Nicotine addiction is mind than matter

Nicotine patches and gum have become a common form of treatment to help people stop smoking. However, most smokers quickly discover that they are not very effective in fighting cigarette cravings. Eg: There are smokers who wear patches, chew gum and continue to smoke...now getting a triple dose of nicotine!

Despite the fact that NRT (Nicotine Replacement Therapy, as this mode of treatment is called) has a very poor  success rate (9.6 per cent after just 10 months), it became the popular mode of treatment. This is because doctors generally believed that cigarette smoking puts the smoker at risk for heart disease and that stopping smoking and switching to NRT reduced that risk.

However, current research shows that nicotine itself promotes blood vessel damage by changing cell structures called podosomes. This important finding, questions the health benefits of helping people quit smoking through smokeless nicotine delivery agents such as gum patches or e-cigarettes. 

Now a new study from Tel Aviv University shows why NRT is ineffective and may also provide the basis for more successful smoking cessation programs based on psychology rather than physiology.

In the new study published in the Journal of Abnormal Psychology, Dr Reuven Dar of Tel Aviv University's Department of Psychology found that the intensity of cravings for cigarettes had more to do with the  psychosocial element of smoking than with the physiological effects of nicotine as an addictive chemical.

Successful programmes

"These findings might not be popular with advocates of the nicotine addiction theory, because they undermine the physiological role of nicotine and emphasise mind over matter when it comes to smoking," Dr Dar says.  He hopes this research will help clinicians and health authorities develop more successful smoking cessation programmes than those utilising expensive nicotine patches or gum. 

The above conclusions are based on two landmark studies. In the most recent study, researchers monitored the smoking behaviour and craving levels of in-flight airline attendants, (both women and men). Each participant was monitored during two flights ― a long flight of 10 to 13 hours in duration, and a shorter trip lasting three to five hours. Using a questionnaire, Dr Dar sampled craving levels of the attendants throughout the duration of their flights.

The researchers found that the duration of the flight had no significant impact on craving levels, which were similar for short and long flights. 

Moreover, craving levels at the end of each short flight were much higher than those at the end of the long flight, demonstrating that cravings increased in anticipation of the flight landing, whatever the flight's total duration. He concluded that the craving effect is produced by psychological cues rather than by the physiological effects of nicotine deprivation. 

In an earlier 2005 study, Dr Dar examined smokers who were religious Jews, forbidden by their religion to smoke on the Sabbath. He asked them about their smoking cravings on three separate days: the Sabbath, a regular weekday, and a weekday on which they'd been asked to abstain. Participants were interviewed at the end of each day about their craving levels during that day. 

The study found that:

• Cravings were very low on the morning of the Sabbath, when the smoker knew he would not be able to smoke for at least 10 hours

• Craving levels gradually increased at the end of the Sabbath, when participants anticipated the first postSabbath cigarette

• Craving levels on the weekday on which these people smoked as much as they wanted were just as high as on the day they abstained, showing that craving has little to do with nicotine deprivation. 

Dr Dar's studies conclude that nicotine is not as physically addictive as heroin, which creates true systemic and biologically-based withdrawal symptoms in the body of the user.

People who smoke do so for short-term “perceived” benefits like oral gratification, sensory pleasure and social camaraderie. 

Once the smoking routine is established, people continue to smoke in response to cues and in situations that become associated with smoking. Smoking cessation techniques should emphasise the psychological and behavioural aspects and not the biological aspects. Such programmes are far more successful than NRT and other physiologically-driven approaches.

(The author is a de-addiction therapist.)

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