Taming That Overwhelming Urge to Smoke

In Brief:
The brain of an addicted smoker treats nicotine as if it is essential for survival.
Genetic traits may predispose some smokers to stronger addiction.

Most smokers try to quit unaided, resulting in a high failure rate.
If you smoke, no one needs to tell you how bad it is. So why haven’t you quit? Why hasn’t everyone?

Because smoking feels good. It stimulates and focuses the mind at the same time that it soothes and satisfies. The concentrated dose of nicotine in a drag off a cigarette triggers an immediate flood of dopamine and other neurochemicals that wash over the brain’s pleasure centers.
Inhaling tobacco smoke is the quickest, most efficient way to get nicotine to the brain.

“I completely understand why you wouldn’t want to give it up,” said Dr. David Abrams, an addiction researcher at the National Institute of Health. “It’s more difficult to get off nicotine than heroin or cocaine.”

Smoking “hijacks” the reward systems in the brain that drive you to seek food, water and sex, Dr. Abrams explained, driving you to seek nicotine with the same urgency. “Your brain thinks that this has to do with survival of the species,” he said.

Nicotine isn’t equally addictive for everyone. A lot of people do not smoke because they never liked it to begin with. Then there are “chippers,” who smoke occasionally but never seem to get hooked. But most people who smoke will eventually do it all day, every day.

New discoveries in genetics may explain why certain people take to smoking with such gusto and end up so addicted. Some people, for instance, produce a gene-encoded enzyme that clears nicotine from their bloodstreams rapidly, so they tend to smoke more and develop stronger addictions. Others possess special receptors in the brain that bond extra tightly with nicotine, giving them an especially intense high that makes it harder to quit.

Drug makers are exploiting the science of addiction to create novel treatments to help smokers quit. The newest stop-smoking medication, the first to be approved in 10 years, is called Chantix. Available by prescription, Chantix masquerades as nicotine well enough to occupy the brain’s nicotine receptors, where it may lessen cravings. Real nicotine, when it comes along, cannot find enough free receptors to do its thing.

Chantix seems to have a higher success rate than Zyban, an antidepressant that helps to balance dopamine levels. And recently released federal guidelines to doctors for helping smokers quit reported that the drug, combined with the nicotine replacement patch and use of nicotine nasal spray or gum as needed, produced higher long-term abstinence than the patch alone.

Doctors have written millions of precription for Chantix, though enthusiasm for the drug was tempered by reports of suiside and bizarre behaviors in people taking it. The reports prompted the Food and Drug Administration to issue a safety warning about Chantix early in 2008.

“That’s something that needs to be taken very seriously, but it needs to be put in the context of what happens if you don’t quit smoking,” said Dr. Michael Fiore, a smoking cessation specialist at the University of Wisconsin and chairman of the government panel that issued the new guidelines. Dr. Fiore used to consult for Pfizer, the maker of Chantix, but said he cut those ties in 2005. He still prescribes the drug but now takes care to discuss the safety warning with patients.

Dr. Nancy Rigotti was involved in Chantix studies conducted at Massachusetts General Hospital in Boston, where she directs the Tobacco Research and Treatment Unit. “Those trials mostly enrolled people who were pretty healthy,” she said. “They did not include people with depression or much of a history of depression.”

Dr. Rigotti said it was possible that varenicline, the generic name for Chantix, “might have more psychiatric side effects in certain groups of people.”

Continued research should help to resolve lingering concerns about the safety of Chantix. Meanwhile, experts continue to recommend the old standbys: nicotine replacement gums, patches, nasal sprays, inhalers and lozenges, which have been proved to be safe.

Nicotine by itself does not cause cancer, heart disease or other major health problems linked to smoking; other chemicals in tobacco smoke are to blame. Nicotine replacement can be used alone or with prescription medications or, for best results, combined with counseling. Recent evidence suggests that using two forms simultaneously, like the patch and gum together, works better than either alone.

Although nicotine replacement products do not require a prescription, the F.D.A. limits where and how they are sold. They are also expensive.
“It’s so much easier to go down to the corner store and get a pack of cigarettes than it is to get access to evidence-based treatment,” Dr. Fiore said.

This year, the New York State health commission petitioned the F.D.A. to revise its rules so that nicotine gum, patches and lozenges could be sold anyplace that sells cigarettes, and at prices comparable to a cigarette pack. The agency is currently reviewing the petition.

Still, no treatment works for everyone. And even with the most successful treatments, only about 30 percent of attempts to quit last more than six months. Compared with willpower alone, however, that’s a huge improvement. Fewer than one in 10 smokers who go it alone manages to go six months without a cigarette. Most do not make it past a week.

When longtime smokers finally do quit, they soon realize that not smoking doesn’t necessarily make them nonsmokers. That’s what counseling is for — learning to function without nicotine and to cope with the cues that trigger smoking urges.

Most important, former smokers have to rediscover that it is possible to enjoy life without cigarettes, although the yearning may never die completely.
“I’m an ex-smoker,” Dr. Abrams said, “and I still miss it.” said.

E-cigarettes

Some health officials blast device marketed as safe alternative to smoking

BEIJING - With its slim white body and glowing amber tip, it can easily pass as a regular cigarette. It even emits what look like curlicues of white smoke.

The Ruyan V8, which produces a nicotine-infused mist absorbed directly into the lungs, is just one of a rapidly growing array of electronic cigarettes attracting attention in China, the U.S. and elsewhere — and the scrutiny of world health officials.

Marketed as a healthier alternative to smoking and a potential way to kick the habit, the smokeless smokes have been distributed in swag bags at the British film awards and hawked at an international trade show.

Because no burning is involved, makers say there's no hazardous cocktail of cancer-causing chemicals and gases like those produced by a regular cigarette. There's no secondhand smoke, so they can be used in places where cigarettes are banned, the makers say.

Health authorities are questioning those claims.
Words of warningThe World Health Organization issued a statement in September warning there was no evidence to back up contentions that e-cigarettes are a safe substitute for smoking or a way to help smokers quit.

It also said companies should stop marketing them that way, especially since the product may undermine smoking prevention efforts because they look like the real thing and may lure nonsmokers, including children.

"There is not sufficient evidence that (they) are safe products for human consumption," Timothy O'Leary, a communications officer at the WHO's Tobacco Free Initiative in Geneva, said this week.

The laundry list of WHO's concerns includes the lack of conclusive studies and information about e-cigarette contents and their long-term health effects, he said.

Unlike other nicotine-replacement therapies such as patches for slow delivery through the skin, gum or candy for absorption in the mouth, or inhalers and nasal sprays, e-cigarettes have not gone through rigorous testing, O'Leary said.

Nicotine is highly addictive and causes the release of the "feel good" chemical dopamine when it goes to the brain. It also increases heart rate and blood pressure and restricts blood to the heart muscle.

Ruyan — which means "like smoking" — introduced the world's first electronic cigarette in 2004. It has patented its ultrasonic atomizing technology, in which nicotine is dissolved in a cartridge containing propylene glycol, the liquid that is vaporized in smoke machines in nightclubs or theaters and is commonly used as a solvent in food.

When a person takes a drag on the battery-powered cigarette, the solution is pumped through the atomizer and comes out as an ultrafine spray that resembles smoke.

Hong Kong-based Ruyan contends the technology has been illegally copied by Chinese and foreign companies and is embroiled in several lawsuits. It's also battling questions about the safety of its products.

Most sales take place over the Internet, where hundreds of retailers tout their products. Their easy availability, O'Leary warns, "has elevated this to a pressing issue given its unknown safety and efficacy."

Prices range from about $60 to $240. Kits include battery chargers and cartridges that range in flavors (from fruit to menthol) and nicotine levels (from zero — basically a flavored mist — to 16 milligrams, higher than a regular cigarette.) The National Institutes of Health says regular cigarettes contain about 10 milligrams of nicotine.

Promoted as 'healthier'On its Web site, Gamucci, a London-based manufacturer, features a woman provocatively displaying one of its e-cigs. "They look like, feel like and taste like traditional tobacco, yet they aren't," the blurb reads. "They are a truly healthier and satisfying alternative. Join the revolution today!"

Smoking Everywhere, a Florida-based company, proclaims it "a much better way to smoke!" while a clip on YouTube features an employee of the NJoy brand promoting its e-cigarettes at CES, the international consumer technology trade show.
Online sales make it even more difficult to regulate the industry, which still falls in a gray area in many countries.

In the U.S., the Food and Drug Administration has "detained and refused" several brands of electronic cigarettes because they were considered unapproved new drugs and could not be legally marketed in the country, said press officer Christopher Kelly.

He did not give more details, but said the determination of whether an e-cig is a drug is made on a case-by-case basis after the agency considers its intended use, labeling and advertising.
In Australia, the sale of electronic cigarettes containing nicotine is banned. In Britain, the products appear to be unregulated and are sold in pubs.

Smoking is tightly woven into the fabric of daily life in Ruyan's home turf of China, the world's largest tobacco market where about 2 trillion cigarettes are sold every year.
Tobacco sales, the biggest source of government revenue, brought in $61 billion in the first 11 months of last year, up 18 percent from 2007, the Communist Party's People's Daily newspaper said.

Pricier optionIn a country where the cheapest brands of cigarettes cost about 20 cents a pack, the e-cig is far pricier. Ruyan's V8 costs $240 and includes batteries and 20 cartridges of nicotine solution, roughly the same number of puffs as 20 packs of tobacco cigarettes. The line has expanded to include cigars and pipes crafted from agate and rosewood.

Ruyan is suing a Beijing newspaper for questioning its safety and for claiming in 2006 that its products have more nicotine than regular cigarettes.
Miu Nam, Ruyan's executive director, blames the newspaper for a hit in sales and profits but declined to give details.

"We have to restore consumers' confidence, we have to clean up people's doubts," Miu said.
An operator at the Beijing Times refused to transfer calls seeking comment Friday to managers at the newspaper. A reporter said she had heard of the case but would not give any details.
Some international experts back Ruyan's claims its product is safe.

David Sweanor, an adjunct law professor at Ottawa University and former legal counsel of the Non Smokers Rights Association in Canada, said e-cigs have the potential to save lives.
With smoking, "it's the delivery system that's killing people," Sweanor said. "Anytime you suck smoke into your lungs you're going to do yourself a great deal of damage. Nicotine has some slight risks but they are minor compared to the risk of smoke in cigarettes."

Dr. Murray Laugesen, a New Zealand physician involved in tobacco control for 25 years who was commissioned by Ruyan to test its e-cigs, said he found "very little wrong" with them.
"It looks more like a cigarette and feels more like a cigarette than any other device so far and yet it does not cause the harm," he said. "It's the best substitute so far invented for tobacco cigarettes."

In the U.S, both Philip Morris USA and RJ Reynolds have introduced cigarettes that did not burn tobacco, but the technologies were very different from the e-cigarette. Neither has been successful.

In 2006, Philip Morris USA, test-marketed the Accord, which used a heating unit activated by puffing. RJ Reynolds introduced its cigarette, the Premier, in 1987 and still sells the Eclipse, which heats the tobacco rather than burning it. Sales are "not great," said spokesman David Howard.

Li Honglei, a fast-talking 28-year-old public relations manager in Beijing, has been smoking since he was in his teens and desperately wants to quit. He thinks he may have found his answer in Ruyan.

"I was intrigued by this new technology," said the pudgy, bespectacled Li as he surveyed products displayed in glass cases at Ruyan's brightly-lit shop in the capital. "I heard acupuncture is effective as well, but this method sounds more painless."

Smoke Less to Quit Smoking

Smoke Less to Quit Smoking

In the study funded by the US National Cancer Institute,

20 healthy adult smokers smoked their usual brand for a week then followed six weeks of smoking cigarettes with gradually decreased nicotine content.

Five smokers quit smoking completely while the study was in progress.
The rest return to their usual commercial cigarette brand at the end of period.

However one month later after that test, they were smoking about 40% fewer cigarettes a day, with a comparable reduction in nicotine intake.
So, this research on reduced-nicotine content cigarettes strongly counters the idea that reducing the nicotine content of cigarettes would lead to smoking more cigarettes.

Tobacco products with reduction of the nicotine yields make cigarettes less harmful.
But other study revealed that low tar, low nicotine cigarettes damage blood flow through the heart as severely as regular cigarettes.

Scientists say cigarettes marketed as low-nicotine do not work because they have high nicotine content and are "engineered" - made with highly porous paper and have ventilation holes above the filter - to deliver more nicotine when the smoker takes more frequent and bigger puffs.

There is easy way to reduce smoker's nicotine intake.
If you are thinking about quitting smoking, try to smoke lesser quantity of cigarettes until your final one and you will be rewarded for your efforts.

This reduction will reduce cigarette cravings and withdrawal symptoms during smoking ending process. It is safe to say that smoking ending process starts, when you initiate changes like decreasing amount of smoked cigarettes in your everyday smoking routine.