Table 3.

Perceived Negative Consequences of Office of Alcoholism and Substance Abuse Services Regulation: Counselors

Category	N	%	n	%	Sample comment
Addict behaviors	71	34.3
Sneakiness			48	23.2	“More people smoking on the ‘downlow,’ more smoking inside the facility”
					“Clients develop sneaky behaviors to enable them to continue to use nicotine”
Unauthorized smoking			12	5.8	“Smoking in the bathrooms”
Underground economy			11	5.3	“Selling and dealing cigarettes”
Enforcement problems	37	17.9
Difficulty enforcing/penalizing			20	9.7	“Staff cannot penalize people correctly for breaking policy”
					“[W]e are not always able to prevent their smoking on the property”
Policing/time lost			16	7.7	“Monitoring smoking takes up the time and energy of staff”
Other			1	0.5	“More regulation to comply with”
Compromises treatment goals	30	14.5
Interferes with drug treatment			19	9.2	“Creates a barrier to clinical connection”
					“Staff's focus shifted from drug use to nicotine use”
Resistance to treatment			10	4.8	“It gives clients another reason to argue against treatment for addictions they may be willing to address”
Other			1	0.5	“Clients no longer come early to fellowship before program”
Negative attitudes	29	14.0
Negative emotional reactions			23	11.1	“Clients are more irritable”
Stigmatization of smokers			6	2.9	“Cigarette smokers are more and more stigmatized and ostracized”
Reduction in patient census	21	10.1
Voluntarily leaving treatment			9	4.3	“Some clients are not ready to stop and leave treatment because of it”
Involuntary discharge			8	3.9	“More people get kicked out of rehab due to smoking”
Fewer patients seeking treatment			4	1.9	“People are not coming into treatment because of this regulation”
Negative patient behavior	11	5.3
Acting out			10	4.8	“You see a lot of clients act out at times if they can’t smoke when they want to”
Other			1	0.5	“Behavior problems increase”
Miscellaneous	8	3.9			“Increased fire risk for all”

Note. Total N = 207. Percentages may not equal 100% due to rounding.