What shackles people to cigarettes?

Scientists search for the weak link to break nicotine addiction.

Since coming to office President Obama has pushed big changes in the country’s health care system – going even beyond the controversial law he just signed. Last year, the president also signed a law giving the Food and Drug Administration the authority to regulate tobacco. Some hailed this as a historic step toward reducing smoking in the US. But here’s the irony: Even the First Smoker still can’t kick the habit. Why is quitting so hard? And what approaches work? WHYY’s health and science reporter Kerry Grens looks for answers.
(Photo: http://www.flickr.com/photos/narciss/ / CC BY 2.0) [audio:100331kgsmoke2.mp3]

Ah, smoking. It’s so bad for us — yet for smokers, it can be the best part of their day.

Diluzio: It’s enjoyable. It’s fun. I really like smoking.

Despite that love, Jayson Diluzio quit smoking about two weeks ago.

Diluzio: I woke up and was really sick. Had a head cold and congested. Said, that’s it. I’m not smoking anymore. I can’t do this anymore. It’s killing me. And I just took my smokes and ran them under the sink so I wouldn’t be tempted to pull them back out of the trashcan, and that was it.

Pulling cigarettes out of the trash — seems like the desperation of an addict. Nicotine is in fact one of the most addictive substances there is. Human brains are vulnerable to the instant psychological reward of nicotine — and even become more vulnerable over time. Caryn Lerman is the director of the University of Pennsylvania’s Center for Interdisciplinary Research on Nicotine Addiction.

Lerman: Somebody who’s a chronic smoker has experienced changes in the their brain and even wiring in the brain that makes it very difficult to function without nicotine.

Smokers spend more than a billion dollars each year on nicotine replacements, such as gum or the patch. But it’s not enough.

Lerman: Despite all the efforts to develop better treatment for nicotine addiction, most of the treatments out there work for only a proportion of smokers. Still most smokers will fail.

Temple professor Brad Collins is taking a different tack. Instead of challenging smokers to quit, he tries just to get them to cut back. He’s working with women who’ve recently had babies.

Collins: It was interesting to see how many moms at enrollment were relieved that they didn’t have to quit smoking to be part of our program.

Half the women were given several counseling sessions and advised to take progressive steps — first, smoke in a different room than the baby. Then smoke outside. Ask family members to join in. Then cut back on cigarettes. And finally, try quitting altogether.

Collins is still following the women for a few months to see if they’ve successfully quit. But it seems like the strategy worked in protecting the children from second hand smoke.

Collins: There were significant differences between the two groups where the behavioral counseling group was more successful in reducing the child’s exposure.

Collins says new moms are especially prone to smoking because of the stress and depression that can accompany parenthood.

Depression is a big cause of smoking relapse. Amy Lazev, a researcher at Fox Chase Cancer Center, says one third of quitters experience a depression deep enough to drive them to light up. Some anti-depressants on the market can help people quit — but for those who don’t want to take a pill, Lazev is trying an alternative
anti-depressant: light. She pulls out a television-sized light box.

Lazev: You turn it on and sit in front of the light box in the early morning for about 45 minutes and you can do whatever you WANT? while you’re sitting there. You can read, eat your breakfast, sit at your computer and you have to just ocassionally look up at the light.

Light therapy is used to help people with seasonal affective disorder, which is winter-time depression. Lazev’s hypothesis is that the light will improve quitters’ moods, and their messed-up circadian rhythms. Smoking causes melatonin levels, and therefore circadian rhythms, to fall out of whack.

Lazev: If smokers have disrupted circadian rhythms it may impact their sleep, their mood, and a number of other factors. So be resetting the circadian rhythms it may make it easier for you to quit smoking.

Lazev is still recruiting people to join her study.

Quitting is an immense struggle for most people, but some will achieve a smoke free life. Others will enter the Sisyphean cycle of quitting and relapsing. Genetics may unlock the mystery as to who falls into each category. Again, Caryn Lerman at Penn.

Lerman: There’s quite a bit of evidence that the quitting process has a heritable component. And that some people are able to quit more easily. Most people have a great deal of difficulty.

Lerman is studying how different approaches — counseling, nicotine replacement or antidepressants — might be tailored to people’s genes. But her results could take a while — so it’s probably better not to wait for them to try to quit.