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Want to stop smoking? First, treat it as an addiction

We do smokers a tremendous disservice when we refer to smoking as a “bad habit.” Picking your nose is a bad habit. Talking with your mouth full is a bad habit.

We do smokers a tremendous disservice when we refer to smoking as a “bad habit.” Picking your nose is a bad habit. Talking with your mouth full is a bad habit. Turning left across traffic with a cell phone to the ear is a really bad habit.

Smoking is an addiction, as powerful as meth or cocaine. It just happens to be legal. It’s such an intense addiction that a Minnesota Department of Health survey found that 17 percent of Le Puffers du Nord light up within five minutes of awakening. Their brain is saying, “Gimme, gimme, gimme.”

So if you’re ready to help the smoker in your life kick the addiction in 2008, there’s a new drug available in the War on Cigarettes, and it’s called Chantix. OK, it’s not so new — the Food and Drug Administration approved it in May 2006 — but it’s gaining popularity. Doctors are growing more comfortable with it, and the U.S. Public Health Service’s “Treating Tobacco Use and Dependence Guidelines” for 2008 will now include Chantix as a first-line therapy option.

Before the arrival of Chantix, most smoking cessation aids were simply some form of nicotine: gum, nasal sprays, lozenges, inhalers, skin patches, hair tonic, dental adhesive, PEZ dispensers. The idea was to replace the nicotine the smoker was used to getting from cigarettes, and then to stave off nicotine withdrawal by gradually chewing less gum, or using a series of less potent patches.

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What makes Chantix unique is that it works by both blocking and stimulating the nicotine receptors in the deep brain, areas that trigger reward and pleasure sensations. By blocking these nicotine receptors, a smoker on Chantix who decides to cheat gets nothing out of a toke except the usual carcinogens. In Pavlovian language, the bell goes off but no food arrives. The act of smoking is dissociated from the pharmacology of smoking.

And because Chantix also lightly stimulates the nicotine receptor, at about one-third to two-thirds the strength of the regular nicotine molecule, the smoker who takes Chantix also avoids going through sudden and severe nicotine withdrawal.

This nicotine receptor blocking/stimulating feature helps explain Chantix’s side effect profile. A third to half of patients will initially experience some degree of nausea, like they did when they puffed their way through their first experimental cigarettes back in high school. Some side effects of Chantix — insomnia and headache for example — are identical to nicotine withdrawal and may be just that. These side effects can be lessened by starting Chantix at a lower dose one week before the “going smokeless” date, and by simple patience.

How good is Chantix compared to other cessation medications? As a base, kicking the addiction by going “cold turkey” has a 3 to 5 percent success rate over one year. Compared to placebo, nicotine replacement therapy increases the odds of quitting 1.5 to 2.0-fold; the antidepressant bupropion increases the odds 2-fold; and Chantix increases the odds 3-fold.

Those are the kind of numbers that get Jan Sieger, Tobacco Cessation Specialist with the Minnesota Department of Health, very excited. “It looks like Chantix is going to be a phenomenal tool for those smokers who are motivated to quit,” Sieger noted.

Need more information? Go to the Minnesota Department of Health’s tobacco website, or if you’re in no particular hurry, stop by my “Death-on-a-Stick” Minnesota State Fair booth and pick up your free cigarette glue-gunned to a bamboo skewer.