New Program Helps Mental Health Patients Stop Smoking By Rick Nauert PhD

Experts say that tobacco use among mental health patients account for nearly half of all cigarettes consumed in the United States.

A program developed by the division of addiction psychiatry at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School to address this addiction has received national recognition by the American Psychiatric Association (APA).

The program, called CHOICES – Consumers Helping Others Improve Their Condition by Ending Smoking – utilizes peer counselors to promote smoking cessation in mentally ill patients.

The counselors, who receive 30 hours of intensive training, are nonsmokers or former smokers who are moderately impaired or disabled by mental illness.

Their goal is not to provide treatment, but to assist smoking patients who are in mental health centers, psychiatric hospitals, group homes and self-help centers, by linking them to treatment, referrals, advocacy and support for smoking cessation in New Jersey.

“Peers are less threatening than professionals,” said Jill Williams, MD, associate professor of psychiatry at Robert Wood Johnson Medical School and co-founder and medical director of the program.

“CHOICES symbolizes empowerment and personal choice in recovery by involving persons with mental illness talking with peers with mental illness who smoke, and who may have low motivation to address their tobacco use.”

A salient feature of the CHOICES program is the unique peer-to-peer approach to promoting tobacco cessation.

In the October issue of its journal Psychiatric Services, the APA said, “The CHOICES program exemplifies many aspects of a successful wellness and recovery initiative. For example, it targets a group with a vital health care need; seeks to reduce tobacco’s harm in a vulnerable group; focuses its efforts in the community, which best accommodates the target population; employs peers to reduce educational and cultural barriers; and develops successful partnerships with key stakeholders for sustainability.”

According to Dr. Williams and co-founder Marie Verna, the program’s advocacy director and senior training and consultation specialist at UMDNJ-University Behavioral HealthCare’s Center for Excellence in Psychiatry, the CHOICES team has conducted more than 280 community visits, reaching more than 9,600 smokers with mental illness, since the program’s inception in 2005. The team also visits consumer conferences and health-related fairs.

An outcome study of the program showed success at reducing the number of cigarettes smoked by consumers each day and an increase in the number of quit attempts following individualized intervention.

Program participants reported that within six months after meeting with a peer counselor, they had talked to their mental health provider about getting help with quitting smoking. Patients also reported that peer counselors were extremely knowledgeable about tobacco and interested in their smoking. Seventy percent of those surveyed said that talking to a peer about their smoking was much easier than talking to a mental health professional.

Peer counselors also reported improvements of their own recoveries from mental illness as a result of participating in CHOICES. They reported on the achievement of personal milestones including participation in publications and conferences on wellness and recovery, and pursuing additional formal education.

Source: >Robert Wood Johnson Medical School

New Grant To Study Depression Treatments

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D.

Depression affects more than 20 million people in the United States. The federal government recognizes the pervasive nature of the disease and has awarded the University of Illinois at Chicago a five-year, $4.8 million grant to develop new therapies to treat depression.

Currently, the most common treatment approach is a combination of antidepressant medication and psychotherapy.

Symptoms can include sadness, loss of interest in activities that were once enjoyed, weight change, difficulty in sleeping (or oversleeping), loss of energy, feelings of worthlessness and thoughts of death or suicide.

The illness can run in families, and it occurs more often in women than men.

What’s needed are antidepressants that work faster, have fewer side effects and that act pharmacologically in new ways, says Alan Kozikowski, UIC professor of medicinal chemistry and pharmacognosy (the study of medicines derived from natural sources) and the grant’s principal investigator.

Kozikowski and his research team had been designing and synthesizing novel nicotine-like compounds that target certain receptors in the brain, in hopes that they would improve cognition in Alzheimer’s disease. Studies in animal models revealed that some of these compounds had antidepressant activity.

“We thus chose to focus our program on depression, as this offered a very different target that might lead to something better, with a faster onset of action,” Kozikowski said.

While the main focus of the research now is to develop medications for depression, Kozikowski said it’s likely some candidate compounds may have other clinical applications, including the treatment of schizophrenia, pain and nicotine dependence.

In fact, the UIC drug discovery group — which also includes investigators from the Barrow Neurological Institute in Phoenix and from PsychoGenics Inc. in Tarrytown, N.Y. — has already found that some of these novel agents do work for pain in animal models.

Prior research has also shown that many smokers smoke to improve their mood, supporting the notion that nicotine itself has antidepressant properties. This would explain, Kozikowski said, why cigarette smoking is much more common among depressed individuals. A recent study found that smokers are 41 percent more likely than nonsmokers to suffer from depression.

Such studies suggest that nicotinic compounds that have been modified to reduce their addictive potential while retaining the ability to balance mood could provide a new family of antidepressant drugs, he said.

This new drug class could have greater efficacy and fewer side effects than antidepressant medications currently on the market that work by inhibiting monoamine reuptake, Kozikowski said. Side effects of current antidepressants include headache, nausea, insomnia, dry mouth, constipation and agitation.

In spite of the intensive efforts that have gone into the design and study of nicotinic drugs, very few of the compounds have reached clinical trials, Kozikowski said.

The new grant is part of the National Cooperative for Drug Discovery and Development Groups and is funded by the National Institute of Mental Health, one of the National Institutes of Health.

Source: University of Illinois at Chicago