Five Questions Douglas Ziedonis, MD, MPH, Director, |
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| Q | Why does tobacco remain the number one cause of death in the United States? Given all the information we have about the benefits of quitting, wouldn't you think that Americans, especially those in the boomer population who are now just turning 60, would simply stop or pick a program to help them kick this deadly habit? |
The boomer population knows the serious health risks of tobacco use. Unfortunately, many don't appreciate that quitting later in life can still result in short and long-term health benefits, and improve life expectancy. Many, who are addicted, may not understand how effective a combination of available treatments can be. About one-third of smokers die prematurely of tobacco related diseases (cardiac, pulmonary, cancer, etc), shortening their lives by 13 to 14 years. A long-term study found that smokers who quit by age 50 gain about 6 years, and by age 60, at least 3 years. Even in the first weeks and months after quitting, there are improvements in lung and heart function, including less coughing, tiredness, shortness of breath, and fewer sinus problems. Cosmetic changes are apparent in better skin tone and oral hygiene. Within a year of quitting, the excess risk of coronary heart disease caused by smoking is reduced by 50 percent. There are better surgical outcomes for nonsmokers, too, including faster wound healing. Benefits continue to build after five to 15 years and include reduced risks of stroke, cancer, and cardiac and lung disease. There are also financial savings. Meanwhile, according to the World Health Organization, someone dies every eight seconds due to tobacco use.
| Q | How did you become interested in addiction psychiatry? |
My interest began in medical school and was solidified in my residency training. Addiction is both a public health and a clinical issue. It can masquerade as any psychiatric problem, and has a profound impact on an individual’s well-being, career, family, and life in general. Although often a chronic condition, recovery can also be remarkable, and I have found satisfaction in helping both individuals and their families.
My career has coincided with the explosion of new knowledge about addiction and the brain. I’ve had wonderful opportunities to work with world leaders in addiction psychiatry. As a Penn State medical student doing a fourth year elective at the University of London, I spent two months with Griffith Edwards, MD, an international leader in alcoholism for the WHO. I also had the good fortune to work at UCLA and Yale University, both on the cutting edge of addiction psychiatry.
In 1998, I joined the UMDNJ faculty as its first academic addiction psychiatrist and head of the newly created division of addiction psychiatry. I have focused on establishing research, clinical and training activities, and most importantly, on recruiting new junior and senior faculty and developing the potential of promising junior faculty. Our outstanding academic addiction psychiatry program is recognized at a national level.
| Q | Can you talk about the connection between smoking and mental illness? |
There is a strong association between tobacco smoking and mental illness, and many biological, psychological and social factors might explain this relationship. About 70 percent of my patients smoke tobacco - and in some settings, such as methadone maintenance clinics, the smoking rate is about 95 percent. Work at Yale University found: high rates of nicotine use among individuals with schizophrenia (>70%); that heavy cigarette smoking is associated with other drug abuse; and that smoking patients require higher medication doses. I was not surprised to learn of the recent Harvard study findings that 44 percent of all the cigarettes consumed in the U.S. are by individuals with psychiatric disorders. Although we knew of the high rates of smoking among psychiatric patients, it was not until 10 years ago that there was clear evidence that most psychiatric patients die of smoking caused illnesses.
| Q | Describe your research interests. |
During the past 20 years I have been developing research to better understand and treat individuals with co-occurring mental illness and addiction. Mental illness and addiction commonly co-occur and the combination results in worse prognosis, treatment compliance, and outcomes compared to either disorder alone. Historically, individuals with mental illness or addiction have been treated in separate mental health and addiction treatment systems as if the disorders were unrelated, and research paralleled this divide. My methodologies have included clinical epidemiology, clinical trials, behavioral therapy development and health services research strategies. We have found that co-occurring disorders are associated with differences in psychopathology and neuropsychological functioning, poorer response to traditional psychiatric or addiction treatments, and increased use of high cost services. Our findings also supported the need for a new treatment model, and I developed the Motivation Based Treatment Model that matches specific treatment approaches to different motivational levels. Many mental health treatment agencies and systems have adopted this model.
| Q | Who are your mentors? |
Some of my current mentors go back to my residency at UCLA, including Joel Yager, Robert Liberman, Rick Rawsen, Murray Jarvik, Steve Marder and David Gorelick. Others are from my faculty experience at Yale and through work on other projects on a national level - including Tom Kosten, Herb Kleber, Bruce Rounsaville and John Hughes. Since coming to UMDNJ in 1998 I have benefited from mentoring by more senior faculty here. In the area of tobacco, John Slade at UMDNJ was an inspiring leader and mentor. I am grateful for the time that we had to work together to begin the development of the UMDNJ Tobacco Dependence Program. Even with his tragic death in 2002, our work at the Tobacco Program is a continuation of his original efforts.