Would-Be Quitters Get Help Winning Against Nicotine
The urge will pass. Lucy Hellenbrand silently repeats this mantra to herself each time she watches others smoke and battles the temptation to light up. Hellenbrand, 28, who works for a printer in Middleton, Wis., chucked her 10-year, pack-a-day addiction on February 1 and is determined to be done with cigarettes once and for all. "I have tried to quit several times in the past," Hellenbrand says. "But it only lasted a week or two." This time, with the aid of a medication called Zyban, nicotine-replacement skin patches, and a support group at the University of Wisconsin-Madison, she hopes to make it stick.
For hard-core smokers like Hellenbrand, it takes an arsenal to beat the habit. "Everyone knows how difficult it is," she says. Of the nation's 50 million smokers, at least 20 million try to quit each year, but fewer than 6 percent succeed in the long term. And these days, it's the toughest cases who are trying to abstain. "Work-site restrictions and social disapproval have gotten the easy-to-quit smokers to give it up," says John Hughes, a professor of psychiatry, psychology, and family practice at the University of Vermont who specializes in nicotine research. So have statistics showing, for instance, that smokers risk shortening their lives by an average of 13.4 years. "Now we are left with the ones for whom quitting may be much harder," says Hughes.
But smokers and their doctors are mounting a renewed campaign against nicotine, with effective new weapons and an approach that treats smoking not as a bad habit akin to nail-biting but as a chronic disorder that calls for serious medical treatment. Ex-smokers can blunt the withdrawal effects and cravings by taking Zyban, a prescription antidepressant approved three years ago for smoking cessation. They can attend counseling sessions to boost their resolve. They can use nicotine patches to ease the transition. Or, like Hellenbrand, they can do all three. In studies, these three approaches have increased the chance of success for quitters by 5 percent to 30 percent compared with going cold turkey. And potentially more powerful weapons are already in clinical trials: other antidepressants, and drugs that block nicotine receptors in the brain.
Renaissance drug. Doctors should be using these tools to help their patients give up cigarettes, a surgeon general's report due out this summer will advise. Treating nicotine addiction as a medical problem not only recognizes that many smokers need help to quit but also removes the sense that relapse reflects failure. "This is a significant, chronic condition not unlike high blood pressure [or] diabetes," says Michael Fiore, director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School. "And, as with high blood pressure, if doctors and patients stick with it, effective treatments can be found."
Most smokers get hooked in their teens, when health concerns seem remote (box, Page 60). Besides offering a way to rebel, smoking introduces teens to what Hughes calls a "renaissance drug" because its effects range from mood stabilization to improved concentration and weight control. "People use nicotine as a tool," he says. "They become dependent on its ability to deliver the benefits every time they smoke." The drug works through the same pathways in the brain as other chemicals of addiction, increasing levels of dopamine, a brain chemical responsible for feelings of pleasure. It elevates mood and sharpens concentration, which may explain why people with a history of depression, attention deficit disorder, and schizophrenia are far more likely to smoke than other people--and have a much harder time quitting. Genes play a role, too, making some people more likely to become addicted.
advertisement
