How might the increasing recognition that nicotine addiction binds smokers to their habit affect efforts to prevent and control smoking? Obviously, a biological addiction mechanism intensifies the bond between smoker and habit. But the FDA's finding on addiction is also "socially and legally" important, according to long-time tobacco opponent Stanton Glantz, a cardiologist at the University of California.
Not only did the finding give the agency power to deal with a substance that's been exempted from most consumer- and health-protection laws. It also put the dreaded word "addiction" into the public discussion, which is likely to distress the tobacco makers, who "shied away from using "addiction" in the warning labels," as Glantz puts it.
Addiction, he adds, "is a very potent idea with kids, because they smoke to be in control, and if they think they would not be in control, that would be a deterrent [to smoking]. That's why the companies did everything they could do to keep the word 'addiction' out of the anti-smoking armamentarium," he says.
Nicotine addiction expert Hughes agrees that the specter of addiction will scare many young people away. "Most youths know that heroin and morphine are addictive, and don't use them for that reason. They don't think the same way about nicotine."
In West Africa, the nation of Mali banned smoking in public just last June.
Help in quitting?
Better knowledge of nicotine's addictive nature will also help cessation programs, Hughes adds, by encouraging an approach parallel to the one used for treating heroin addicts, which, instead of relying on self-control and counseling, often includes treatment of associated psychiatric problems.
Hughes, who has consulted for SmithKline Beecham, maker of a nicotine replacement therapy skin patch, says unaided smokers have a 5 percent chance of quitting (per attempt). With a self-help kit, the odds double to 10 percent. With group therapy, or a nicotine patch, the odds double again to 20 percent. Combine group therapy and the patch, he says, and the odds rise again to 30 percent. Now you don't even need a prescription for nicotine skin patches.
These may be discouraging numbers, he says, but eventually they add up -- half of all smokers eventually quit for good. "You should not have the expectation that you are going to do it perfectly the first time. Look at golf or tennis -- how likely is it that you will do that perfectly the first time?"
Social factors
But cigarette addiction is more than nicotine addiction, Hughes adds. There is also "a very intense habit. ... If I had a habit for 30 years of puffing 200 times a day, it would be very difficult to stop," even without any chemical dependence.
Smoking, he adds, has been associated with taking a break, eating and sex. "These non-pharmaceutical factors can be as important" as the nicotine addiction. Thus some patients "can take all the nicotine patches (defined) they want, but until they get into a group, they are not going to quit smoking."
Clinically speaking
In the gathering effort to counter cigarette smoking, doctors are talking about making tobacco a new "vital sign." That would give it equal weight alongside blood pressure, heart rate and temperature, which are assessed at every clinic visit. "If we could get physicians and nurses to do that, we'd not only know the smoking status," says Ronald Davis, director of the Center for Health Promotion and Disease Prevention at the Henry Ford Health System in Detroit, we'd also be able to advise them to avoid tobacco more consistently, and offer more assistance in quitting."
Here's some quitting information.
These folks were hooked on the idea of describing the science of smoking and the nature of nicotine addiction.
 |
 |
 |
 |
There are 1 2 3 4 5 6 7 8 9 10 documents. (Glossary | Bibliography)