Why smoking is hard to kick

It is somewhat surprising that with all the medical information we have that tells us how incredibly dangerous smoking cigarettes is that so many people continue to smoke. And it’s not just people who are likely to be unaware of the harmful effects of smoking; often highly intelligent and well educated individuals who know that what they are doing is likely to kill them continue to do it. The big question is, why don’t they just quit?

This question became a subject of great interest to Dr Ron Aspinall, a Canadian born, Australian trained physician who practised medicine in Canada for many years before his recent return to Australia. Extensive research into the subject of addiction uncovered some disturbing results.

‘When people take a drug such as nicotine, it stimulates the release of dopamine in the brain, activating dopamine receptors,’ explained Dr Aspinall. Dopamine is a neurotransmitter that affects the brain process that controls the ability to experience, among other things, pleasure.

‘What a person becomes addicted to is not the drug but the increased levels of dopamine it produces,’ he said. ‘Nicotine, which works in a very similar way to cocaine, overstimulates the dopamine system and weakens it. Once the dopamine system is damaged, the person becomes needy all the time. One reason it is so hard to break the addiction is because the region of the brain that controls dopamine release is in what is referred to as “the old brain” which operates fairly primitively; it cannot be controlled by intelligence.’

Once a person becomes addicted to nicotine use, the whole dopamine system becomes damaged by the rapid release of dopamine and the overstimulation of the dopamine receptors resulting in changes in brain chemistry. Thus Dr Aspinall describes addiction as ‘a chemical infection of the brain’.

‘While anybody can become addicted to any drug if they use it frequently enough, some people are more susceptible to addiction because they have a genetic lack of dopamine in the brain,’ said Dr Aspinall. ‘Characteristically, a person with naturally low levels of dopamine would have had an incredibly sweet tooth as a child, developed addictions early, had multiple addictions and a family history of addictions.’

So are tobacco companies aware of how their products cause people to become addicted? Yes they are, and what is more they have actively pursued ways of making cigarettes even more addictive to boost sales.

‘In the 1960s, Phillip Morris started experimenting with freebasing some of their products – Marlborough and Kool cigarettes – modelled on the freebasing of cocaine to produce the highly addictive crack cocaine,’ said Dr Aspinall. ‘Of course once someone is addicted to crack cocaine they never go back to straight cocaine. Adding a small amount of bleach to their cigarettes had the effect of releasing dopamine far more quickly and inducing a more powerful high. They noticed that sales of these two brands of cigarettes started to increase, so now all cigarettes are freebased.

‘Nicotine addiction is a paediatric disease; the tobacco companies aim their products at teens and pre teens who then become addicted adults. The cost of smoking one pack of cigarettes per day over a lifetime [for one person] is half a million dollars, and that doesn’t include interest.’ So armed with these facts and the odds stacked against him, Dr Aspinall set about designing a program to help people break their addiction effectively. Using a multi faceted approach he has come up with an extremely successful program appropriately named KickButt! Dr Aspinall attributes the six month program’s success to his understanding of the complexities of addiction.

‘There are so many factors that contribute to addiction and they differ from person to person,’ said Dr Aspinall. ‘My program identifi es all those factors and then treats them all at once, giving the person a far greater chance of success.’

The six month program starts with a two to four week preparation phase which comprises three processes: insight – the explanation of what their addiction is; willpower – the strength to overcome the addiction; and separation psychology – the removal of the addiction from the patient’s comfort zone.

‘This third process, in which the patient no longer smokes where they are comfortable but goes outside or otherwise isolates themself allows them to regain control over their environment,’ said Dr Aspinall. ‘The addiction then becomes a nuisance and they begin to resent it.’

On a more practical note, it often results in a reduction of the number of cigarettes the patient is smoking, so by the time ‘quit date’ comes, they have already lessened their addiction.

‘It is vitally important to choose the right quit date,’ said Dr Aspinall. ‘For example, women experiencing pre menstrual stress (PMS) are far more likely to fail in their attempt to quit, so I would never recommend they quit mid cycle. In some women, particularly those who are in peri menopause – typically women in their late thirties and early forties who often have low progesterone – it is benefi cial to give a natural progesterone supplement to overcome the PMS symptoms.

‘Once quit date has been reached, I start using dopamine booster medication such as nicotine patches, gum or drugs such as Zyban. Because these drugs boost the release of dopamine gently, they do not damage the dopamine receptors and are not addictive. The extent of the addiction will dictate the level of medication I use.’

That is not all, however, as Dr Aspinall has found that omega 3, or fi sh oil, and vitamin B6 supplements also assist with breaking the addiction. He also recommends an increase in exercise, hypnosis and acupuncture, although these last two may not be necessary. What is vital, however, is frequent visits with the therapist. ‘You really need a multi functional approach to succeed,’ said Dr Aspinall. ‘KickButt! has a 53% success rate after one year as compared with 7% in self quitters, 13% in those who quit with Zyban and GP advice only, 10% in those who use hypnosis and/ or acupuncture, and 15-20% in those following formal programs. Those statistics were taken before I learned about the effects of hormones and nutrients; I estimate the success rate is now more like 60%.’

Dr Aspinall is keen to make this program available to residents of Byron Shire and beyond and to teach new techniques to other physicians and non-physician nicotine addiction therapists. He can be reached during offi ce hours at Holdsworth House Medical Practice in Byron Bay on 6680 7211 or by email on raspinall@holdsworthhouse.com.au.