"Nicotine grabs people very strongly."

"Nicotine grabs people very strongly."(MICHAEL MILLER)

Michael M. Miller, MD, an addiction medicine specialist, is the medical director of the NewStart Alcohol/Drug Treatment Program at Meriter Hospital in Madison, Wis. He is also the president of the American Society of Addiction Medicine and an associate clinical professor at the University of Wisconsin School of Medicine and Public Health.

Q: Why is it so hard to quit smoking?

A: The hardest part about quitting drugs is the physical withdrawal symptoms—and it's especially hard to “establish abstinence” when the symptoms hit right away. Nicotine's withdrawal symptoms are powerful and hit the fastest of all drugs. People experience agitation, insomnia, irritability, and strong cravings within two to four hours of their last cigarette.

Q: Is smoking more addictive than alcohol?

A: Yes, the drugs that seem to be the most addictive are nicotine, cocaine, and methamphetamine. Those three are different from all other drugs. Among those who drink alcohol on a regular basis, around 15% develop an addiction. About 45% of those who smoke on a regular basis get addicted.

Q: Is nicotine addiction inherited, like alcoholism can be?

A: Genetics are the biggest factor in determining whether you will be among the 10% of the population to develop an addiction. Perhaps 50% to 60% of ones likelihood of developing alcohol addiction is genetic, for instance. Many people thought that phenomenon was limited to alcohol. But the genetic contribution to drug addiction, including nicotine addiction, is at least as strong as it is for alcohol, and probably greater than 60%.

Q: How are the effects of nicotine addiction different from other drugs?

A: People using injection drugs will develop physical problems a few years after they start shooting up. People who use alcohol can go 10 or 20 years before developing significant health problems from drinking. But people who use tobacco can easily go 20 to 30 years without developing health consequences. During all those years, the risk for harm is accumulating, but they dont see it yet. So people think theyre getting a free pass. They think it isnt harming them, or that theyll be able to escape the harm.

[ pagebreak ] Q: Why do I “feel” addicted to nicotine?

A: People usually think of addiction as being about drugs. Its really about the brain. When somebody uses tobacco, alcohol, or another drug, chemicals are released that result in a sense of pleasure or euphoria. Thats the intoxicating “high” that people find fun and enjoyable. It makes people want to have that experience again. Addiction itself is actually separate from the intoxication process. It is due to a problem in another area of the brain that causes people to develop a pattern of abnormal, compulsive use.

Q: Is my addiction to smoking partly psychological?

A: Yes, it is. Addictions are often described as “habits.” With tobacco, the role of habit is stronger than with some other chemical addictions. This is partly due to frequency: If someone smokes a pack a day and takes 10 drags off each cigarette, thats 200 drags a day—or more than 70,000 each year. Smokers light up so often that they make associations with it: driving, for instance, or talking on the phone or drinking a cup of coffee.

Q: What's the best way to quit?

A: The best way to quit involves both medication, which deals with withdrawal and cravings, and behavior therapy, which deals with habits. The newer medications go beyond just replacing the nicotine. They work on other brain chemistry systems and appear to work better than just nicotine replacement—nicotine patches and gums. Cognitive-behavioral and other therapies can help people develop different ways of thinking about their addiction and about themselves.

Q: Will we have more tools for quitting in coming years?

A: The science related to addiction is very new. The research thats being done using brain scans shows what parts of the brain light up when you have a certain chemical in your body and how the brain changes during intoxication, withdrawal, addiction, and recovery from addiction. This is a fascinating area of research that will result in newer medications coming onto the market. Physicians and the general public are going to be amazed by what science gives us in the coming decades.