Thanks to public education campaigns, smoking is on the decline. However, many smokers find it hard to kick the habit. Smoking is highly addictive because nicotine penetrates into the brain where it binds to nicotine receptors on neurons, which are then stimulated to produce the neurotransmitter, dopamine. Dopamine is responsible for many effects and is believed to be the main reason for the pleasurable sensation associated with smoking. Similar dopamine response pathways are activated with other drugs of addiction such as cocaine, amphetamines and methamphetamines, which goes to show how powerful substances that alter dopamine pathways can be.
Fortunately, there are several options for those who want to quit smoking. This article will briefly summarize the pros and cons of the different options and help you decide which is best for you.
Quitting Cold Turkey
The first thing most smokers try is to just simply stop smoking. However, research has shown that this is probably the least effective method for most people. If a smoker tries to quit smoking all of a sudden, they immediately begin to experience symptoms of withdrawal, which can range from mild to severe. Withdrawal symptoms occur because the body has become used to being stimulated through nicotine and if you take it away all of a sudden, the body doesn’t have enough time to adjust and the dopamine pathway in the brain goes haywire.
Pros: no cost
Cons: mostly ineffective, unless you have a strong motivation to stop, or strong self-control
Nicotine Replacement Therapy (NRTs)
Nicotine replacement therapies are exactly what they sound like and are better known as nicotine gums, patches or inhalers that you can buy off the shelf in drug stores. These types of ‘quit smoking’ aids deliver nicotine at a controlled rate throughout the day, as opposed to the sudden spikes in nicotine levels smokers normally get from smoking a cigarette. The even delivery of nicotine helps to ease withdrawal by allowing the body to adjust without completely removing nicotine.
However, NRTs have been reported to cause sleep disturbances, which is due to the complex interactions between nicotine and our nervous system that we don’t fully understand. Nevertheless, recent studies have discovered that mutations in a dopamine processing protein called COMT can determine the effectiveness of nicotine patches on patients. Genetic testing of the COMT gene could help determine whether nicotine patches are effective for you.
Pros: widely available, relatively inexpensive
Cons: potential side effects, inconvenience (have to remember to take them)
There are currently two ‘quit smoking’ aids available as a prescription, bupropion and varenicline. Bupropion was originally developed as an anti-depressant, which means it interacts with dopamine pathways similar to nicotine. However, the exact mechanisms through which bupropion works is still unclear. Varenicline is a newer drug developed specifically for those looking to quit smoking. It works as a weaker nicotine substitute by binding to nicotine receptors in the brain, displacing nicotine but also only partially stimulates dopamine production.
These prescription aids have been found to be the most effective, especially when used in combination with NRTs. However, they can cause serious side effects including nausea, vomiting, insomnia, convulsions and suicidal tendencies.
Pros: most effective
Cons: can be expensive depending on health coverage, serious side effects
Behaviour modifications as a way to quit smoking is based on the principle of behaviourism developed by psychologist B.F. Skinner. Behaviourism states that all behaviours are shaped by either positive or negative reinforcement. Seen in this light, people who are addicted to cigarettes continue this behaviour because they feel better, more focused, less stressed when they smoke (positive reinforcement). On the other hand, they might feel lethargic and irritable when they don’t smoke (negative reinforcement).
Therefore, using this method to quit smoking requires the smoker and/or his friends and family establish a system of rewards for avoiding cigarettes, and punishments for relapsing. For example, every day that Alex doesn’t smoke, he puts the money he saved from not buying cigarettes, into a jar. Every time that he relapses, he has to take money from the jar to buy his cigarettes.
Pros: inexpensive, more structured than just quitting cold turkey
Cons: need to create an effective reward/punishment system, depends on self-motivation
A common alternative method to quit smoking is acupuncture, which is a principle of chinese medicine. Traditionally, acupuncture has always been a way to detoxify the body to promote overall well-being, and it has been shown to help reduce withdrawal symptoms when combined with normal treatment. Patients who have used acupuncture to help quit smoking or with other addictions report decreased cravings, and an increased state of calm and relaxation.
However, studies on the effectiveness of acupuncture alone remain inconclusive, and thus acupuncture is generally not recommended. But given the complexity of addiction, it would be unwise to eliminate alternative treatments that are otherwise relatively safe.
Pros: promote overall well-being, change of pace from normal methods
Cons: inconclusive scientific evidence, may be expensive
As always, you should consult your doctor before beginning any treatment to quit smoking. The usefulness of genetic testing in helping people quit smoking or other addictions is still a very new area of research. Nevertheless, early studies are encouraging and as the science progresses, genetic testing will likely be able to help determine whether NRTs or prescription medication will be effective for you and help you to plan the best strategy to finally kick that habit!
If you’re interested in some of the more established ways genetic testing can complement your health, check out this article about the 3 main uses of genetic testing!