slideshow widget

Thursday, September 23, 2010

Is nicotine addictive?

This is part 2 of a series by Tim Frymyer from over at To view part 1 in this series, click here. To view part 3, "Stop smoking Aids" click here.

Thanks again to Rick for letting me occupy the Respiratory Therapy Cave for another day to discuss the topic of smoking cessation. Today we’ll look at addiction. For over fifty years now, people have been telling us that smoking is addictive. The nicotine is said to increase the levels of dopamine in your brain which then gives the smoker that pleasure sensation or that feeling of satisfaction, every time they inhale. In fact, the brain produces more receptors to accommodate more and more nicotine, in an effort to get more of that feeling. Researchers state that over 85% of all smokers are addicted to nicotine. Given the low success associated with smoking cessation aids and the relatively high rate of recidivism or relapse, it is easy to see how one could come to the conclusion that nicotine is addictive. In fact, nicotine is said to be as or even more addictive than opium or cocaine.

The second part of habitual smoking is the behavioral side. We humans are creatures of habit and tend to associate certain activities together. For example, we all know people who smoke only when they drink. Those two behaviors are said to be associated or linked. Many smokers take cues from their environment which then trigger that smoking response. Often times these are simple cues like finishing a meal, driving to work, or some other basic, repeated cue that occurs throughout the day. Behaviorists say that the act of smoking takes on a Pavlovian response to environmental triggers. Adding this classic conditioning makes smoking a difficult one-two punch to beat.

However, new research from Tel Aviv is challenging the assumption that smoking causes a physiological addiction, like heroin. In the Journal of Abnormal Psychology, Dr. Reuven Dar examines the idea that smoking may be a simple case of mind over matter. His premise states that smoking's primary driver is behavioral. He feels these triggers are so strong, they cause the appearance of physiological addiction. His study looked at a simple measurement tool, craving intensity on regular smoking days, a voluntary day of abstinence and the required smoking cessation on the Sabbath.

His findings show that cravings on the Sabbath were less intense when the smoker knew they couldn't smoke. However, the cravings on the day of abstinence were just as strong as the regular smoking days. This lead Dr. Dar to conclude that when the individual knew they couldn't smoke, they were not showing the addictive calling card, intense cravings, that were present on every other day; in essence, mind over matter.

I think we all would agree that smoking addiction is a very complex physiological theme to dissect, though there just may be something to Dr. Dar's research. After treating thousands of patients in the hospital, it has been my experience that once the patient had made up their mind to stop smoking, it didn't really matter what method they used, they simply stopped. And they seemed to stop without any trouble. I’m sure you all have had similar experiences with your patients as well.

Skeptics, however, will argue this “mind over matter” concept. Research is still warranted to determine just which side of the addiction represents the most influencing motivation to smoke. In fact, there is also new research out of Duke University pointing to a smoking gene which, when present, can predict how successful a person will be when trying to quit. However, this genome testing is very expensive and still in it's infancy.

But I believe the idea founded in Dr. Dar’s research can give us a unique opportunity for education when we talk with our patients. Many patients feel quitting is just too difficult, especially in light of the very real stress they may be feeling about their current physical condition. However, we can give them hope and perhaps convince them that quitting may just be as simple as making a decision, followed by another decision and another. Simply resolving each day to quit, might be the “trick” our patients have been looking for

No comments: