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"Addiction Policy Research Update" Newsletter - Spring 2008

This is the sixth volume of the quarterly news tips from the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation-a $66 million program that funds research into policies related to alcohol, tobacco and illegal drugs.

Please contact me at if you'd like to follow up on any of the news items below. -Prabhu Ponkshe

Research Update

Spring 2008


State Policies Matter

The Case of Outpatient Drug Treatment Program Practices

Offering new evidence that state policies (over local or federal laws) are the lynchpin for ensuring the existence of comprehensive substance abuse treatment, a recent report published in the Journal of Substance Abuse Treatment shows that unless individual states support substance abuse treatment programs through policy requirements, these services are significantly less likely to be offered.

While the results may seem obvious, until now there has been no study to examine the relationship between state policy requirements and actual treatment program practices.

"In other words, even if a policy had been in place, no one knew whether it was in reality making a difference. Now we can say with certainty that state policies have an impact on treatment programs," explains author Jamie F. Chriqui, PhD, with the University of Illinois at Chicago.

Researchers collected and analyzed state policies that were effective as of February 1, 2003, and February 1, 2004, and compared them with treatment practice data obtained from the National Survey of Substance Abuse Treatment Services for those same years.

They found that treatment programs were much more likely to be offered as an option in states that had requirements for comprehensive substance abuse assessment, family counseling, substance abuse and infectious disease/sexually transmitted disease testing services, HIV/AIDS education, and aftercare services.

Of interest, the authors note, was the low percentage of substance abuse treatment programs located in states requiring specific testing services. For instance, only 6 percent of programs were in a state actually requiring drug or alcohol testing/screening. State testing requirements for diseases associated with substance use (hepatitis B and C, HIV/AIDS, STDs, and TB) were present for only 9 to13 percent of programs.

Requirements for HIV/AIDS education, however, were more prevalent in states that had treatment programs; more than one third of programs were in states with such policies. The study also found that 28 percent of the programs were in states with requirements for relapse-prevention services and nearly half (43 percent) of the programs were located in states with requirements for continuing care/aftercare counseling services.

Services aimed at maintaining treatment effects were also widespread: 87 percent of programs provided relapse-prevention and continuing care/aftercare counseling.

Understanding the nature of this relationship is important because, in the absence of a national regulatory system, state policy requirements are one of the only common denominators that could help drive the use of proven and effective practices into the vast majority of programs operating today.

Because state policy requirements are mandatory for state-authorized programs (i.e., all programs included in this study), the states are uniquely positioned to institute specific policies based on scientific research in the substance abuse treatment arena, suggesting that a comprehensive approach, specific services, or both are associated with positive treatment outcomes and reduced recidivism.

Such data may be used to inform future state policy decision-making practices regarding outpatient substance abuse treatment program requirements. These data also imply the importance of a closer working relationship between researchers and clinicians who identify effective treatment practices and state policy makers, the authors write.

Smoke-Free Laws Have No Impact on Employee Turnover

Supporting the argument that smoke-free laws do not damage the hospitality industry, restaurants that ban cigarette smoking haven't suffered from increased employee turnover, according to a new report published in the current online issue of Contemporary Economic Policy. The report , "Smoke-Free Laws and Employee Turnover," was the first of its kind to examine the impact of smoke-free laws on the restaurant labor market.

"We already know from multitudes of other studies that going smoke-free doesn't hurt business," said Ellen Hahn, professor at the University of Kentucky College of Nursing. "But this is the first one to look at how smoke-free laws may impact employee retention and training."

The study examined payroll records of a franchise of a national full-service restaurant chain that operates 23 restaurants in the state of Arizona, a state where several communities have adopted smoke-free laws.

"We thought we might see a short term spike in turnover but we didn't see that," said Eric Thompson, associate professor with the University of Nebraska-Lincoln. In fact, they found a decline in the probability of turnover in the initial months after a smoke-free law was implemented as well as evidence that turnover rates were lower 16 to18 months after implementation. However, over the long-run (a five year period) there was no consistent pattern of either a decline or an increase in employee turnover after the implementation of a smoke-free law.

By focusing on how a smoke-free policy impacted the restaurant workers' interest or ability to stay on the job, the study supports existing evidence showing that smoke-free laws are positive for business.

"The reactions of the workers to the smoke-free laws showed that they weren't apt to leave their jobs after their restaurants went smoke-free," said Hahn.

Health advocates support local smoking ordinances as a public health strategy to enhance the safety of workplaces. But like many safety regulations, smoke-free laws have the potential to introduce economic inefficiencies. One earlier belief was that the introduction of a smoke-free law may cause some workers to leave their jobs at bar and restaurant businesses.

"The concern was that once smoking was no longer allowed, workers would no longer be interested in that particular job. Ostensibly, when the smoking law changed, the mix of characteristics in their job (such as wages, job responsibilities, the presence of second hand smoke) may have changed and caused people to choose another place of work. But the study did not bear this out," said Thompson.

Author Ellen Hahn hopes that this study will give the restaurant industry the courage to stop fighting smoke-free laws.

"There's no reason the hospitality industry should resist smoke-free legislation in light of the huge body of research showing that it doesn't impact business," said Hahn.

If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at

State Budget Cuts Impacting Efforts to Curb Smoking

Budget cuts to tobacco control programs significantly reduce their effectiveness, according to a new report by researchers at the University of Wisconsin and RTI International.

The study, published in the online edition of Tobacco Control, assessed the effects of dramatic reductions in funding for the Florida Tobacco Control Program in June 1999. They found that those budget reductions had immediate effects on program exposure as well as teens' thoughts about starting to smoke. After budget reductions, fewer teens were opposed to initiating smoking.

"Budget cuts to the program had large effects on exposure to televised anti-smoking ads and stalled progress in promoting non-smoking intentions among Florida teens," said Jeff Niederdeppe, PhD, post-doctoral fellow at the University of Wisconsin and the paper's lead author. "There is a critical need to maintain and enhance funding for state tobacco control programs to continue nationwide progress in preventing youth from initiating cigarette smoking."

The study analyzed survey data from between 1998 and 2000 to assess outcome changes resulting from the tobacco control budget cuts. The researchers studied how Florida teens' non-smoking intentions, anti-industry beliefs and tobacco control program exposure changed after Florida's 1999 tobacco control program budget cuts.

According to the authors, dramatic reductions in funding for Florida's tobacco control program in 1999 reversed upward trends in recall of the Florida "truth" anti-smoking campaign, which had contributed to large declines in Florida youth smoking prevalence.

"The launch of the national 'truth' campaign in February 2000 likely offset some of the effects of the budget cuts on trends in anti-industry beliefs, which are also linked to reduced smoking initiation," said Matthew Farrelly, PhD, director of RTI's Public Health Policy Research Program and the paper's co-author. "However, funding for the national campaign has also been reduced, making it unlikely that there would be similar compensatory effects today."

Research has found comprehensive state tobacco control programs as well as media campaigns to be effective strategies to reduce cigarette consumption and smoking prevalence, and have contributed to smoking declines in California, Massachusetts, and Florida, as well as nationally. However, several states have had dramatic reductions in funding of tobacco control programs.

The study was funded by the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation.

If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at

DUI Policy

Every year, nearly 17,000 lives are lost in the U.S. to alcohol-related traffic crashes. Such crashes are the leading cause of death for those between the ages of 4 and 34. As a result, over the last 40 years, hundreds of policy changes have been made in the U.S. to deter driving under the influence of alcohol (DUI).

A new Knowledge Asset posted on the SAPRP website ( examines the research-based evidence on the effects of various DUI policies.

The DUI Knowledge Asset shows that laws that a particular state chooses to implement or to not implement can have enormous effects on the health and safety of its residents, and not all laws have been found to be significantly effective. Those that are effective, though, can have broad benefits to the public health of its community, not only reducing alcohol-related traffic fatalities, but also fights and unsafe sex. Already, tens of thousands of lives have been saved by just a few policy changes over recent decades.

Some of the policy changes that have been made in the U.S., for better or for worse, include:
  • Reductions in legal blood alcohol content (BAC) limits;
  • Mandatory minimum jail and fine penalties for those already convicted of DUIs;
  • License revocation at the time of arrest;
  • Implementation of sobriety checkpoints;
  • Minimum legal drinking ages; and
  • Laws which lengthen the driving learning period and limit nighttime driving for teens.
This Knowledge Asset summarizes the results of studies conducted about the effectiveness (or ineffectiveness) of these policy changes. It is a valuable resource for policymakers and media interested in examining DUI laws.

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