your weapon carefully ...
The goal of the project, Piper says, is to unify these ideas into one strong theory that explains smokers' behavior and predicts the best tactics to help individual smokers quit. Physical withdrawal can be acute, but it is always short-lived. The psychological dependence -- rooted habits, memories of stress relief, social routines -- is the kicker in quitting, says Piper.
A smoker's reward hits the brain in mere seconds and, since the behavior does not interfere with a user's ability to function, it is easy to maintain. "A person can light up 10 or 20 times a day, always see other people smoking, usually find a place to do it in the middle of the day," Piper notes. These reasons, along with nicotine's powerful addictive qualities, make smoking one of the hardest addictions to overcome.
Still, says Piper, different rules probably apply to light and heavy smokers. Heavy smokers "feel like smoking is a best friend," while lighter smokers often merely enjoy the momentary taste and experience.
Thankfully for quitters everywhere, there is a method for every disposition, and more on the way.
Telephone quit lines, for example, are becoming an increasingly-common -- and, says Piper, effective -- way to offer would-be quitters the social support and advice that is so needed. The Wisconsin quit line, for example, offers immediate counseling and referrals for callers who are interested in further treatment. Curious? Try it out: 1-877-270-STOP. Counseling alone increases a person's chances of quitting long-term by a factor of two, says Douglas Jorenby, Director of Clinical Services at Wisconsin's Center for Tobacco Research and Intervention. "The more you talk to people, the more time you spend with them, the more likely they are to quit," he says.
Still, nicotine-replacement products are the most popular quitting aids. They include the patch, the gum, the nasal spray, the inhaler and the recently-approved lozenge.
Jorenby's research has confirmed that, like counseling, nicotine-replacement strategies nearly double the long-term quit rate. And, he says, "Combination therapies are especially promising, particularly if people haven't been able to quit using just one treatment. No one should have to try to quit old turkey even there first time out."
But nicotine-replacement products have not been an absolute success. One reason is that the steady dose of nicotine provided by a patch or a stick of gum does not supply the instant reward of a cigarette-induced buzz. And now that nicotine replacement therapy is available over the counter, people are less likely to stick with a product for the full treatment.
And for those who consider nicotine-replacement products as a permanent replacement for cigarettes, there is some reason for concern. "These products are better than smoking," says Philip Dennis of the National Cancer Institute Center for Cancer Research, "but nicotine alone might be deleterious to your health."
Dennis and his colleagues have found that nicotine alone stimulates the growth of cancer cells cultivated in a lab dish. While preliminary, the results suggest nicotine may not be as innocuous as was once assumed. Still, Dennis says, his work should not be taken as a reason to avoid nicotine-replacement products, when used properly. (For an excellent discussion of Dennis' work, see "More than a kick," in the bibliography)
Another, somewhat more dramatic, treatment option is the anti-depressent bupropion (marketed under the name Zyban). A recent study of schizophrenics, a group with strikingly high smoking rates, found that smokers were 40 percent more likely to quit successfully when treated with bupropion than with no medication. Another study conducted earlier this year found that 25 percent of women smokers with a history of depression were able to quit for a year using bupropion, compared with 8.5 percent of those who took a placebo. Among the general population, bupropion improves the chance of quitting by about 10 percent.
Photo: Department of Veterans Affairs
The treatment option that may be stirring the most excitement, however, is the long-awaited nicotine vaccine, now in human trials. Nicotine molecules are too small to be recognized by the human immune system, so the body has no way to fight it off. The vaccine, developed by the UK-based company Xenova, is a solution of nicotine molecules attached to larger proteins. The idea is that the body will recognize the duplex molecules as foreign, and an immune response will fire up. When a vaccinated person is later exposed to nicotine -- in whatever form -- soldier antibodies will recognize the drug and clear it away before it reaches the brain. In theory, a smoker could fire up a pack of Marlboro Reds and be rewarded with nothing more than a hacking cough.
The treatment options can be overwhelming as they are plentiful, Jorenby admits. That's why services like tobacco quit lines are a good place to start. Piper's advice? "Get help. We don't have a magic bullet that will guarantee you can quit, but get help and keep trying. The more you try, the better your chances."
-- Sarah Goforth
Light up our bibliography.
©2003, University of Wisconsin, Board of Regents.