study involves focus groups comprised of individuals with CUD, clinicians, project researchers, and an expert gamification company to co-design a gamified application. Second, a longitudinal prospective study will follow individuals with CUD attending SAP for six weeks. Participants will report their cannabis-tobacco usage patterns, type and frequency of tobacco use, nicotine dependence, withdrawal symptoms, psychoemotional factors, and motivation to quit both substances. Predictive analysis techniques will be employed to analyze clinical, demographic, psychological, and environmental data to predict the probability of achieving abstinence. Third, homogeneous focus groups will be conducted to explore participants' experiences during their CUD treatment. Discussion. All participants will provide informed consent, and their information will be kept confidential and anonymized in accordance with confidentiality rules. The research team is committed to disseminating the results obtained to professional and patient groups, as well as informing public health agents, in order to positively influence political and social decision-makers and design programmers. Additionally, we aim to prioritize publication of the results in high-impact journals specializing in drug abuse, public health, and health care services research. Trial registration number. The DuCATA project has been registered at Clinicaltrials.gov under the identifier [NCT05512091].

A pragmatic double-blind randomized controlled trial was conducted in Barcelona to assess a telephone-based smoking cessation intervention’s effectiveness for individuals with mental health disorders post-discharge. Participants were divided into an intervention group (IG) and control group (CG) with a 2:1 allocation ratio. The IG received proactive motivational assistance, while the CG received brief advice. Biochemically validated past 7-day abstinence was the main outcome measure. Of 530 screened individuals, 294 were enrolled (200 IG, 94 CG). During follow-up, participants reported 97 episodes of ≥ 7-day abstinence (IG, 51; CG, 26). Overall abstinence probability was 30–35%, with no difference between groups at 1-year follow-up. However, intervention participants were more likely to report abstinence if they quit during hospitalization or were considering quitting. The intervention effectively supported smoking abstinence in motivated individuals. Combining this with clinical and community-based interventions holds promise for aiding smoking cessation in those with mental disorders. ClinicalTrials.gov Identifier: NCT03230955.

Accessible Summary What is known on the subject? Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. What the paper adds to existing knowledge? The ‘061 QUIT‐MENTAL study’ evaluated the efficacy of a proactive telephone‐based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non‐mental health specialized nurses and other health professionals to provide evidence‐based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. What are the implications for practice? While the training programme was successful in improving non‐mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population. Abstract Introduction The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long‐term viability. The 061 QUIT‐MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone‐based intervention addressed to mental health patients conducted by non‐psychiatric specialized nurses. Aim We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method Mixed methods study: (1) Pre‐post evaluation to assess self‐reported knowledge, self‐efficacy and opinions about smoking cessation. (2) In‐depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population‐based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population‐based interventions to individuals with mental health disorders. Implications for Practice Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population.

Background The global demand for treatment of cannabis use disorder has significantly increased, prompting a need to understand effective strategies for addressing concurrent cannabis and tobacco use. This study focuses on clinicians' experiences and perceptions in delivering smoking cessation services to cannabis users. Methods Three focus groups consisting of substance use professionals in Catalonia, Spain, were analyzed using Atlas-ti software, revealing five main themes and 17 subthemes: (i) User characteristics; (ii) Professional characteristics; (iii) Models of intervention; (iv) Organizational healthcare models; and (v) Health policies. Clinicians stressed the importance of intervention models and the active role of professionals in addressing tobacco use within routine care. Results Clinicians believed that tobacco cessation could mitigate social isolation and chronic issues among cannabis users, especially those engaged in polydrug use. Recommendations included integrating smoking cessation into all services, reducing healthcare service fragmentation, improving resource accessibility, enhancing clinical documentation, and advocating for stronger population-level tobacco control policies. Conclusions Clinicians suggested adopting a personalized therapeutic approach, implementing a more comprehensive model with increased resources, and reinforcing population-level tobacco control policies to enhance intervention effectiveness.

Background and Objectives Gambling is highly comorbid with disordered use of tobacco and other drugs, and may increase relapse risk among substance use disorder (SUD) patients. We investigated associations between gambling and tobacco use behaviors among SUD patients to inform clinical care. Methods Patients ( N = 651, 170 female) from 25 residential SUD treatment programs in California completed surveys about tobacco use, health, and gambling. Using multivariate regression, we examined associations between gambling, tobacco use behaviors, and mental and physical health. Results Past‐year gamblers were more likely than non‐gamblers to be current smokers (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.03, 2.01). Smokers who gambled had higher mean Heaviness of Smoking Index (HSI) scores (mean difference = +0.32, 95% CI = 0.04, 0.60), and more often reported smokeless tobacco use (AOR = 1.73, 95% CI = 1.16, 2.58), compared to non‐gambling smokers. Past‐year problem gamblers were more likely than all others (non‐gamblers and non‐problem gamblers) to be current smokers (AOR = 1.44, 95% CI = 1.08, 1.90) and to report high psychosocial stress (AOR = 1.87, 95% CI = 1.34, 2.61). Smokers with problem gambling also had higher HSI scores (mean difference = +0.54, 95% CI = 0.14, 0.95) compared to smokers without problem gambling. Discussion and Conclusions Gambling and problem gambling were associated with tobacco use and heavier smoking. SUD patients with gambling comorbidity may be heavier smokers and may need concurrent treatment for tobacco use and problem gambling. Scientific Significance This study provides novel data regarding gambling and tobacco use behaviors among SUD patients.