On July 24, 2008 New York State (NYS) became the first in the nation to require all 1,419 state- funded or state-certified addiction treatment programs overseen by the NYS Office of Alcoholism and Substance Abuse Services (OASAS) to be 100% tobacco-free (www.oasas.state.ny.us/pio/press/pr-7-23-07.cmf). The goal of creating healthier workplaces for employees and fostering tobacco independence in clients is laudable and may yield positive effects over time (e.g., lower rates of smoking, better treatment outcomes). However, the implementation of the regulation will be a major change for substance abuse treatment centers in NYS and the failure rate associated with implementing innovations is high (Rogers, 2002), particularly when they are externally imposed (Bolman &Deal, 2006;Rogers, 2002). Moreover, the OASAS regulation is highly restrictive, broad in scope, and challenges deeply-held beliefs about how to best treat substance using clients. As such, as the regulation is implemented over time it may have wide-ranging effects on clinicians'work reactions and work experiences.
Specific Aims of the proposed project are to: (1) provide an analytic description of the implementation of the OASAS Tobacco-Free Regulation in NYS treatment settings over time, (2) examine longitudinally the relationship between clinician perceptions of how extensively the OASAS regulation has been implemented at their treatment center and their psychological need fulfillment, strain reactions, and (3) examine longitudinally how clinician involvement in the implementation process relates to both proximal implementation outcomes (procedural justice perceptions, self-efficacy for change) and distal (strain reactions, clinical practice behaviors) implementation outcomes. The project also will provide a fine-grained analysis of change over time as the regulation becomes implemented in NYS treatment centers.
Clinicians'perceptions of the implementation of the OASAS tobacco-free regulation are expected to relate to psychological and cognitive reactions, which in turn are proposed to relate to psychological, behavioral, and physical strain. Clinicians working in substance abuse treatment facilities are already working in a high stress, high burnout occupation. Thus, understanding the additive effects of the implementation of this top-down driven, restrictive, state-mandated regulation on clinicians has substantial individual health and health policy implications.
