Smoking and Cessation: Non-nicotine Treatments
A recent scientific research looked at why smokers find it so hard to quit despite knowing the benefits of quitting and the dangers of continuing. It found that nicotine distorts the type of reward smokers seek; i.e., they become less concerned with the value of a non-drug reward or punishment (e.g. gaining or losing money) and more driven to assess the magnitude of the reward (i.e. the immediate relaxation and good feelings brought on by smoking). This may, in part, explain why using nicotine-based treatments such as gum or patch are not very successful.
Over the past few years several non-nicotine treatments have become available for treating nicotine dependence. Some of the more successful ones are listed below:
- Bupropion (Zyban): An antidepressant medication that has shown some efficacy in treating nicotine use whether there is any depression present or not. About 40% achieve abstinence at the end of treatment (about 12 weeks), but about 50% relapse in a year
- Nortriptyline: Another antidepressant that doubles the odds of long-term abstinence from nicotine.
- Varenicline (Chantix): It reduces withdrawal symptoms and doubles or triples the odds of quitting and staying abstinent.
Rose EJ et al. Acute nicotine differentially impacts anticipatory valence- and magnitude-related striatal activity. Biol Psychiatry 2013 Feb 1; 73:280
Addy NA and Picciotto MR. Nicotine, striatum, and reward. Biol Psychiatry 2013 Feb 1; 73:205