Psychiatric Comorbidity of Smoking and Nicotine Dependence: An Epidemiologic Perspective
Naomi Breslau, Ph.D.

SUMMARY: Associations of smoking with mental and substance use disorders have been consistently reported in clinical and epidemiologic studies. Both causal and noncausal explanations have been proposed. Dr. Naomi Breslau examined recent cross-sectional epidemiologic studies on age of onset of daily smoking and psychiatric disorders and a few prospective studies estimating the relationship between smoking and specific disorders. Elevated risks for subsequent first onset of panic disorder and agoraphobia in current smokers were reported in both types of studies. Breslau found results on smokers’ relative risk for major depression to be inconsistent, and explained details of these studies during her presentation.

The Neurobiology of Nicotine Dependence and Comorbid Psychiatric Disorders
George F. Koob, Ph.D.

SUMMARY: Dr. George Koob outlined the reward dysfunction hypothesis, which states that the neurochemical changes related to nicotine use and addiction are similar to those reward and stress function changes that are key elements of affective, anxiety, and psychotic disorders. Koob argued that the dysregulation of these specific neurochemical mechanisms (affecting serotonin, dopamine, gamma-aminobutyric acid, corticotropin-releasing factor, norepinephrine, and neuropeptide Y) may link the comorbidity of some psychiatric disorders with nicotine dependence. The reward dysfunction hypothesis provides a heuristic model with which to integrate molecular, cellular, and circuitry neuroadaptations in brain motivational systems involved in addiction and comorbid psychiatric disorders.

Nicotine-Dependence Treatment in Individuals with Schizophrenia
Douglas M. Ziedonis, M.D.

SUMMARY: Although evidence suggests that existing nicotine dependence treatments can be effective for the schizophrenic population, under-recognition and under-treatment of nicotine dependence in this population continue to be common. Dr. Douglas Ziedonis’ presentation stressed that the unique mental health treatment setting and schizophrenia-specific characteristics contribute to the onset and maintenance of nicotine dependence in individuals with schizophrenia, and that there is both an immediate need to address tobacco use in this population and to expand research agendas. Ziedonis discussed innovative psychosocial interventions and reviewed research supporting medications and psychosocial treatments for this population. Effective model programs and system changes were presented, including the specialized program for schizophrenic smokers at the University of Medicine and Dentistry of New Jersey Tobacco Dependence Program (tobaccoprogram.org).

Behavioral and Pharmacological Treatments for Smokers with Depression
Richard A. Brown, Ph.D.

SUMMARY: Dr. Richard Brown’s presentation reviewed existing clinical research evidence for the efficacy of adding cognitive-behavioral mood management treatment and for the use of antidepressant pharmacotherapy for smokers at risk for poor outcomes due to depression-related characteristics. Research has demonstrated significant associations between depression and cigarette smoking, and evidence suggests that depression is a risk factor resulting in poor smoking cessation outcomes. Early studies suggested that past major depressive disorder was a primary risk factor for poor outcomes in smoking cessation, but more recent evidence suggests that current depressive symptoms and a history of recurrent major depressive episodes convey the greatest risk in this regard.