New(ish) study demonstrates power of nicotine addiction

[SmokeyJoe]

I missed this in April's copy of Scientific American, but chanced upon it today - I normally read and reread SciAm and New Scientist but I've been busy. Here is the article from the Journal of Family Practice that inspired the article.

Anyway, it is a very interesting study indeed.

To summarize for those who don't have the inclination to read such a large article:

1. Symptoms of withdrawal can occur within the first weeks of smoking - leading scientists to devise new models of how it affects the brain - previously it has been believed that the initial use of cigarettes was a psychological one, with physical addiction kicking in later.
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2. The new theory says the brain quickly adapts to nicotine exposure, and when it is no longer present withdrawal symptoms occur since the adaptation is still in place.
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3. The period of time between nicotine exposure and symptoms of withdrawal depends on the frequency of nicotine exposure. Therefore, self-described "social-smokers" who smoke only a few cigarettes a week are able to do so because the latency-withdrawal period is larger than daily smokers.
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4. Nicotine withdrawal does occur in those who smoke fewer than 5 cigarettes per day - contrary to previous assumptions that dictated that those who smoke less than the required amount to keep a constant level of blood-nicotine levels could not be addicted.
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5. This leads to an interesting paradox in which smokers without nicotine in their system (ie, after 12 hours) may not suffer any withdrawal symptoms until after that point. The traditional model assumes that withdrawal is dictated only by the lack of nicotine in the system.

   In rats, the first dose of nicotine increases noradrenaline synthesis in the hippocampus for at least 30 days after the nicotine is gone. (23) Given this information, it is quite plausible, then, that a few puffs from a cigarette could suppress withdrawal for many days, and perhaps even several weeks

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6. In this new model, a novice smoker is likely to smoke again at some point regardless of the amount already smoked. If he does not, he will likely experience withdrawal and the urge to smoke. Over time, the latency to withdrawal period will shorten as he preemptively smokes to avoid symptoms. The circle is thus completed and addiction sets in.
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7. The brain is permanently restructured by nicotine, dependent on the intake and duration of usage. It never returns to its pre-exposed state, although those who do quit end up with a brain dissimilar to both smokers and those who have never smoked.[/*:m:373h5twz]

I have to say that this mirrors my early experience of smoking far better than other studies on nicotine addiction that I have read over the years.

Another intersting point raised in the Journal article, is that of those who experience the FIRE response (First Inhalation Relaxation Experience - experienced by roughly a quarter of young people) from a cigarette, 91% subsequently lost autonomy over their control of smoking. Pretty remarkable, huh?

[TropicalBob]

7. The brain is permanently restructured by nicotine, dependent on the intake and duration of usage. It never returns to its pre-exposed state, although those who do quit end up with a brain dissimilar to both smokers and those who have never smoked.

Thanks for passing this along. It does shed some new light on my personal addiction but does not explain to me how my two cousins now in their late 80s could have smoked for 50 years and each claims to have quit without a problem. One did FOUR packs a day. An in-law also just up and quit one day while shaving. Claims no withdrawal problems. Me? I still think of a cigarette daily and will have been without one for a year as of next month.

I began at age 16, because peers and idols smoked. It's not a joke when I tell people I started at a pack a day. I loved cigarettes almost from the first one. I quickly leveled off at one carton a week.

I guess over the next 50 years, my brain was permanently rewired to handle a large quantity of nicotine, which is why I keep using snus, Stonewall tobacco bits, pipe and e-cigarette. Until I read the studies you cite, I thought my biggest problem with quitting would be the habit part. A smoker is who I am! Always have been, it seems. Now I know the truth when some tell me they always want a cigarette, even 10 or 20 years after they quit. That will be me, until I die.

I wish I were more like my cousins, but I'm not. Thank goodness for safer alternatives -- like e-smoking and snus.

[dnakr]

My hubby is the same way. He can put down a cigarette right now and never want one again. He has no withdrawal problems whatsoever. He says he smokes because he likes it, not because he has to.

I on the other hand went 6 weeks on the patch and within 2 hours of taking it off, I was smoking a cigarette. During the time of using the patch, all I thought about was a cigarette.

It's now been 5 1/2 months since I began e-smoking and my desire for a cigarette is not there. I hope I will never that desire again. This has truly been a life changing event for me.

[SmokeyJoe]

Indeed there is not any explanation in this study for those who seem able to quit without problem, although there is a hint towards a large variety of experience amongst nicotine users. The FIRE response interested me, particularly because I had sort of expected that most people got this reaction from nicotine. A quarter seems quite low, and would suggest a genetic predisposition. It is feasible, don't you think, that the other 75% react to nicotine in a variety of different ways.

The other interesting thing to bear in mind is that previous studies have found that long term smokers who do not experience the FIRE response are actually less likely to have quit one year after their quit date. Go figure.

[CaSHMeRe]

great article ...

i would love to see research as to why, most addicts find cold turkey easier then nicotine therapy replacement when it comes to quiting ... (atleast from what I've seen in real life and not tv ads)

I tried patches, gum, nasal inhalers, etc.... I smoked MORE when I was on those things then when I was just smoking regularly ... I quit cold turkey and after 2-3 days and a hiccup about a week later, never had issues :?

i now miss the oral fixation/ritual part of smoking and feel i have beat the nic addiction itself ...

[SmokeyJoe]

Perhaps the withdrawal-latency period is quite flexible either way? In other words, going long periods of time without nicotine might force the period to lengthen in the same way as it contracts as more nicotine is consumed.

If that were the case, would this go some way to undermining NRT as an effective method for quitting? If the user is never without nicotine, perhaps the latency-withdrawal period will not lengthen.

I have been chatting with a friend this afternoon who has quit for some years. Recently he has smoked on occasions and has quickly found himself having to force himself not to buy his own tobacco, days after smoking. Anecdotal, of course, but interesting nonetheless.

I bet everyone here has also known a smoker that has quit for years but says they occasionally get strong cravings out of the blue. I always thought there was a psychological mechanism that would explain this, but perhaps this is a manifestation of the latency-withdrawal, the latency period becoming more unpredictable over time?

SJ

[quirky]

One area I would like studied is how smoking affects pregnant women.
When I was pregnant with my son I had no trouble quiting. It was the only time I found it easy.
But, when he was about 6 months old, my milk began to dry up. As soon as it started drying up I began to crave cigarettes.
One might be tempted to think that this was just psychological - but I am inclined to think that there is some hormone released around pregnancy that precludes a simple psychological explanation.
I realize a lot of women are not able to quit - but this alone would only suggest the diffenences in brain physiology rather than prove any psychosomatic reaction taking place. (do you know how many times I had to use spell check with this post?)

[TropicalBob]

Quirky, what can a guy know? But I've always thought our bodies communicate needs to us. Never more strongly than during pregnancy, when so much rides on future mom's proper nutrition and care. Even those food cravings some pregnant women experience have a nutritional need at their bases. Your body told you, properly, not to take nicotine into your bloodstream, where it would be shared with your unborn. As that little brain developed, it would develop nicotine receptors just as reported in SJ's article. Those receptors never go away. And you would have given birth to a baby wanting a nic hit .. a baby almost certainly destined to become a future smoker if the new theories prove correct.

[UncleMidriff]

Interesting read.

My story:

Even at a very young age, with no smokers in my house, I enjoyed the smell of cigarette smoke. When my friends would catch a whiff of it and snort and wrinkle their noses, I'd take a good long sniff and enjoy the smell.

I began smoking on a road trip with one of my friends about 5 ears ago. The first tobacco I tried was a Black and Mild. I had no idea what I was doing ( didn't know how to inhale properly), and wasn't impressed. When I explained my disappointment to another friend, she told me the "proper" way to smoke; inhale deeply, hold it for a bit, and then exhale through the nose. I did that, and nearly fell out of my chair. The nic hit was extremely powerful, and extremely great.

After that, I'd only buy pack of cigarettes whenever I was stressed out. And even then, I'd smoke one or two cigarettes and throw the rest out, because I didn't want to get addicted. That progressed slowly, until I was smoking about 3 or 4 cigarettes each weekday, more on weekends. Around this time, my wife started giving me a hard time about smoking every time she smelled smoke on me.

Thus, several times over the last year or two, I've "quit" smoking for weeks at a time or longer. This last time, I made it 7 months without any nicotine.

During the entire 7 months, I never experienced a single withdrawal symptom other than just wishing I didn't have to refrain from smoking. No headaches, no (extra :-) ) irritability, no nothing. I wanted to smoke because I really enjoyed everything about the experience, but I never felt ill. I always assumed that this was because of the relatively low amount I smoked, but I guess this study might cast some doubt on that assumption.

For comparison's sake, I was on low dose of Xanax for about 2 months for panic attacks. That bull.... got ahold of me and didn't want to let go. I had absolutely zero desire to take it, but if I didn't, I felt absolutely horrid. It took over 4 months for me to wean myself off of that stupid ..... So, It's not like I'm somehow generally resistant to physical addiction.

[Mamba]

To play devil's advocate I think Difranza's article reeks of anti-smoking propaganda. Most of the research is from subjective questionnaires given to high school students, surveys given to adults and DSM IV criteria for addiction. There is only one example of a brain study which supposedly shows an instant increase (within 24 hours) in nicotine brain receptors. One must also note that this study was on adolescent rats (the cited article title of "Short-term adolescent nicotine exposure..." is misleading) and Difranza doesn't mention this fact in his article. So rat brains may be 'remodeled' but apparently no connection to actual nicotine addiction in humans was shown in the cited study.

I'm not sure what to think of Dr. Yael Abreu-Villaca (the author of the brain study) anyway. (S)he has studies (which I'm not sure have been replicated) supposedly linking prenatal nicotine exposure to the increased likelihood that the offspring will become smokers as teenagers. This is also a rat study. Do the results apply to human populations at all? For complex behaviors like addictions I don't put much stock in rat studies.

Joseph R. Difranza is obviously trying to push the idea that "it only takes one cigarette to get hooked". He is blatantly ignoring sociocultural factors and he tries very hard to make it seem like his argument is scientific even though his 'evidence' is mostly subjective or based on animal studies. I wonder if the same people given the same questionnaires concerning sugar consumption wouldn't have similar answers. Here's a sarcastic analogy:

"Within minutes of consuming sugar drastic biological changes occur in the body to respond to the massive glucose assault. Just one candy bar can lead to a life-long addiction. And just that one candy bar can come back to haunt you years down the road. Your body remembers that sugar rush and feeling of well-being and the increased glucose 'remodels' the brain and leads to permanent changes in neurochemistry. Blah, blah, blah..."

Well, I obviously don't really buy this line of reasoning. Even if some of it turns out to have a biological basis then it would apparently only seem to apply to a percentage of the population as many people claim they have quit nicotine with no withdrawal symptoms. I don't know if there is any way to tell from someone's first reaction to nicotine either. I had a profound response to nicotine the first time I ingested it and I have quit for up to five years at a time with no withdrawal or cravings whatsoever. My experience is only anecdotal, but so is just about everything in Difranza's article.