Smoking Cessation Clinic
Dedicated to the goal of reducing the prevalence of tobacco use, the Clinic has conducted research towards elucidating the nature of tobacco dependence and the development of pharmacological and psychological treatment approaches. In so doing, it has assisted thousands of smokers in the New York area to stop smoking.
Research in this clinic led to the first controlled evidence that non-nicotine medications may be useful cessation aids; to the initial observations regarding the association between mental disorders, smoking, and smoking cessation; and to the development of the Nicotine Dependence Scale, a tobacco dependence measure based on psychiatric criteria.
Current research activities focus on social, psychological, genetic and treatment factors that influence the ability to stop smoking and avoid relapse. These activities provide opportunities for clinicians and investigators who wish to develop expertise in tobacco dependence treatment and research.
Risks of Smoking
Tobacco use is the leading preventable cause of death in the US, accounting for the deaths of more than 430,000 U.S. citizens each year - more than alcohol, cocaine, heroin, homicide, suicide, car accidents, fire, and AIDS combined. Tobacco is a leading cause of cardiovascular disease, is implicated in over 90% of all lung cancers, contributes to cancers at many sites including the larynx, esophagus, kidney, bladder, and cervix, and is a principal risk factor for respiratory illnesses such as emphysema and chronic bronchitis. Tobacco use also causes damage to non-smokers, for example to spouses, and young children in the smoker’ s environment through passive exposure to cigarette smoke.
Tobacco is a national economic burden, accounting for more than $100 billion per year in direct health costs to the smoker and indirect costs including perinatal care for infants of mothers who smoke, medical care costs due to second-hand smoke exposure, and other costs to society such as smoking-related fires.
Tobacco Dependence and Psychiatric Illness
Researchers at the Clinic have published studies during the past few years that have demonstrated a strong association between cigarette smoking and psychiatric illness. Compared with persons without mental disorders, persons who have a history of major depression, alcohol dependence, anxiety disorders, and schizophrenia have been shown to be more likely to become regular cigarette smokers and to have greater difficulty stopping. These findings, replicated in other research, have led to trials of various medications known to affect depression and other psychiatric disorders as smoking cessation aids. Of these medications, bupropion (Zyban) has been found to be a highly useful first-line treatment for tobacco dependence.
The best smoking cessation treatments address both the neurobiological and psychological aspects of tobacco dependence
Nicotine Replacement Therapies (NRT) - This includes the nicotine patch, nicotine gum, nicotine inhaler, and nicotine nasal spray. These replacement therapies provide users with lower overall nicotine levels than they receive with cigarettes and reduce withdrawal symptoms in most users. Clinical trials have shown that NRT doubles the rate of smoking cessation compared with placebo. The nicotine patch is applied once a day, while the gum, inhaler, and nasal spray can be used several times during the day, as needed. The nicotine patch and gum can be purchased without a doctor ’s prescription.
Bupropion (Zyban) – Daily use of Zyban for about 6 to 8 weeks, as well as combined use of Zyban and the nicotine patch, has been shown to substantially increase the short-term smoking cessation rate in several placebo-controlled studies. Zyban requires a doctor’s prescription.
Behavioral Interventions- Behavioral interventions aimed at helping the smoker manage the tobacco withdrawal period and develop coping skills to prevent smoking relapse have been shown to increase the usefulness of smoking cessation medications. Success rates increase with increasing duration and intensity of counseling and clinical support.
Participate in Research
The Clinic is now actively recruiting participants into two large-scale studies, both funded by the National Institute on Drug Abuse. One study examines whether extending treatment duration from the standard period of two months to six months will reduce the high relapse rate associated with smoking cessation. These treatments include Zyban, nicotine replacement, and counseling which are provided at no cost to participants. The other study, conducted with researchers from the Department of Medical Genetics at NYSPI, examines DNA material obtained from families of smokers to explore genetic factors that contribute to nicotine dependence. Individuals interested in participating in these studies may call the Clinic at 212-543-5905.
Director - Lirio S. Covey, Ph.D. Dr. Covey is a Research Scientist at the New York State Psychiatric Institute, an Associate Professor of Clinical Psychology (in Psychiatry), College of Physicians and Surgeons at Columbia University, and a New York State licensed psychologist.
Medical Director - Alexander H. Glassman, M.D. Dr. Glassman established the Smoking Cessation Clinic in 1986 and is the Chief of the Division of Clinical Psychopharmacology at the New York State Institute. He is also a Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons.
Study Physicians – Jane Fried, M.D., Joshua Berman, M.D., Ph.D
Program Manager – Rene Laje, Ph.D.
Clinical Coordinator - Sally Woodring, R.N.
Counselors - Roxanna Rodriguez, B.A., Victoria Salzman, B.A., Fay Stetner, M.A.
American Cancer Society- www.cancer.org/tobacco/
American Heart Association- www.americanheart.org.
National Institute of Drug Abuse (NIDA)- www.nida.nih.gov/drugpages/nicotine.html
Nicotine Anonymous- www.nicotine-anonymous.org/
NYC Tobacco Control Program- www.ci.nyc.ny.us/html/doh/html/smoke/smoke.html
This page updated 04/10/07