1 January 2007
The Real Reasons You Smoke
by Serena Mackesy
The second-commonest New Year's resolution is to give up smoking. The commonest, of course, is to pressurize someone else into giving it up. Unfortunately, statistics show that both are destined to face disappointment: 35 percent of smokers try to give it up every year, but fewer than 5 percent will actually succeed by doing it cold turkey. In fact, only 45 percent of people who have ever smoked will succeed in giving it up in their lifetimes.
Despite the constant nagging, negative advertising and increasing levels of social exclusion, they're still there, the smokers, hopping from foot to foot in knee-deep snow and wondering why the world doesn't seem content with them wanting to give it up, but actually wants to hate them. In fact, given the tendency to violent radicalization the world is going through at the moment, it shouldn't be long before the fundamentalist grass-roots offshoot of ASH deems themselves entitled to start spraying petrol in the faces of the miserable grey-faced holdouts, animal-rights-style.
Smoking is stupid. But you know what? There's not a person on the face of the planet who has access to cigarettes that doesn't know that. That's why 80 percent of smokers would like not to do it. Smokers aren't stupid. In fact, given nicotine's stimulation of neurotransmitter production, smokers' brains are probably revving a bit higher than their non-smoking sisters' grey matter.
But it's not just a question of stopping, is it? Here are some facts about smoking, shorn of moralistic finger-wagging. They might help, they might not, but for those of you seriously intent on helping a loved-one stop lighting up, they might help you at least to understand the smoker's mindset.
- Researchers at the University of Osaka, Japan, have identified a gene linked with a propensity to nicotine addiction.
- While in the developed world, average rates of smoking stand between 20-25 percent, rates among those with mental health problems are far higher. Fifty percent of chronic depressives smoke, right up to over 95 percent of paranoid schizophrenics.
- Alcoholism treatment success is approximately 50 percent, opiate dependence is 60 percent, cocaine dependence is 55 percent and nicotine dependence is 30 percent.
- The only really effective drug therapy so far developed for smoking cessation is Bupropion. More commonly known as Zyban, bupropion was originally developed as an alternative anti-depressant to Prozac, stimulating production of dopamine and norepinephrine. A surprise side-effect during trials was that smokers on whom the drug worked also lost the desire to smoke. That said, there is little evidence that depression causes smoking in the first place. But the fact is that people with depressive tendencies are far more likely to experience dysphonic mood states when they quit.
- Nicotine works - to quote Mark S. Gold, M.D., Chief of the Division of Addiction Medicine at the University of Florida Brain Institute, writing in Psychiatry Today - like this: "Nicotine results in release of dopamine into the synaptic cleft as measured by in vivo micro dialysis with increased outflow in the nucleus acumens reported in laboratory animals. Nicotine’s dopamine overflow effects in the nucleus acumens are robust and similar to other drugs of abuse. Nicotine and other substances in smoke, inhaled almost continuously throughout the day for years causes changes in the brain that we call addiction." There is some evidence to suggest that these changes are likely to be permanent: hence the smokers who gave up 30 years ago who still long for just one hit.
- Bearing that in mind, it would be sensible to suggest that nagging will not do a whole lot of good. Much better, therefore, to concentrate on stopping them starting in the first place. But as magnificent pop-boffin Malcolm Gladwell points out in The Tipping Point, approaches to doing so thus far have been a resounding failure, mainly because, at the point at which most teenagers take up the habit, peer example is going to be far more potent than lectures from people they regard as contemptibly uncool, such as teachers, politicians and parents. The people to target are the style leaders among the teenagers themselves. If they didn't smoke, then the likelihood is that a lot of their peers would follow suit. The problem being that teachers are notorious for misidentifying role models. And advertising people seem to think that "don't smoke or he won't want to snog you" suffices as a "cool" message. Sigh.
- Among other positives, nicotine increases the strength of synaptic communication between neurons in the hippocampus: it really does, as smokers often claim, aid memory and concentration. It has been shown to have positive effects in inflammatory bowel disease and ulcerative colitis. It is thought likely that, medicinally, nicotine may well have uses in both memory and movement disorders, and is thought to have neuroprotective effects in drug users.
- While it is true that nicotine is necessary to smoking, smoking is not necessary to the intake of nicotine. Until recently, the medical establishment's approach to nicotine has been one of total prohibition. There are signs, however, that this attitude is changing. The British Medical Journal reported that a 1996 study had shown no untoward effects from five years' use of nicotine gum: certainly not a finding that was widely publicized at the time; all the information I've received up until this point was that nicotine replacement therapy (NRT) would Still Cause Cancer. Interestingly, US Public Health Service guidelines recently suggested that prolonged use of NRT was necessary for some smokers, and infinitely preferable, from a health point of view, to continuing to smoke. This, coupled with a study from the University of Vermont that came up with the startling news that cutting back is better than nothing, shows that a more realistic attitude is creeping in on the subject.
So, look: if you're hoping to get your loved one to quit tobacco, or if you're looking to quit it yourself, it's becoming fairly clear that NRT is the way to go, especially if you're dreading the assault of depression. Yes, we'd all like to be perfect people who can cope with life without props, but the fact is that vast numbers of us self-medicate one way or another, be it with Prozac, alcohol, exercise or fags. Give it a try. Do it gently. Use NRT to cut back and then use it as a substitute. Don't just expect to be smoke-free overnight, but treat it as a long-term goal. And if you get stuck ruining the taste of your red wine with the mint bite of a nicotine lozenge for the rest of your life? Well, it's still better than the alternative.
Tobacco Addiction Is Not Just Nicotine Dependence
Mark S. Gold, University of Florida Brain Institute