Medical Treatments for Tobacco, Smoking and Nicotine Addiction

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Nicotine addiction, like other addictions, has more than one component. Successful medical treatment has to stop a dependence on the drug itself, and also stop the habit. The act of smoking – the whole routine of lighting, inhaling; the gestures and mannerism; even the equipment needed, the ashtrays and lighters – becomes bound up into unthinking habit. These behaviors are just as difficult to break as the physical addiction to nicotine itself.

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The habit is largely psychological, but is reinforced by the drug. Smoking becomes a script played out whenever the urge hits. The initial craving is driven by blood levels of nicotine, so that as the amount in the body falls, an urge to smoke arises. But once this trigger is pulled physically, all the behaviors come into play. At no point does a specific decision have to be made. The next cigarette (or dip of snuff, or chaw) just ‘happens’.

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Nicotine replacement therapy

Unlike other drugs, nicotine addiction is legal. One strategy is then to replace the more harmful ways of taking the drug with less harmful alternatives. There are two reasons this helps. The first is to break the scripted, unthinking behavior of lighting a cigarette or taking a dip of snuff. Patients find that eliminating the unconscious routine will help them when they finally quit altogether. It is a divide-and-conquer strategy. Gums and patches can help addicts separate the behavior of smoking from the physical cravings.

The second reason replacement therapy helps is that the dosing is different. Patches and nicotine gums do not push the drug into the body as quickly as absorption from the lungs. The cycle of spiking a high amount of nicotine in short periods (20 – 40 cigarettes a day or more) is switched for a steadier dose when a patch is used. This helps retrain the physical addiction away from the more immediate craving/smoking cycle.

Replacement therapy can be found in many forms:

Gums, inhalers, transdermal patches, and even a nasal spray.

Medications for nicotine addiction

Medications used to treat nicotine addiction come in two types. The first specifically addresses the cravings smokers suffer when they try to quit. The actual physical withdrawal from nicotine is quite quick. Most smokers are free from the physical effects after just a few days, but what causes them to take up the habit again are the mental effects, which can be quite powerful. It seems, from the smoker’s point of view, as if they are being tortured by cravings.

Zyban (buproprion)
Zyban was originally marketed for depression (under the trade name Wellbutrin) but was discovered to be useful in smoking cessation. It doesn’t block nicotine’s effects on the body, but helps make cravings manageable.
Chantix (vaenicline)
Chantix is a type of medication that blocks nicotine’s effects on the body. Cigarettes no longer satisfy the physical addiction -- as if something other than tobacco was being smoked. These medications do not block cravings however, and recently, there have been warnings about suicide risk. It is not known how these drugs might make someone suicidal.

Other treatments

Many other quasi-medical treatments for nicotine addiction exist. Hypnosis, acupuncture, herbal remedies and others are marketed. Primarily, the key element to all of these remedies (and important in pharmacological remedies as well) is how motivated a person is to quit. Unfortunately, many smokers underestimate the difficulty and the suffering they will undergo when they attempt quitting. The rule becomes, “Don’t quit quitting.” Someone who is highly motivated (perhaps because of a medical diagnosis) has a much greater chance of success – no matter which method they try.

Because motivation is such a strong component, almost any remedy will work for some populations. Even ‘cold turkey’ with no treatment at all will work if there is enough desire. How well patients do on non-medical therapies is in dispute, and many suspect a placebo element comes into play, so that if someone believes that hypnosis will help them, it may actually become a self-fulfilling prophecy. Each non-medical method has its promoters and all claim extremely high rates of ‘cure’.

photo by John Nyboer

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