This week is National Stop Smoking Week.   I have worked with many smokers and have some views on smoking that may be useful for those of you who currently smoke and would like to quit.  To this end, I will blog several times this week in order to give you information that you will find useful.

Addiction is defined by compulsive drug-seeking and abuse, even in the face of negative health consequences.  Smokers would definitely fall under this category – but what are they actually addicted to, and how are they addicted?  Smoking addiction is in a class by itself, in my opinion.  Smokers assume that they use tobacco products on a regular basis because they are addicted to nicotine.  The truth, however, is that they are not physically addicted to the effects of nicotine. They are addicted to the psychological effects of nicotine.  I first became aware of this fact when a woman who routinely smoked at least 2 packs a day got pregnant.  She immediately stopped smoking for the entire pregnancy with no cravings and no side-effects from stopping.  How is this possible?  If she had been addicted to heroin instead, it would have been virtually impossible without severe physical withdrawal symptoms.

Research indicates that nicotine acts on the brain’s reward pathways – and those involving the neurotransmitter dopamine.  Nicotine increases dopamine in the “reward” circuits.  All the effects that smokers attribute to nicotine are actually the result of dopamine stimulation in the brain.  Nicotine is rapidly distributed to the brain with peak levels occurring within 10 seconds of inhalation.

Nicotine is also rapidly eliminated from the body, so the nicotine-stimulating effect on dopamine is short.  In order to maintain the drug’s effects, the smoker has to take another nicotine “hit”.

The problem with smokers is that they are usually dopamine deficient to begin with – and nicotine makes them feel “good”. The unfortunate thing about most current treatments for nicotine addiction is that they concentrate on the supposed physical effects of nicotine withdrawal.  Take the patch, for example.  The patch is designed to give decreasing nicotine doses over time assuming that this will allow a smoker to “wean off” nicotine.  The problem with this approach is that it doesn’t give the smoker more dopamine I.e., it doesn’t address the dopamine deficiency.  A chronic smoker will actually experience symptoms relating to “not enough” dopamine  (irritability, craving, depression, anxiety, cognitive and attention deficits, sleep disturbances) rather than nicotine “withdrawal” symptoms. In order to quit smoking, the dopamine deficiency must be addressed.  If we can get the smoker’s brain to make more dopamine or find another way to stimulate dopamine release, then

Stopping smoking can become relatively easy – and I have never met a smoker who really didn’t want to quit.

Until the next installment…

Dr. Gatis