Posted by Ron Hill on August 16, 2003, at 19:06:54
In reply to Re: Day 24 of Nicotrol Inhaler..., posted by Ame Sans Vie on August 16, 2003, at 15:42:17
Hi Ame Sans Vie,
> That's really interesting, thanks... it's really awful to think that the vast majority of smokers would not even be motivated to quit after reading things like this.
It is a very difficult addiction for anyone to break, and as discussed in the two articles pasted below, it is even more difficult for certain segments of the population (e.g. those with a history of depression). The hell of the depression and/or the torment of the dysphoric mood-states that some people experience in association with smoking cessation, can make the risk of a shortened lifespan seem like an acceptable tradeoff in order to ease the immediate pain. Therefore, it is little wonder that some people choose to run the risk of developing cancer (or one of the many other life-threatening diseases associated with smoking) while at the same time being fully aware of the dangers.
What is your plan of attack for the downward titration of your nicotine intake? I think the step-down patches are better than the inhaler when it comes to titrating off of nicotine (i.e.; breaking the addiction). With the patches the dosage is spread out evenly over the day, and it is easier to estimate the amount of nicotine administered on any given day. By contrast, the inhaler introduces additional variables such as the volume of the inhaled dose (how big a drag one takes), how long the inhaled dose is held in the lungs, how deeply the dose is inhaled, etc. All of these variables add uncertainty to the estimation of the quantity of the daily administered dosage. Clearly, if the goal is the gradual downward titration of the nicotine dosage, then one can ramp down more smoothly if one can more accurately estimate the amount of nicotine administered on any given day. Having said all that, if you like the inhaler, use it for the titration. Go with what works for you.
I'm cheering for you Ame Sans Vie. If (God forbid) you ever desire a cigarette to the point that you are tempted to ignite one and draw the poisonous gases into the vunerable tissues of your lungs, talk to me first and obtain my approval beforehand.
Here are the two articles:
http://www.nih.gov/news/pr/may98/nida-06.htm
NATIONAL INSTITUTES OF HEALTH National Institute on Drug Abuse
EMBARGOED FOR RELEASE
Wednesday, May 6, 1998
2:00 PM Eastern Time Mona W. Brown
Sheryl Massaro
(301) 443-6245
Severity of Brain Changes
During Nicotine Withdrawal Comparable to Those for Other Drugs of Abuse
Dramatic changes in the brain's pleasure circuits during withdrawal from chronic nicotine use rival the magnitude and duration of similar changes observed during withdrawal from other abused drugs such as cocaine, opiates, amphetamines, and alcohol, according to a new study funded by the National Institute on Drug Abuse (NIDA), National Institutes of Health. Scientists at The Scripps Research Institute found significant decreases in the sensitivity of the brains of laboratory rats to pleasurable stimulation after nicotine administration was abruptly stopped. These changes lasted several days, and may correspond to the anxiety and depression experienced by humans for several days after quitting smoking "cold turkey."
"Understanding these decreases in the brain's sensitivity to pleasurable stimulation that occur during nicotine abstinence helps explain why it is so hard for people to stop smoking. This understanding may also help in the development of better treatments to address the withdrawal symptoms - depression, anxiety, irritability, and craving - that interfere with people's attempts to quit smoking," said Dr. Alan I. Leshner, director of NIDA. "The similarity to other drugs of abuse emphasizes that there are common characteristics to withdrawal from all addictive substances, one of which is a decrease in sensitivity to pleasure."
A research team led by Dr. Athina Markou of The Scripps Research Institute in La Jolla, California measured the effects of nicotine withdrawal and abstinence on the brain's sensitivity to pleasurable electrical stimulation. Researchers allowed rats to self-administer a baseline intensity of pleasurable electrical pulses and measured "pleasure" (or reward) associated with stimulation of the area of the lateral hypothalamus, part of the brain's reward circuitry. Reward sensitivity measures were taken both during and after administration of nicotine.
For one week, the rats were given a steady dose of nicotine that produced blood levels equivalent to those of an individual smoking one and a half packs of cigarettes a day. While the nicotine was being administered, the rats' sensitivity to brain reward remained stable, as indicated by no significant change in the self-administration of the electrical pulse. When the rats were taken off nicotine, however, intensities of electrical current had to be increased by more than 40 percent before the rats again found them to be pleasurable. Brain reward sensitivity was affected for at least 4 days and some rats did not return to baseline for over 2 weeks.
"These results are comparable to the altered brain reward sensitivity found also during withdrawal from many other addictive drugs," said Dr. Markou. "The results of this research indicate that we have a good animal model to study the neurobiology of nicotine abstinence and thus assist in the development of behavioral and pharmacological treatments for nicotine addiction." This research was funded in part by Novartis Pharma AG of Basel, Switzerland. The study, "Dramatic decreases in brain reward function during nicotine withdrawal," will be published in the May 7 issue of NATURE.
The use of nicotine products is a major preventable cause of death in the United States. About 62 million Americans age 12 and over are current cigarette smokers, making nicotine one of the most heavily used addictive drugs. The scientific facts about nicotine addiction, based on the latest research, will be the focus of Addicted to Nicotine: A National Research Forum to be held July 27-28, 1998. The conference, sponsored by NIDA, the Robert Wood Johnson Foundation, the National Cancer Institute, and the Centers for Disease Control and Prevention's Office on Smoking and Health will highlight the sources of nicotine addiction, prevention of tobacco product use, and state-of-the-art treatment strategies. The conference will be held at the Natcher Auditorium on the NIH Campus in Bethesda, MD. For more information, contact the NIDA Press Office.
NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The Institute also carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on health effects of drugs of abuse and other topics can be ordered free of charge in English and Spanish, by calling NIDA Infofax at 1-888-NIH-NIDA (-644-6432) or 1-888-TTY-NIDA (-889-6432) for the deaf. These fact sheets and further information on NIDA research and other activities can be found on the NIDA home page at http://www.nida.nih.gov.
--------------------------------------------------http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s30646.htm
Radio National
with Natasha Mitchell
Nicotine Withdrawal
Monday 21 June 1999
Summary: The cravings for nicotine can last much, much longer than has been anticipated in the past. Some people still have cravings years after they've given up smoking.
Well from one addiction to another. Anyone who's tried to give up smoking knows how ghastly the cravings can be. For the first few weeks you feel awful, but it's meant to get easier after that. But what if it doesn't?It turns out it's not your imagination, or a sign of weakness. Researchers in the United States have measured the way people's withdrawal symptoms change during the months after their last cigarette, and they've found that for some people, the pain of giving up can last for a very long time.
Rae Fry visited the coalface, a Quit Clinic, and spoke to Judy.
MUSIC
Judy: I had been smoking for about 25 years and each time I had a child I always gave up smoking for health reasons, but then I would go back on as soon as I had my first two children. And then when I had my daughter I gave up smoking when I was pregnant and then I didn't smoke for eleven years after that. I don't think in that eleven years I really ever lost the urge. I still could have had a cigarette all that time. And then I started smoking again.
MUSIC
SONG - kd lang
My old addiction
Changed the wiring in my brain,
Sort of went and turned the switches
And I am not the same ...
Rae Fry: Poignant words from kd lang. And the testimony you heard was from Judy, a participant in the Quit Smoking program run by St Vincent's Hospital and the Curran Foundation in Sydney. This isn't the first time that Judy's given up, and lots of smokers can relate to her experience of craving a cigarette a long time after they've quit. But according to the theory of nicotine withdrawal, that's not the way it's supposed to be.
Professor Timothy Baker is from the Center for Tobacco Research and Intervention at the University of Wisconsin.
Timothy Baker: We were doing a lot of treatment studies, and in some of the treatments we would meet with smokers for many weeks or months after they quit. And our standard line, in fact what most treatment programs tell smokers, is that 'Well if you can just hold on for two or three weeks, things will get a lot better and your withdrawal will go away and you'll notice a steady decrease, and almost every day you'll be feeling better.' And we told smokers this time and time again, and we noticed that many smokers were coming back to us two months, three months after they quit and they'd tell us that 'It's worse than ever. You told me it was going to be better, and now it's worse, and why is that?' Eventually we started to listen to them and not just discount what they were telling us.
So we decided to actually measure withdrawal symptoms over a fairly good span of time, in this case two to three months, and we found that in fact we were wrong and the smokers were right.
Rae Fry: What Timothy Baker and his colleagues did was ask people to carefully record their withdrawal symptoms. This is what the quitters had to put up with: weight gain, sleep disturbance, irritability, anxiety, lack of concentration, and depression.
Timothy Baker: Those are the types of withdrawal symptoms that seem to be so important in getting smokers to relapse back to smoking, dealing with those things day after day after day, and of course they're associated with craving. Because when a smoker feels depressed, or when a smoker feels irritable or anxious, the first they think about is having a cigarette.
Rae Fry: Withdrawal symptoms in most studies are only measured in the early stages. In this study, people kept track of how their symptoms changed over time. And they found that the pattern varied enormously from person to person. For some people it was the way it was 'supposed' to be: their symptoms got worse for the first few days, then gradually declined after two to three weeks. But it wasn't like that for everyone.
Timothy Baker: In a good number of smokers, sometimes half, sometimes more, the symptoms either failed to go away, or they'd begin to increase at some point down the road, perhaps four weeks, five weeks after a person quits, we noticed a definite increase in the magnitude of those symptoms, and those are the smokers who are at greatest risk to go back to smoking.
Rae Fry: So for those people, rather than it getting easier over time, it actually gets harder?
Timothy Baker: Oh, absolutely. It gets harder and the difficulty is probably compounded by the fact that they're not expecting it. They were told it was going to get easier, they were looking forward to it getting easier and how disappointing it must be for it to be getting worse. And I'm sure those smokers they say to themselves, 'Well this proves it. I am a particularly highly dependent, or highly addictive smokers. I'm one of those smokers who can't quit.' And they don't see it as being a normal part of quitting that there may be these worsenings or exacerbations, they see it as a sure sign that they simply won't be able to quit. But it's not the case that they're doomed, because we do have a certain number of smokers in the study, who experience tremendous swings and withdrawal. They experience very severe withdrawal five weeks, six weeks after they quit, and yet they don't go back to smoking, and eventually their withdrawal symptoms decline.
Rae Fry: So what is it about those people that even though they have these very strong withdrawal symptoms weeks, months, after quitting smoking they're still able to give up?
Timothy Baker: Well we don't know exactly, because we don't know ahead of time who's going to be able to get through it. We haven't been able to focus on those people, but other research suggests the people who tend to be most successful are the ones who have the strongest, clearest reasons to quit. These are people for instance who might have been diagnosed for some smoking related disease. These are people who have finally come to grips with the fact that they've got to quit for the good of their kids or the good of their families. And also we know that certain groups of people, people who have a history of depression, are much more likely to have a tough time quitting. And also heaviness of smoking plays a role: someone who inhales deeply and smokes 40 cigarettes a day is going to have a tougher time quitting than the person who smokes 15 cigarettes a day. So the amount of smoking prior to quitting, not in terms of the number of years, but in terms of the heaviness of smoking, plays a big role.
Rae Fry: Professor Timothy Baker from the University of Wisconsin.
He admits that after what smokers had told him, he shouldn't have been surprised that some people's withdrawal symptoms lasted so long. But he was. And he was also surprised that the symptoms that really seemed to matter were the ones to do with mood. A lot of people tended to take up smoking again when they were feeling depressed or anxious.
Timothy Baker: Often we've concentrated on other aspects of withdrawal. For instance, we've concentrated on the weight gain and we've concentrated on the sleep disturbance, or we've concentrated on inability to concentrate. But in fact it's literally how bad you feel, it's how bad your mood is that is the crucial thing to examine.
Judy: You know, you have your ups and downs and you'll have an upset, or otherwise you'll have a social event, all different things are just triggered off. And it's like having a drink, one's never enough. You think you can have one and you won't have any more tomorrow, but then something else triggers it off again in a few more days, and before you know, you're back on it again.
Rae Fry: So why do some people find it so much harder than others to give up smoking? Timothy Baker says there's probably a number of reasons, both psychological and physical. But it could be partly genetic differences in the way that the wiring in our brains responds to nicotine.
Timothy Baker: There are receptors like locks in the brain, and the nicotine molecule is like a key that fits into the lock. And these receptors are widely distributed throughout the brain. Nicotine turns on these receptors very effectively, and so nicotine excites a lot of different parts of the brain. One of the parts of the brain that it excites is an area of the brain where we experience pleasure, where we experience the rewarding effects of all sorts of things like food and sex; and nicotine turns on this same area. And so if you think about it in terms of what withdrawal is like, it's like experiencing a stimulus that becomes highly valued, highly important, in a way, highly loved like, say a loved one, a person. And then withdrawal is simply having that stimulus taken away very abruptly and withdrawal is akin to mourning.
SONG
My old addiction
Is a flood upon the land
This tiny lifeboat can keep me dry
My weight is all that it can stand ...
Rae Fry: But does knowing all this help if you're actually trying to give up smoking? Judy, from the Quit Smoking program, is finding it a bit easier with the help of her fellow quitters.
Judy: People have compassion and that for people who drink or have a drug problem, and they're getting counselling and they're getting support. But when I said I was giving up cigarettes to my older son who's a fitness trainer, he just said, 'Mum, give me the cigarettes. You don't need to go in there, just give up smoking' because he doesn't understand. Coming in here to the session we had to write how we felt. I just wasn't feeling myself, just not motivated, and the lady sitting next to me wrote identical to me, and that made me feel good, because I thought, 'Oh I'm just depressed', and when I spoke to the others they were having the same sort of feelings.
Timothy Baker: I think that being forewarned is being forearmed. I believe that's true. But I also think that it opens the door to different kinds of treatment. For instance, one thing you might do is you might have smokers check in via phone, or check in via computer every day; once a day they check in, and you simply look at their withdrawal symptoms to see how they're doing, and if they're starting to experience much worse withdrawal, you could change their medication. You could have them come in for some additional sessions when things are getting really rough.
Rae Fry: People who were partners, or friends of people who were trying to quit smoking, do you think that it might make people a bit more sympathetic?
Timothy Baker: Yes, I hope so. It is a tremendously difficult thing for many people to do. Some people can put down their pack of cigarettes and have nary an urge and quit with apparent ease. But for many smokers it's a prolonged, very draining, very stressful, very difficult thing to do, and smokers are often chagrined to find that their spouse or their families two weeks after they quit, say, 'Well now that's over, don't you feel better?' but the fact of the matter is it's not over and they feel worse. It's only the beginning.
SONG
My old addiction
Now the other side of day
Springtime of my lifestyle
Turns the other way ...
Natasha Mitchell: kd lang. And before her, Professor Timothy Baker from the University of Wisconsin. Rae Fry with that report.
Reference: Thomas M. Piaseckiki, Michael C. Fiore, and Timothy B. Baker, 'Profiles in discouragement: two studies of variability in the time course of smoking withdrawal symptoms', Journal of Abnormal Psychology, 1998, Vol.107, No.2 pp 238-251
Guests:
Professor Timothy Baker
Center for Tobacco Research and Intervention,
University of Wisconsin Medical School,
Madison, Wisconsin,
U.S.A.
More information:
Center for Tobacco Research and Intervention, University of Wisconsin
http://www.medicine.wisc.edu/sections/gim/ctri/ctri.htm
For information about the Quit Smoking Program, contact:Ilan Cohen,
Centre Co-ordinator,
Healthy Lifestyle Centre,
St. Vincent's Hospital,
Darlinghurst NSW 2010
Ph: 02 - 9361 2625
email: smokerssvhs@hotmail.com
National Quit Campaign
http://www.quitnow.info.au/
Quit Smoking Program, St. Vincent's Hospital and The Curran Foundation
http://wwwsvh.stvincents.com.au/healthy.htm#QSMOKE
Quit Smoking Program, St. Vincent's Hospital and The Curran Foundation
http://wwwsvh.stvincents.com.au/healthy.htm#QSMOKE
poster:Ron Hill
thread:251147
URL: http://www.dr-bob.org/babble/20030812/msgs/251414.html