Would-Be Quitters Get Help Winning Against Nicotine
The flip side of nicotine's pleasurable effects is the misery experienced by many smokers who try to quit. Long-term exposure to nicotine causes the number of nicotine receptors in the brain to increase. This boosts the body's demand for the drug, according to Jack Henningfield, former head of clinical pharmacology at the National Institute on Drug Abuse. These hungry receptors lead to irritability, depression, and anxiety when the brain is deprived of nicotine. "There is no debate about the fact that if you are smoking and you stop, you may have problems with concentration, mood control, and handling stress," says Henningfield.
Nicotine-replacement products, which provide much smaller doses of the drug in gum, skin patches, nasal sprays, or inhalers, help smokers wean themselves from cigarettes. Jane Cooper, a 66-year-old retired cook from Monona, Wis., smoked a pack a day for 45 years. She tried to stop three times before doctors told her she had emphysema, a lung disease common in smokers. Three years ago, she finally succeeded. "I don't think I would have been able to quit had it not been for the patches," says Cooper. "I wanted a cigarette every minute, but the patches made it much more tolerable." Treatment with patches typically lasts between six and eight weeks, but Cooper says that she still slaps one on when she will be with people who are smoking.
Less pain, less gain. The antidepressant Zyban can also help, by minimizing effects such as bad mood, irritability, and difficulty concentrating. As a bonus, it can forestall the weight gain--typically 5 to 10 pounds--that makes some smokers reluctant to quit. "Zyban really helped me keep down the weight gain," says Lucy Hellenbrand. "And it helped control the mood swings I experienced in the past." Others need even more help. Gary Ferrell, 43, an inventory manager for the Durham County Alcoholic Beverage Control Board in North Carolina, smoked 21/2 packs of cigarettes a day for 26 years. "I felt it was impossible" to quit, after four years of unsuccessfully trying hypnosis, Zyban, patches, and self-help tapes. "One time I made it two months without smoking," he says. "But each time I quit, eventually I would tell myself that I was only going to smoke one cigarette, then I would buy a pack, and pretty soon it was all over." Finally, Ferrell enrolled in a clinical trial of an experimental drug that blocks nicotine receptors in the brain, and he stopped smoking over a year ago.
Mecamylamine, the drug under investigation, is meant to block the rewarding effects of nicotine while the person is still smoking. "The connection in the mind of the smoker between smoking and feeling good is very strong," says Jed Rose of Duke University, who is the study's lead investigator. That link, he says, " is a major contributor to relapse."
So is what Leslie Schuh, a professor of psychiatry and behavioral neurosciences at Wayne State University School of Medicine in Detroit, calls a sense of mourning in smokers who quit. "People become very attached to their cigarettes because they provide a sense of security, relief from boredom, and help people relax," she says. "Often people need help finding something to fill the void." Many take up hobbies such as knitting or gardening. Counseling can also help quitters through the rough patches. Willpower often breaks down at parties where people are drinking alcohol or after stressful encounters, says Saul Shiffman, professor of psychology at the University of Pittsburgh. Step out of the room for a 10-minute break if necessary, he suggests. Some doctors recommend avoiding alcohol for the first few weeks because it can weaken resolve and because many smokers reflexively light up whenever they drink. And if you relapse, don't give up, says Fiore. "Think about what helped and what hurt and use that information the next time you try."
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