Apr. 24, 1998 By Melanie Fridl Ross
GAINESVILLE, Fla.---University of Florida psychiatrists are wielding new weapons in the war against nicotine addiction: antidepressants.
Part of a three-pronged approach that may include nicotine replacement therapy and counseling, the idea is to help smokers kick the habit by tackling addiction at its root: long-lasting changes in brain chemistry that train the brain to expect new levels of pleasure it eventually considers normal.
This chemical conditioning occurs gradually, but the changes persist for months after someone stops smoking, setting the stage for relapse, reports UF substance abuse expert Dr. Mark Gold in an article on tobacco smoking and nicotine dependence in the current edition of the "Journal of Addictive Diseases."
As a result, many people who try to quit report feeling irritable, moody and even depressed, said Gold, professor of psychiatry, neuroscience, community health and family medicine at the UF Brain Institute and UF's College of Medicine.
Smoking tobacco, like smoking heroin or cocaine, is "profoundly addictive," and nicotine dependence is particularly resistant to treatment, he said. Treatment programs for alcoholism and cocaine addiction are effective at least half the time. In contrast, although 80 percent of smokers want to stop, only 20 to 30 percent of those who do are smoke-free a year later. Less than 5 percent quit successfully with no intervention.
"This is a very, very tenacious addiction," said UF psychiatrist Dr. Douglas Eaton, an addiction medicine specialist. "This is as hard an addiction to crack as heroin or cocaine -- right up there with the biggies."
Up to now, many physicians have relied solely on the nicotine patch, which helps smokers cope with acute withdrawal symptoms.
"Social prohibitions, the stigma and health information that smoking is bad for you works for some people," Gold says. "Who is left? People with a pathological attachment to smoking, who are getting antidepressant effects from smoking. They love smoking; it's a source of pleasure.
"The idea that you can treat all smokers with a nicotine patch or gum is not realistic," he adds. "It's like saying you've discovered the cure for all alcoholism is alcohol. You wouldn't propose to most alcoholics who were drinking vodka that they should switch to beer. So the idea behind nicotine replacement and detoxification may be somewhat flawed."
Smoking cigarettes is tied to more than 400,000 deaths in the United States each year from cancer, stroke and cardiovascular disease, according to the American Lung Association.
UF physicians, practicing in the newly formed Smoking Cessation Clinic within the Psychiatric Specialty Clinics at Shands hospital at UF, tackle the problem on both fronts - using nicotine replacement therapy to treat acute withdrawal symptoms and antidepressants to combat the longer-lasting brain changes.
Smoking releases a cascade of brain chemicals associated with survival-enhancing behaviors such as eating and sex. UF physicians have studied the effects of two new medications for smoking - buproprion and naltrexone. Both act on the area of the brain that rewards survival-enhancing behaviors. UF physicians also offer patients strategies for attaining and maintaining abstinence from tobacco.
"Of course, smoking cigarettes is not survival enhancing, but the brain doesn't know that," Eaton said.
"We in the addiction field have known that smoking is a drug addiction as serious or devastating in the long run as heroin or cocaine," he added. "It is perhaps even more malicious because the negative effects are not as quickly apparent, so it's easier for everyone involved to be in denial about the seriousness of the problem."
Just ask Eaton: He smoked a pack a day for 20 years and tried dozens of time to quit. When the FDA approved the drug, he decided to make another go at it.
He has not smoked in nearly a year and a half. "This time I had no cravings, gained no weight and had no mood swings," Eaton said. "Previously, I noticed I'd become very angry and irritable when I tried to quit and had problems sleeping, but none of that occurred this time. In fact, I lost a little weight, much to my pleasure."
Tom Benedict, 47, of Ponte Vedra Beach, also quit successfully by taking a combination of nicotine gum and buproprion for smoking cessation. Before he sought treatment at UF, he had tried to quit seven times in the past 25 years.
"It made a big change in me," Benedict said. "Physically, I rollerblade and walk a lot more, do activities around the house and garden. It's night and day in terms of how I feel -- I just feel so much better."
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