Tobacco dependence diagnosis and treatment in Veterans Health Administration residential substance use disorder treatment programs


Correspondence to: Elizabeth V. Gifford, VA Palo Alto Health Care System, Center for Health Care Evaluation, 795 Willow Road, Menlo Park, CA 94025, USA. E-mail:



To explore tobacco dependence (TD) diagnosis and treatment utilization, and identify predictors of nicotine replacement therapy (NRT) among veterans with substance use disorders (SUDs) enrolled in Veterans Health Administration (VHA) SUD residential treatment programs (SRTPs).


Retrospective cohort study.


VHA SRTPs, which treat veterans with SUD and multiple severe psychosocial deficits, from 1 October 2009 to 31 September 2010.


Identified tobacco users among veterans with SUD treated in SRTPs during fiscal year 2010 (FY10).


Rates of documented TD diagnosis and pharmacotherapy were assessed nationally, regionally and by facility. Patient-level predictors of NRT were examined using a mixed-effects logistic regression model with facility as a random effect.


A total of 12 097 of the 15 320 veterans in SRTPs in FY10 (79%) were identified as probable tobacco users. Among these, 33% had a documented TD diagnosis, 34% were treated with pharmacotherapy and only 11% were both diagnosed and treated for TD while in SRTP. NRT was more common among patients with a current documented TD diagnosis, recent history of TD treatment, comorbid mental health disorder, age 55 years or younger and identified as white.


Most veterans in Veterans Health Administration substance use disorders residential treatment programs appear to use tobacco, yet only one in 10 receives a documented ICD-9 TD diagnosis and pharmacotherapy while in a substance use disorders residential treatment program.