Tuesday, November 8, 2011

Can personality traits tell which cessation medication will work best?

Every smoker is different and when trying to decide which medication is the best one to use, it is often a matter of trial and error. But over the years I have seen different patterns emerge. It's only my observation and not scientific but it may be better than trial and error.

I always ask smoker to complete the following sentence: "I want to quit BUT......" What I've noticed is what comes after the BUT can influence what medication may work best.

For someone who says "I want to quit BUT I enjoy smoking, it relaxes me, I like it..." Their focus is on the enjoyment and positive benefits received from smoking. Chantix seems to help these smokers since Chantix works by blocking the receptors in the brain which decreases the pleasure a smoker gets when smoking. It also releases a small amount of dopamine (the I feel good neurotransmitter in the brain).

For someone who says, "I want to quit BUT I can't handle the side effects, the depression, irritability, ..." Their focus is on the negative effects of quitting. In this case a combination of Zyban and nicotine replacement products (NRT) helps. It it unknown why Zyban helps smokers quit. It was originally developed as an anti-depressant and over the years, it was noticed that smokers would quit.

For smokers worried about weight gain after quitting, Zyban and NRT have been shown to stave off weight gain during the first 6 months after quitting. But NRT needs to be taken on a regular schedule to be effective. To be helpful oral NRT needs to be used on a regular basis to keep the level of nicotine in the blood steady.

 Often smokers will wait until a craving comes up before they pop a piece of gum or a lozenge but by that time, it's too late and then will say that NRT doesn't work. The reason it's not working is because they were under dosing themselves. When you smoke a cigarette, the level of nicotine in your blood peaks at about 20-25 mcg/L in 5 minutes. At the end of one hour, the level drops to about 8 mcg/L.

In contrast, it takes The Patch 2 to 6 hours to reach the maximum absorption. The absorption is similar for nicotine gum, lozenge and inhaler at about a peak of  8mcg/L at 30 minutes. Only the nicotine spray gives a kick within 5 minutes like a cigarette but at less than half the amount of nicotine as a cigarette.

Experts in tobacco control are now even recommending that smokers start using NRT before they quit to help them cut down. The reason why this wasn't suggested in the past was because the fear of nicotine overdose. But every smoker can spot nicotine overdose symptoms--all you have to do is think  back to your very first cigarette ever--you probably got dizzy, light-headed, maybe had a headache or nausea, maybe even vomiting---these symptoms are nicotine overdose but as you continued smoking your body adjusted to the level of nicotine and developed a tolerance for these side effects.

One reason why the e-cigarette has gained popularity is that is delivers a higher and faster dose of nicotine than NRT's because it was designed to keep a smoker addicted to nicotine instead of helping them wean off of it. There also is probably a placebo effect by having something to hold in your hand that is similar to a cigarette. It tricks the brain into associating the sensory effects.

There are other factors besides personality when making a choice about cessation medication. It depends on your medical and mental health history, how much you smoke, how long, what other medications you take and what you've used before.

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