GAINESVILLE---University of Florida psychiatrists are wielding new weapons in the war against nicotine addiction: antidepressants.
Part of a three-pronged approach that may include nicotine replacement therapy and counseling, the idea is to help smokers kick the habit by tackling addiction at its root: long-lasting changes in brain chemistry that train the brain to expect new levels of pleasure it eventually considers normal.
This chemical conditioning occurs gradually, but the changes persist for months after someone stops smoking, setting the stage for relapse, reports UF substance abuse expert Dr. Mark Gold in an article on tobacco smoking and nicotine dependence in the current edition of the "Journal of Addictive Diseases."
As a result, many people who try to quit report feeling irritable, moody and even depressed, said Gold, professor of psychiatry, neuroscience, community health and family medicine at the UF Brain Institute and UF's College of Medicine.
Smoking tobacco, like smoking heroin or cocaine, is "profoundly addictive," and nicotine dependence is particularly resistant to treatment, he said. Treatment programs for alcoholism and cocaine addiction are effective at least half the time.
In contrast, although 80 percent of smokers want to stop, only 20 to 30 percent of those who do are smoke-free a year later. Less than 5 percent quit successfully with no intervention.
"This is a very, very tenacious addiction," said UF psychiatrist Dr. Douglas Eaton, an addiction medicine specialist. "This is as hard an addiction to crack as heroin or cocaine -- right up there with the biggies."
Up to now, many physicians have relied solely on the nicotine patch, which helps smokers cope with acute withdrawal symptoms.
"Social prohibitions, the stigma and health information that smoking is bad for you works for some people," Gold says. "Who is left? People with a pathological
Contact: Melanie Fridl Roass
University of Florida