Treating Nicotine Dependence in Smokers with Mental Illness and Chemical Dependencies. Lirio S. Covey, Ph.D. David Kalman, Ph.D. Taru Kinnunen, Ph.D. Kimber Richter, Ph.D. Jill M. Williams, M.D. Nancy Kaufman, M.A. Today’s Goals. The nature of nicotine dependence
Treating Nicotine Dependence in Smokers with Mental Illness and Chemical Dependencies
Lirio S. Covey, Ph.D.
David Kalman, Ph.D.
Taru Kinnunen, Ph.D.
Kimber Richter, Ph.D.
Jill M. Williams, M.D.
Nancy Kaufman, M.A.
Tobacco use, in particular, chronic use of tobacco, is a disorder in itself.
Nicotine Is a Drug: Neurochemical Effects of Nicotine and Chemical Dependencies
Pleasure, Appetite Suppression
Arousal, Appetite Suppression
Arousal, Cognitive Enhancement
Mood Appetite suppression
Reduction of Anxiety, Tension
among persons with mental illness.
Alcohol and drug dependence
Anxiety disorders (GAD, phobias, PTSD)
Current Smokers by Mental Illness and Chemical Dependencies
History, Lasser et al, JAMA, 2000
None Ever Ill Past Month
None Ever Ill Past month
16.9 21.5 11.4 0.6 50.7
Per cent prevalence of the condition in US population
4.8 6.4 11.0 6.5 50.7
Percent prevalence of the condition in the US population
Major Depression and Chemical Dependencies
Glassman, et al, JAMA, 1990
Breslau et al, 1992
Smith, Nicotine & Tobacco
Covey et al, Am J Psychiatry, 1997
Covey et al, Comp Psychiatry,1991
Smith et al, 2003 Hall et al, 1998 Kinnunen et al, 2003
who are currently depressed.
Over 25 studies to date
Most studies focused on either smokers in early recovery (< 3 months) or later recovery (> 1 year)
Treatment included behavioral counseling and medication (nicotine replacement, bupropion)
Rates of successful quitting
about 10% for smokers in early recovery
about 25% for smokers in later recovery
499 smokers in alcohol dependence treatment
Smoking treatment (counseling + NRT)
Concurrent or delayed (6 months)
Outcomes - smoking and drinking status
Factors affecting smoking cessation outcomes for alcoholics in early recovery
Saturated social network of smokers?
Combination pharmacotherapies (e.g., bupropion plus naltrexone)
More frequent smoking cessation counseling.
% Providing service to at least 1 patient
Staff not trained 30 Days(118)
Patients not interested (111)
Other drug treatment more important (78)
Not enough staff (58)
Clinic does not receive reimbursement (49)
Staff are too busy (36)
Staff smoke cigarettes (20)
Smoking treatment is ineffective (7)
Other (33)Most Important Barrier to Providing Smoking Cessation Services, Richter, 2003
13% abstinent for 24 weeks
50 Subjects, 7 weeks group counseling
10 weeks of NRT (patch)
- 42% abstinent at 7 weeks
- 16 % abstinent at 12 weeks
- 12% at 24 weeks
No change in symptoms of schizophrenia
No great difficulty in having schizophrenics use the patch
66% in bupropion vs. 11% in placebo