Current interventions fall short for smoking cessation
One reason that smokers have such difficulty quitting may be that their minds crave the sensory rewards of smoking just as much as their bodies crave the nicotine, according to a new study.
While drug companies keep producing new ways to curb smokersâ€™ cravings, such as nicotine patches and chewing gums, none have addressed the sensory rewards of cigarette smoking, such as the feeling of smoke going down the throat and into the lungs, say the authors, who suggest that treating early-stage quitters with nicotine-free cigarettes may be an option.
"The emphasis on nicotine, as opposed to other constituents of tobacco, has obvious merit given the large body of evidence that the reinforcing effects of nicotine play a significant role in smoking. However, there is a growing body of evidence suggesting that other aspects of cigarette smoke, namely the sensory effects, also contribute to the maintenance of smoking," says Lisa H. Brauer, Ph.D., of the University of Minnesota School of Medicine and her associates. The research was conducted at Duke University and the Durham VA Medical Centers.
The majority of smokers, about 70 percent, report wanting to quit. Half of those smokers attempt to quit each year, but only 2.5 percent of all U.S. smokers actually succeed in overcoming their dependence, according to statistics from the American Lung Association.
In the analysis of 138 smokers, many subjects reported almost as much satisfaction and craving reduction from smoking cigarettes that had the nicotine removed as from smoking regular cigarettes. Interestingly, smokers who were established as more dependent were less likely to differentiate between the two types of cigarettes, compared with less dependent smokers. On average, men reported less of a difference between the nicotine-free and nicotine-containing cigarettes than did women.
"More dependent smokers rely more heavily on sensory cues than do less dependent smokers. In contrast, less dependent subjects appear to rely more heavily on the direct effects of nicotine," the investigators deduced.
This phenomenon may result from long-time smokers coming to associate the physical effects of nicotine with the sensation of smoking. Prolonged and intensive smoking may also lead to tolerance that blunts the effects of high levels of nicotine, thereby making the psychopharmological effects of nicotine relatively less important in maintaining smoking, they hypothesized.
This study, which is published in the May 2001 issue of Nicotine and Tobacco Research, consolidated information from nine studies conducted by the investigators.
Subjects were asked to rate on a scale if the cigarette they just smoked was satisfying, tasted good, made them dizzy, calmed them down, helped them concentrate, made them feel more awake, reduced their appetite, made them nauseous, decreased irritability, produced enjoyable sensations in the throat and chest and reduced cravings for cigarettes.
Smokers who scored high for nicotine dependence, rated nicotine-free cigarettes less than half a point lower than normal cigarettes on a 7-point scale of sensory reward, while less dependent smokers rated more than a point difference, on average, between the cigarettes. All the smokers gave both types of cigarettes a high rating for satisfying their smoking cravings.
"The fact that sensory factors play an important role in smoking helps to explain the lack of robust effects of nicotine replacement therapies for smoking cessation," the researchers said. "Although it would be counterproductive to suggest that smokers switch to [nicotine-free] cigarettes for a prolonged period of time, it may be fruitful to provide a limited number of these cigarettes to smokers during cessation attempts, for use in conjunction with nicotine replacement therapy. This strategy may be particularly effective during early abstinence and in highly dependent smokers."
The study was supported in part by the National Institute of Drug Abuse and the Medical Research Service of the Department of Veterans Affairs.