Treating Nicotine Addiction as a Chronic Disease

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“You will either quit smoking or you will never see me grow older.”

These were my words to my father when I was around four years old. He did quit and lived to see me become an adult, but it wasn’t easy for him. He had been smoking since age twelve, and not even professional soccer interfered with this habit. When he played in the 1960s and 1970s, he would ask the referees how long until halftime so that he could go to the locker room and light up to relax his nerves. His water-drinking teammates looked on with disapproval.

When he retired from soccer, his habit worsened. He couldn’t keep from smoking everywhere in the house and in front of family members; and so we would “smoke” with him. His appetite decreased, and his daily coughing and heavy breathing made him sound like a flaming dragon. A mild heart attack at age 51 made him realize that he wouldn’t be able to smoke two packs a day for much longer.

Unfortunately for my father, there were no nicotine patches or smoking cessation classes available in the 1980s in Greece. Every previous attempt he made to quit failed within a couple of weeks. It wasn’t until he was threatened by his angry four-year-old son that he finally succeeded. Little did we know that quitting could have killed him faster than smoking would.

The catastrophic effects of smoking on the human body are well known. The World Health Organization estimates that more than five million people die each year from tobacco-related illnesses. This is no surprise considering that a single cigarette burns nearly 7,000 chemicals, 69 of which are known to cause cancer. How, then, could quitting smoking have killed my father—or any smoker—faster than smoking itself?

As experts now realize, quitting “cold turkey” can be very painful and, under certain circumstances, dangerous to the person’s mental health. An ex-smoker may worry less about cancer and heart or lung disease, but find that moodiness, anxiety, depression, and even suicidal thoughts invade his or her life. There is also an increased risk of weight gain, which experts think is the result of over-eating due to nervousness and other psychological effects from nicotine addiction.

Just like cocaine and amphetamines, nicotine is a powerful stimulant that impacts the reward center of the brain. This sneaky stimulant mimics acetylcholine, the predominant neurotransmitter in the brain. Acetylcholine assists in basic muscle functions and neurological reactions such as the release of another neurotransmitter, dopamine, which plays a big role in bodily motion and motivates the body to feel pleasure.

While nicotine tricks your brain into thinking it is acetylcholine, it is also activates the neurotransmitter glutamate, which is associated with both short- and long-term memory. The stimulation of glutamate during the release of dopamine creates an ingrained reminiscence of euphoria connected to the consumption of nicotine. The frequent repetition of this chemical reaction throughout the day (by lighting one cigarette after another) is what generates such a strong addiction. Because of this, sudden nicotine deprivation can cause serious withdrawal and extreme stress.

In 2011, Public Library of Science (PLOS One) alarmed the scientific world with its findings in a smoking cessation treatment study. The study treatment included counseling without pharmacological intervention (“cold turkey”) and a variety of nicotine replacement products, such as bupropion (an antidepressant) and varenicline, known by the trade names Chantix and Champix. Researchers identified 3,249 reported cases of suicidal/self-injurious behavior or depression with varenicline being responsible for ninety percent of these. Bupropion and “cold turkey” comprised the remaining ten percent. Statistically, the use of varenicline showed a significantly increased risk of reported depression and suicidal/self-injurious behavior.

A few years after this study, a Vancouver Sun investigation accused Champix of the deaths of forty-four patients, thirty of them from suicide, since the drug’s approval in Canada in 2007. The Canadian press also linked Champix to more than 1,300 incidents of suicide attempts or ideation, depression, and aggression between 2007 and 2015.

Pfizer, which manufactures Champix, claims that there is reliable scientific evidence to support varenicline, including fourteen clinical trials with more than seven thousand smokers. The company also cites the product’s approval by regulatory authorities around the world to demonstrate that the medication is an effective and appropriate treatment option for adult smokers wanting to quit.

The pharmaceutical giant accused the Canadian paper of focusing on an extremely tiny number of patients who had bad side effects with Champix. Health Canada admitted in a public statement that the database of doctors, pharmacists, and drug companies reporting bad side effects experienced by patients represented as little as one percent of those who suffered complications.

Scientists are more alarmed now than ever about the possible consequences of quitting smoking.

Regardless of the incomplete numbers and statistics, scientists are more alarmed now than ever about the possible consequences of quitting smoking. As the study published by PLOS One concluded, the increased risk in quitting smoking is independent of treatment and usage of different drugs. Though varenicline was responsible for ninety percent of the reported cases, there was still that ten percent of ex-smokers who displayed suicidal behavior and depression with or without pharmaceutical help.

Those smokers who may be reading this should keep in mind that smoking is undoubtedly bad for you and is considered an early ticket to the grave by nearly every scientist and medical expert out there. However, you should also know that every individual is different; and what may work for others might not work for you. If you experience negative side effects, whether from quitting cold turkey, using anti-smoking treatments, or taking a spiritual approach such as yoga or meditation, call for a professional or ask for help. You are not alone in your struggles.

If you are reading as a member of the public or a healthcare provider, you ought to consider nicotine addiction as a chronic disease, which changes the structure of the brain and affects many aspects of one’s health. Doing so is a step towards decreasing the stigma surrounding smokers, as well as providing better resources and clinical support to those who desire to quit. The reality is that cessation may be a lifelong process with many relapses along the way. In such cases, ex-smokers may benefit from ongoing therapies similar to Alcoholics Anonymous, in addition to more conventional, short-term treatments. It is imperative that we support those individuals who make the decision, however tenuous, to improve their lives and those of their loved ones.

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About Author

Graduating from law school, serving in the Greek Navy, and excelling in martial arts weren't enough to keep Theo away from his first love: writing. His work has appeared in Ars Technica, Gizmodo, Ozy, and Mental Floss, among other outlets. He is the proud single father of a beautiful boy and is highly addicted to hot chocolate, great-smelling cologne, traveling, martial arts, and films. You can find him on twitter at @Theodorosll.

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