What's the best way to give up smoking?

09 October 2018

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Question

What can science tell us about ways to quit smoking?

Answer

We received this question from listener Fran. Chris Smith asked addiction expert Bianca Jupp to spark up an answer...

Bianca - Definitely, definitely. And, yeah, quitting smoking is definitely a worthy and good thing to do. But, fortunately, tobacco seems to be one of the addictions we seem to be reasonable at treating. But it’s also really important to recognise again, getting back to this idea that most of us actually aren’t vulnerable to addiction so people just being able to quit smoking willy-nilly could just potentially be that they’re not actually addicted. They’re dependent - yes. You have the withdrawal effects but you’re not actually addicted and so you manage to, for whatever reason, grow out of your addiction and stop.

Chris - Can I clarify something then because that was very interesting what you just said. You said “most of us are not vulnerable to addiction”. So roughly, what proportion of the population are then?

Bianca - It’s between 12 and 20 percent of the population who use drugs to ultimately go on to develop addiction.

Chris - So you’d call them high risk of addiction type people?

Bianca - Yeah.

Chris - Okay. And so if you focus on those, say you’re in that 20 percent - which is interesting you say 20 percent because that’s roughly the proportion of adults in western countries that smoke, isn’t it? So they’re probably the high risk of addiction type people aren’t they?

Bianca - Definitely.

Chris - So what can you do to help someone who finds themselves in that high risk bracket and they’re a smoker, what can they do to stop?

Bianca - Yeah. Essentially, when you stop smoking, or stop whatever your vice happens to be, you’re looking for this dopamine hit - your craving as they say, and you’re used to getting this through your hit of nicotine. And what most people us to come off it is nicotine replacement therapies; this idea of gum or even now these electronic cigarettes, and what that is doing is kind of replacing that hit of dopamine with another form that’s potentially less harmful. So it’s a harm minimisation strategy.

Chris - Is that effective? Do you think is the best way of nailing the habit?

Bianca - Yeah. It definitely works for some people. And I think the biggest criticism that comes out of these sort of studies looking at this is that people don’t take enough nicotine replacement therapy or for long enough, so they eventually relapse. And it’s a very slippery slope.

But, amazingly, the brain is very plastic - it works like a muscle. So everytime you manage to resist having a cigarette, your ability to be able to resist having a cigarette gets stronger. And in this way NRT - nicotine replacement therapy - is one way to do it.

The other therapeutic that we have that works exceptionally well is called Champix or Varenicline, and that works on basically blocking these nicotine receptors within the brain. In blocking them, it actually stimulates them so you get your hit of dopamine but also amazingly, because it sits in the receptor, any time you do happen to have a cigarette if you do relapse, you don’t get that same hit so it’s not rewarding anymore. So again, it’s like flexing that prefrontal cortex and getting better at being able to inhibit that craving. And yeah, so it’s actually been an exceptionally useful therapeutic. Unfortunately it does have some side effects; people report having really crazy vivid dreams. So it doesn’t work for everyone unfortunately. But yes, that’s currently the best way to go about this.

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