Medical Cigarettes

Is it “Inhumane” to Take Cigarettes Away from Schizophrenics?

In an article for Brain Blogger a couple of years ago, I looked into the astonishing fact that, as a typical study of in-patient smoking among schizophrenics in Britain revealed, about 80-90% of the patients diagnosed with schizophrenia were cigarette smokers. Given that the running rate in the general population hovers around 20-25% on average, this is really quite amazing. It seems clear that nicotine is doing something for a schizophrenic that makes cigarettes into a form of self-medication that almost all schizophrenics apparently discover at one time or another.

A review of relevant studies through 1999, undertaken by Lyon and published in Psychiatric Services, shows unequivocally that schizophrenic smokers are self-medicating to improve processing of auditory stimuli and to reduce many of the cognitive symptoms of the disease. “Neurobiological factors provide the strongest explanation for the link between smoking and schizophrenia,” Lyons writes, “because a direct neurochemical interaction can be demonstrated.” According to Lyon, “Several studies have reported that smokers require higher levels of antipsychotics than nonsmokers. Smoking can lower the blood levels of some antipsychotics by as much as 50%…. For example, Ziedonis and associates found that the average antipsychotic dosage for smokers in their sample was 590 mg in chlorpromazine equivalents compared with 375 mg for nonsmokers.”

In particular, smoking seems to help quell auditory and visual hallucinations. The process known as “sensory gating” refers to lower response levels to repeated auditory stimuli. A schizophrenic’s response to a second stimulus is greater than a normal person’s, and this is also impacted by cigarettes. Sensory gating may be involved in the auditory hallucinations common to schizophrenics. Receptors for nicotine are involved in sensory gating, and several studies have shown that sensory gating among schizophrenics is markedly improved after smoking.

There is an additional reason why smoking is an issue of importance for health professionals. Dr. Bill Yates at Brain Posts recently examined a small study by Michael Allen and colleagues in the American Journal of Psychiatry in which 40 schizophrenic patients were admitted to a psychiatric emergency service, where they were given standard antipsychotic therapy. In addition, the researchers randomly assigned either a 21mg nicotine patch or a placebo patch to the subjects upon admission. As Dr. Yates summarized the results:

--Nicotine patches reduced agitation by 33% in the first four hours and 23% at 24 hours. And the reduction was greater than with either the antipsychotic alone, or in conjunction with the placebo patch.

--Subjects with lower nicotine dependence scores tended to show the most response compared to placebo.

--The effect of nicotine replacement on agitation reduction approached the level seen with standard antipsychotic therapy.

As Yates notes, this finding is “pretty dramatic.” It seems to show that acute nicotine withdrawal only makes the situation worse in a clinical setting. The study authors also argue that stronger patches combined with nicotine gum might quell agitation more quickly and effectively. “Encouraging patients with psychotic disorders and mood disorders to quit smoking is an important general health strategy,” Dr. Yates writes. “However, this study suggests that attempting this during an acute psychotic break is probably counter productive and may be inhumane.”

Photo Credit:http://drugabuse.gov/

Challenging the Received Wisdom on Tobacco Addiction

What does it take to get hooked on nicotine?

--Smokers who smoke five or fewer cigarettes per day can still become addicted to tobacco.

--Tobacco addiction can also be present in non-daily smokers.

--Nicotine withdrawal symptoms do not necessarily begin within 24 hours.

These and other controversial assertions come from Joseph R DiFranza, a physician with the Department of Family Medicine and Community Health at the University of Massachusetts Medical School. Dr. DiFranza recently authored a provocative examination of smoking truisms in an article for the online publication Harm Reduction Journal.

In an attack on what he calls the Threshold Model of Addiction, DiFranza defines the model as follows:

In brief, the threshold model maintains that until tobacco consumption is maintained above a threshold of 5-10 cigarettes per day (cpd) for a prolonged period, smokers are free of all symptoms of tobacco addiction. It holds that declining blood nicotine levels trigger withdrawal symptoms so quickly that addicted smokers must protect their nicotine levels by smoking at least 5 cpd. The threshold model states that until addiction is established with moderate daily smoking, smoking is motivated and maintained by peer pressure, pleasure seeking and the social rewards of smoking.

DiFranza breaks this prevailing paradigm into a half-dozen hypotheses, offering his opinion on the state of scientific evidence that, in his view, refutes every one of them:

--Hypothesis 1. Tobacco addiction cannot occur in nondaily smokers, or even in daily smokers who regularly consume fewer than 5 cpd.

DiFranza’s response:   “Although it is difficult to prove a negative, this hypothesis would be supported if study after study demonstrated that all surveyed subthreshold smokers (individuals who smoke < 5 cpd) have no symptoms of addiction…. Since no studies have demonstrated a complete lack of addiction symptoms in any representative population of subthreshold smokers, the peer reviewed literature soundly refutes the hypothesis that tobacco addiction requires as a prerequisite the daily consumption of 5-10 cigarettes. The threshold model and the DSM are wrong. “

--Hypothesis 2. Tobacco addiction requires prolonged daily use as a prerequisite.

Response: “Many subjects developed symptoms quite soon after the onset of intermittent tobacco use. These findings have been replicated in several longitudinal studies, in cross-sectional studies showing symptoms of addiction in nondaily smokers, and by case histories showing the same.”

Hypothesis 3. Nicotine withdrawal symptoms begin within 24 hours in all smokers.

“The standard subject in all early smoking studies was an adult who had been a heavy daily smoker for decades. Such individuals do experience nicotine withdrawal soon after their last cigarette. A problem arises when this observation is inappropriately generalized by applying it to all smokers, including children, novices and nondaily smokers.”

Hypothesis 4. Addicted smokers must maintain nicotine above a threshold blood concentration to avoid withdrawal.

“Since a person must smoke at least 5 cpd to maintain a minimum nicotine level throughout the day, another approach to testing this hypothesis would be to determine if all smokers that experience withdrawal symptoms smoke at least 5 cpd. This test has been completed over a dozen times, and always with the same result. Withdrawal symptoms have been reported in smokers of fewer than 5 cpd in every study that has examined this issue.”

Hypothesis 5. Psychosocial factors maintain smoking over the several years it may take to reach threshold levels of smoking.

“There must be thousands of studies that demonstrate that social factors such as socioeconomic status, smoking by family and friends, cigarette advertising, the availability of cigarettes, smoking depictions in movies, and attitudes and beliefs are predictive of which youth will try smoking. However, if such factors sustain tobacco use until tobacco addiction develops, they should predict which smokers will advance to addiction in prospective studies. But this has not been shown. None of more than 40 psychosocial risk factors for the onset of smoking was able to predict the progression to tobacco addiction. The author is aware of no studies that establish that peer pressure of other social factors sustain adolescent or young adult smoking over the 4 or 5 years it may take for smokers to reach threshold levels of smoking. “

Hypothesis 6. Increasing tolerance to the pleasurable effects of smoking drives the escalation in tobacco use up to the threshold of addiction.

“The author is not aware of any studies that demonstrate that smokers must smoke more cigarettes over time to obtain the same amount of pleasure (for example smoking 10 cpd to obtain the same pleasure initially obtained from smoking 1 cpd. Indeed, our data indicate that the pleasure obtained from smoking each cigarette actually increases in proportion to the degree of addiction, with pleasure ratings correlating strongly with addiction severity. While this is only one study, it directly contradicts the hypothesis that non-addicted novice smokers obtain much more pleasure from each cigarette than do addicted heavy smokers.”

Photo Credit: http://nikotin.floridadmat.com/

New Warning Labels for U.S. Cigarettes; Big Tobacco on the Rampage

Philip Morris Intl. sues Uruguay and Brazil.

Lots of developments on the nicotine front these days. On opposite ends of the news spectrum, so to speak, the Food and Drug Administration (FDA) announced plans to slap new and much more graphic warning stickers on cigarette packs--while elsewhere in the world, the world’s major tobacco companies got busy fighting tougher regulations on cigarette marketing. Meanwhile, the state of California has set limits on the marketing of e-cigarettes, disallowing companies from promoting the nicotine inhalers as “smoking-cessation devices.”

So let’s get busy. In the first significant change for cigarette advertising in 25 years, the FDA, freed by Congress last year to regulate tobacco products, will select nine new designs from among 36 contenders for new, far more graphic warning labels on cigarette packages. The new warning labels will begin appearing in about a year. To view the contenders, go to www.fda.gov/cigarettewarnings.

But will new, grisly images of dying smokers and rotted lungs really make a difference to the roughly one-quarter of adult Americans who still smoke?  “I am pleasantly shocked that [they are] doing this,” Stanton A. Glantz, a tobacco researcher at UC San Francisco, told the Los Angeles Times.  “There is no question but that strong graphic warning labels work,” he said. “Right now we have the weakest warning labels in the world. Now we will be right up there tied for the strongest.”

No so fast, counters John F.  Banzhaf, the executive director of Action on Smoking and Health and a George Washington University law professor. In the same L.A. Times article, Banzhaf said he was “quite disappointed,” stating that the agency “has done nothing more than exactly what Congress told them to do, and not one iota more.” So far, the FDA has banned advertising in magazines for young people, nixed the marketing ploy of handing out free samples on the street, and forbidden tobacco companies from marketing cigarettes by using the words “light” or “low-tar.”

Perhaps a more important result of Congressional approval of FDA oversight is that Medicare has now changed its rules to include smoking cessation products for covered beneficiaries. Previously, only people dying of lung disease were approved for smoking cessation products—a bit late in the disease cycle to do anybody much good.

According to a variety of estimates from government and research agencies, as many as half a million Americans die prematurely from smoking-related diseases. The Department of Health and Human Services has lately been stymied by a smoking rate of about 20%, basically unchanged since 2004. In 1965, about 42% of Americans smoked. The Department of Health and Human Services (HHS) has a stated goal of bringing smoking levels down to 12% by 2020.

That will not be an easy target to hit. And neither Congress nor the FDA nor HHS can count on anything amounting to cooperation from the cigarette giants. The New York Times, in an article by Duff Wilson, notes that worldwide cigarette sales rose 2% last year, as cigarette companies increasingly shift their marketing efforts toward a hunt for new customers in developing countries.  The aggressive nature of the worldwide cigarette marketing push was underscored this year when Philip Morris International sued the governments of Uruguay and Brazil, claiming that those countries had enacted tobacco regulations that were excessive and a threat to the company’s trademark and property rights.

Dr. Douglas Bettcher of the World Health Organization’s Tobacco Free Initiative accused the company of “using litigation to threaten low- and middle-income countries.” Philip Morris subsidiaries are also filing suits in Ireland and Norway over display advertising prohibitions. (Philip Morris USA, a separate division, is not involved in these lawsuits, and did not join with R.J. Reynolds and other tobacco companies in filing suit against the FDA last year.)

In the New York Times article, Wilson writes:

Companies like Philip Morris International and British American Tobacco are contesting limits on ads in Britain, bigger health warnings in South America and higher cigarette taxes in the Philippines and Mexico. They are also spending billions on lobbying and marketing campaigns in Africa and Asia, and in one case provided undisclosed financing for TV commercials in Australia.

As tobacco expert Dr. Cynthia Pomerleau points out on her blog, low smoking rates among women in the developing world make them a particularly tempting marketing target for the tobacco industry. Pomerleau, research professor emerita in the University of Michigan’s Department of Psychiatry, also reminds us that “the real goal here is not to remove health warnings altogether—health warnings have actually worked well for them by legitimizing the claim that if people choose to smoke, it’s not their fault—just to prevent them from dominating the package and actually becoming salient.”

It is important for the industry, says Pomerleau, to publicize “effects that can be achieved or problems that can be addressed by smoking.” In this respect, Pomerleau is concerned about the likelihood that the tobacco industry will seize upon the relationship between smoking and thinness as the wedge for sales campaigns aimed at women. “If it worked in the U.S., why not in Africa or Asia or South America?”

And finally, under a consent judgment worked out with California state Attorney General Jerry Brown, the Florida-based Smoking Everywhere company, a distributor of electronic cigarettes, has agreed not to target minors in its advertising, or to make claims that its products are safe alternatives to tobacco. The move comes shortly after the FDA announced plans to regulated battery-powered e-cigarettes as new drug delivery devices. Smoking Everywhere distributes e-cigarettes manufactured in China. The consent judgment also bars the company from selling its products in vending machines, and requires the products to contain warning labels about the dangers of nicotine.

And don’t forget: Thursday, November 18 marks the 35th annual Great American Smokeout.

Vitamin B6 May Lower Risk of Lung Cancer

Large European study confirms earlier findings.

It doesn’t mean you should start popping handfuls of B vitamins if you are a smoker or a former smoker (those who never smoked rarely get the disease). What it appears to mean is that people with the highest levels of vitamin B6 in their bodies may have as little as half the risk of developing lung cancer as people with very low levels of B6--also known as pyridoxine.

In a June 16 article in the Journal of the American Medical Association (JAMA) , dozens of researchers from around the world deconstructed a European medical database from the 1990s, containing medical data and blood test results for more than 380,000 people. They were looking for meaningful statistical correlations having to do with the 899 people in the study who eventually developed lung cancer.

According to Nathan Seppa in Science News, the international research team found that “people with vitamin B6 levels ranking in the top one-fourth of all the samples taken had less than half the risk of lung cancer as those with the lowest vitamin B6. A similar comparison found that people with high levels of [the amino acid] methionine seemed to have almost half the cancer risk of people with low levels. High folate levels seemed to give less protection.” The researchers calculated that having high levels of all three compounds could reduce lung cancer risk by as much as two-thirds.

Much remains unknown. Can smokers use B6 vitamin supplements to protect against lung cancer, or are the protective effects, if verified, due to a B6 level that reflects diet and other metabolic factors at work over decades? And, as always, there is the question of B6 from vitamin supplements vs. B6 from B6-rich foods like fish, beans, and grains.

A smaller prospective study undertaken in 2001 came up with similar results. Published in the American Journal of Epidemiology, the study involved 300 lung cancer patients in Finland between 1985 and 1993. The researchers looked at B6, B12, and folate, and found “significantly lower risk of lung cancer among men who had higher serum vitamin B6 levels. Compared with men with the lowest vitamin B6 concentration, men in the fifth quintile had about one half of the risk of lung cancer.” The researchers speculate that one of the mechanisms by which B6 could influence carcinogenesis is the role the vitamin plays in homocysteine metabolism. B6 is involved in the complex process of metabolizing homocysteine, another amino acid. Absent sufficient B6, homocysteine levels can build up in the body, causing heart disease and other ailments.

Mattias Johansson, et. al. (2010). Serum B Vitamin Levels and Risk of Lung Cancer Journal of the American Medical Association, 303 (23), 2377-2385

Graphics Credit: http://helios.hampshire.edu/

Economy Down, Addictions Up?

Do people drink more or less during a recession?

According to a report from Mintel, a consumer research firm, "sin stocks" historically have performed well during times of economic recession. "Chocolate, cigarettes and alcohol again seem relatively recession-proof," comments Marcia Mogelonsky, senior analyst at Mintel.

Lest anyone think that somehow the tobacco dragon has been tamed after 45 years of public health announcements (surely no one can afford cigarettes anymore?), Mintel documents that "cigarette and tobacco product sales increased 44% from 2003 to 2007 to $103 billion.” Moreover, “as price and tax increases continue to take hold, Mintel projects that the cigarette and tobacco market will grow 28% through 2011 (to $132 billion).”

There is also a bull market for chocolate: “Innovative, dark and premium chocolates are extremely popular, so Mintel expects Americans to continue indulging in this favorite treat. The market research firm predicts 4% annual sales increases each year for the next six years.”

As for alcohol, a mixed picture: “Motivated by high gas prices and expensive bar tabs, more Americans are opting to drink at home. But that doesn't mean they're drinking less. New research from Mintel reveals the market for at-home alcohol is expected to reach $77.8 billion in 2008, a 32% increase from 2003.” Mintel expects in-home alcohol sales to rise as much as 5% per year.

However, earlier studies of the matter have been inconclusive. Melissa Healy reported in the Los Angeles Times that the connection between “hard times and hard drinking isn't clear. In the U.S., a state's alcohol consumption declined by 3% for every one percentage point increase in that state's unemployment rate, according to one study. But another study found that rates of binge drinking went up 8% when unemployment rose 5%. The increase in binge drinking was concentrated most heavily among adults who were still employed.”

In the Los Angeles Times article, Andrew Barnes of the UCLA School of Health Services, estimates that “during this economic decline, those who drink alcohol will consume 12% less (10% less nationally), there will be a 13% reduction in alcohol-impaired driving, and a 1.2% decrease (1% nationally) in the number of people who drink at all. The probability of being a heavy drinker (consuming 60 or more drinks per month) is predicted to decline in California by 31%.”

Graphics Credit: www.bloggingstocks.com

addiction drugs smoking

Gates, Bloomberg Target Cigarettes

Billionaires pledge $500 million, but will it do any good?

If money were all it took, tobacco smoking would be on the run after Bill Gates and Michael Bloomberg jointly pledged last month to fight tobacco use worldwide, especially in low- and middle-income countries, through the Bill and Melinda Gates Foundation and Johns Hopkins University.

Mayor Bloomberg, who has been involved in anti-smoking campaigns for years, admitted at a joint news conference that "all the money in the world will never eradicate tobacco. But this partnership underscores how much the tide is turning against this deadly epidemic."

The program, put together by Bloomberg and Dr. Margaret Chan of the World Health Organization (WHO), is an ambitious, multi-faceted effort to be coordinated by the Bloomberg Initiative to Reduce Tobacco Use, the WHO, the World Lung Foundation, the Johns Hopkins Bloomberg School of Public Health, and the Centers for Disease Control and Prevention (CDC).

As Donald G. McNeil described the $500 million program, dubbed Mpower, in the July 24 New York Times: "It will urge governments to sharply raise tobacco taxes, prohibit smoking in publics places, outlaw advertising to children and cigarette giveaways, start antismoking advertising campaigns and offer people nicotine patches or other help quitting." The program also intends to bring "health officials, consumer advocates, journalists, tax officers and others from third world countries" to the U.S. for workshops and training.

It will not be the first such effort--far from it. Troubled by the rising tide of nicotine dependence among the common folk, Bavaria, Saxony, Zurich, and other European states outlawed tobacco at various times during the 17th Century. The Sultan Murad IV decreed the death penalty for smoking tobacco in Constantinople, and the first of the Romanoff czars decreed that the punishment for smoking was the slitting of the offender’s nostrils.

In America, the Prohibition years from 1920 to 1933 coincided with a short-lived effort to prohibit cigarettes. Leaving no stone unturned in the battle to eliminate drugs and alcohol from American life, Henry Ford and Thomas Edison joined forces to wage a public campaign against the “little white slavers.” Edison and Ford wanted to stamp out cigarette smoking in the office and the factory. Although that effort would have to wait another 75 years or so, New York City did manage to pass an ordinance prohibiting women from smoking in public. (See Siegel, Ronald K. Intoxication: Life in Pursuit of Artificial Paradise). Fourteen states eventually enacted various laws prohibiting or restricting cigarettes. By 1927, all such laws had been repealed.

Finally, Adolf Hitler himself took on the battle against cigarettes--and lost. In 1942, after letting loose a torrent of misbegotten screed about "the wrath of the Red Man against the White Man," Hitler, in one of the most aggressive anti-smoking campaigns in history, banned smoking in public places and slapped heavy taxes on tobacco. But by the mid-1950s, smoking in Germany exceeded prewar levels.

There is no evidence to suggest that any culture that has ever taken up the smoking of tobacco has ever wholly relinquished the practice voluntarily.

Photo Credit: National Health Service

Can Obama Quit Smoking?

Does nicotine addiction matter in a president?

Presidents Eisenhower, Kennedy, Johnson, Ford, and Clinton all enjoyed their occasional cigarettes and cigars. Laura Bush as been accused of bumming a cigarette or two since entering the Oval Office.

Presidential candidate Barack Obama smokes, too, but I could not find a picture of him actually doing it--and neither can anybody else, it seems. By all accounts, Barack Obama continues to struggle mightily in his current quitting attempt, which began in the form of a campaign promise to his wife. Sources say he’s getting by—barely--with the “strenuous” use of nicotine chewing gum.

Is there any way for Obama to connect with FDR and his rakish cigarette holder? Or is a president who smokes simply out of step with a nation seemingly bent on emptying all workspaces and gathering places of tobacco smoke? In a smoke-free nation, will the next president be forced to huddle on the rear portico of the White House, with the serving staff, and fieldstrip the odd Marb?

The fact that Obama may have messed with a little weed, a little blow, back in the day, seems, at long last, to be a non-starter as a wedge issue of any consequence. If Newt Gingrich smoked pot in college, everybody smoked pot in college. Even before Obama had officially entered the race last year, Michael Currie Schaffer of the Dallas Morning News ventured to guess that “youthful coke-dabblers probably outnumber adult smokers among Mr. Obama’s fellow 1980s, Harvard law students.”

On the other hand, as Maureen Dowd cooed in the New York Times, the smoking habit made Obama “intriguingly imperfect.” Ah, that touch of the rogue. Simply irresistible. Clearly, this is meant to separate Obama as a candidate from that oh-so-perfect and impeccably smoke-free Hilary Clinton, who in point of fact was personally responsible for the first official no-smoking regulations in the White House.

Nonetheless, as Schaffer points out, nowadays smoking is “actuarially foolish and hopelessly out of fashion,” and as such, can do Obama no good, even as a humanizing gambit. Fox News called it “Obama’s dirty little secret.” The fact that Obama hasn’t officially overcome the habit means he cannot lean on any sort of triumph over adversity, any type of uplifting self-help story, as even George Bush was able to do with his former drinking.

Some anti-smoking advocates want Obama to come out of the closet and embrace his inner nicotine fiend in public. According to the New York Times, “Smoking cessation experts say they hope Mr. Obama’s example of using a nicotine gum will encourage smokers to try a nicotine replacement product to help them quit.” But for ABC News, as correspondent Jake Tapper put it, the big question is: “Will Nicorette be enough to get him through Iowa and New Hampshire? Or will he inhale?”

One of the problems with nicotine gums and lozenges, as a British health report recently made clear, is that nicotine replacement is not widely used, because it is expensive--and because it is subject to greater regulation than cigarettes themselves. Warning labels on a pack of Nicorette far exceed the side effects listed on a pack of Camels.

smoking smoking

Smoking in New York City

A Borough-By-Borough Survey

New York City has 240,000 fewer smokers than it did in 2002, according to a recent report released by the city’s Department of Health and Mental Hygiene. City health official Jennifer Ellis told the New York Times that the data represent the sharpest fall-off in cigarette smoking since the department began the surveys in 1993.

The report cited bans on smoking in public places, higher taxes on tobacco products, and a multi-million dollar local advertising campaign as the ingredients that helped lead to the overall reduction in the number of smokers. Based on a citywide survey of adults, Who’s Still Smoking states that as many as 800,000 smokers attempted to quit in the past year, but less than one-fifth of them succeeded.

However, quit rates over the 5-year period varied markedly from borough to borough. Staten Island proved to be the home of the city’s most stubborn and recalcitrant smokers: While the citywide smoking rate dropped by almost 20 per cent, Staten Island’s smoking rate—27 per cent, according to the survey--has remained steady since 2002. Manhattan and the Bronx ended in a virtual tie for first place, with smoking reductions of about 24 per cent, while Queens trailed slightly. Brooklyn came in second to last, with a quit rate of only 13 per cent.

On August 21, the Health Department began a nicotine-replacement giveaway program aimed specifically at Staten Islanders. The 5-week giveaway and associated media campaign will run Tuesdays through Thursdays at the Staten Island Ferry’s Whitehall Terminal.

Men still lead women in smoking, 20 per cent to 15 per cent overall, but the report claims that quit rates are similar for both sexes. Low-income adults and adults without a high school education are more likely to attempt quitting by a slight margin, but less likely to be successful per attempt. One important side note: A separate analysis of survey data showed that only 11 per cent of heavy drinkers who smoke were able to quit in the past year.

The average pack-a-day smoker now spends $2,500 a year to support his or her habit. Health officials stressed that the use of nicotine replacement, either as patches or gum, along with anti-craving medications like Zyban and Chantix, can at least double a smoker’s chances of successfully getting free.

Information in the report was gathered through a random telephone survey of 10,000 adult New Yorkers.

Image courtesy of the National Library of Medicine.

smoking

Book Review (Part 1): "Women Under the Influence"

Women and Cigarettes: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

“Compared to boys and men, girls and women become addicted to alcohol, nicotine, and illegal and prescription drugs at lower levels of use and in shorter periods of time, develop substance-related diseases like lung cancer more quickly, suffer more severe brain damage from alcohol and drugs like Ecstasy, and often pay the ultimate price sooner. Yet 92 per cent of women in need of treatment for alcohol and drug problems do not receive it. Stigma, shame, and ignorance hide the scope of the problem and the severity of the consequences.”

--Joseph A. Califano, Jr.

“Women Under the Influence,” with a Foreword by former Health, Education and Welfare Secretary Joseph Califano, appeared in print last year, but is well worth a second look. The result of studies undertaken at Columbia University’s National Center on Addiction and Substance Abuse, and collectively written by that group, “Women Under the Influence” gathers together a decade’s worth of research on the gender differences researchers have thus far been able to identify in the addict population.

The same genetic and biological mechanisms that predispose certain men toward alcoholism and other forms of drug addiction do the same in women. Young women with family histories of alcoholism will, like Pavlov’s dogs, salivate more intensely at the sight of alcohol than women from families without addiction histories. Studies of female twins also confirm the behavioral link between major depressive disorder and substance abuse. Women who have suffered from major depression are three to six times more likely to suffer from alcoholism than those who have not. Despite these and other commonalities, however, women and men often follow different arcs of addiction on a drug-by-drug basis.

We begin with cigarettes, since it is with nicotine that women have lately shown the ability to achieve a grisly parity, or in some cases even outdo men in the damage done by nicotine. About one American woman out of five smokes. While rates of lung cancer in men have been slowly declining since 1980, the number of women with lung cancer has increased 600 percent over the past 70 years. More women now die of lung cancer than the combined fatalities from breast cancer, ovarian cancer, and uterine cancer. As Antonia C. Novella, former U.S. Surgeon General, put it: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

80 per cent of female smokers began smoking before the age of 18, and women did not begin smoking in large numbers until the late 1940s, thus producing a delayed epidemic of lung cancer in women. To make matters worse, the Columbia group concluded that “At the same level of exposure to tobacco smoke, women have a greater risk of developing lung cancer than men.” Up to three times more likely, according to some studies. Moreover, women who smoke more than 20 cigarettes a day face an 80 per cent greater risk of developing breast cancer, compared to non-smoking women.

Women who smoke heavily have four times as many heart attacks as non-smoking women. Add in oral contraceptives, and the risk of heart attack increases by 1,000 percent.

Women who smoke have more respiratory disorders. Wheezing rates are consistently higher for women than for men, at all age levels. Women smokers develop more crow’s feet around the eyes than men who smoke. Female pack-a-day smokers suffer a steady accretion of bone density and a concomitant increase in rates of osteoporosis. And the fact that nicotine is an effective appetite suppressant is an open secret, as a couple of generations of chain-smoking supermodels have demonstrated.

Cigarette companies are increasingly placing their bets abroad, among a new generation of young women in countries like China, where authorities estimate that as many as 20 million Chinese women have taken up smoking over the past ten years. In “Lung cancer in U.S. women: A contemporary epidemic,” published in the Journal of the American Medical Association (JAMA 291(14):1767), J.D. Patel et. al. suggest that “Curtailing the increase in tobacco use among women in developing countries represents one of the greatest opportunities for disease prevention in the world today.”

The silver lining, if there is one, is that a majority of women still choose not to smoke.

Women Under the Influence--purchase info

End of Part One.

Brain Injury Stops Smokers Cold

In a research development that the director of the National Institute on Drug Abuse (NIDA) calls nothing short of “ming-boggling,” stroke victims lost all desire for cigarettes after suffering damage to a tiny structure in the forebrain. The stroke victims who smoked were seemingly freed from nicotine addiction by damage to the insula, a part of the brain that has not previously been a primary target of addiction research.

Along with the nucleus accumbens, the amygdala, and other structures in the limbic system, certain regions of the cerebral cortex are also implicated in active addiction. Now, said NIDA’s Dr. Nora Volkow, “Everybody’s going to be looking at the insula.”

Researchers at the University of Iowa and the University of Southern California collaborated on the brain injury study, published in the January 26 issue of Science. Neuroscientist Antoine Bechara of USC had learned of a stroke patient known only as N.

A heavy smoker from the age of 14, N. quit cold after a stroke at age 28, telling doctors: “My body forgot the urge to smoke.” A striking percentage of smokers with similar damage to the insula had apparently quit smoking after the injury just as effortlessly as had Patient N.

The role of the insula in brain activity is not well understood, but neurologists believe that the structure may help integrate subcortical inputs into coherent emotions and conscious urges.

No one is suggesting brain surgery for nicotine addiction, but researchers hope to discover ways of interfering with the operation of the insula, perhaps by means of a targeted drug. However, it is not yet clear what other functions the insula may perform, and whether the damage that seemingly eliminates the cigarette urge might also eliminate more positive urges and emotions as well.

Sources:

--Naqvi. N.H., et. al. “Damage to the insula disrupts addiction to cigarette smoking.” Science 315 531-534. Jan 26, 2007.

--Brownlee, Christen. “Addiction Subtraction: Brain damage curbs cigarette urge.” Science News 171 51. Jan 27, 2007.

--Carey, Benedict. “In Clue to Addiction, Brain Injury Halts Smoking.” New York Times. January 26, 2007.

Snail Toxin and Nicotine

This post courtesy of Biology-blog.com

http://www.biology-blog.com/

A New Tool Against Brain Disease

University of Utah scientists isolated an unusual nerve toxin in an ocean-dwelling snail, and say its ability to glom onto the brain's nicotine receptors may be useful for designing new drugs to treat a variety of psychiatric and brain diseases.

"We discovered a new toxin from a venomous cone snail that may enable researchers to more effectively develop medications for a wide range of nervous system disorders including Parkinson's disease, Alzheimer's disease, depression, nicotine addiction and perhaps even schizophrenia," says J. Michael McIntosh.

McIntosh is the same University of Utah researcher who as an incoming freshman student in 1979 discovered another "conotoxin" that was developed into Prialt, a drug injected into fluid surrounding the spinal cord to treat severe pain due to cancer, AIDS, injury, failed back surgery and certain nervous system disorders. Prialt was approved in late 2004 in the United States and was introduced in Europe last month.

Prialt, sold by Ireland's Elan Pharmaceuticals, took roughly 25 years to reach market after its discovery in venom from the fish-eating cone snail Conus magus or magician's cone. McIntosh says he expects it will take 10 to 20 years to develop new medications based on what is learned from the new toxin named alpha conotoxin OmIA (oh-em-one-ay) isolated from a cone snail species named Conus omaria, which lives in the Pacific and Indian oceans and eats other snails. It ranges from 1 to 3 inches long....

Diseases that Might Benefit from the New Snail Toxin

McIntosh says the OmIA toxin will be useful in designing new medicines because it fits like a key into certain lock-like "nicotinic acetylcholine receptors" found on nerve cells in the brain and the rest of the nervous system.

"Those are the same types of receptors you activate if you smoke a cigarette," he says, explaining that nicotine in cigarette smoke "binds" to the receptor to trigger the release of a neurotransmitter, which is a chemical that carries a nerve impulse from one nerve cell to another, allowing nerve cells to communicate....

A medicine that could block certain nicotinic receptors could be used to help people stop smoking cigarettes, and the same method might work for alcoholism because nicotinic receptors may be involved in alcohol addiction, McIntosh says.

Other nicotinic receptors trigger the release of neurotransmitters involved in memory, so activating the right receptors might lessen Alzheimer's memory loss.

"One reason people smoke is they feel their thinking may be a little better, with increased attention and focus," McIntosh says, noting that pharmaceutical companies "would like to mimic that positive benefit without all the downsides of cigarette smoke".

Other nicotinic receptors influence "the release of serotonin and norepinephrine, two neurotransmitters strongly implicated in mood disorders" such as depression, so a drug to activate those receptors might treat depression, he adds.

Schizophrenics tend to smoke heavily because something in cigarette smoke "seems to help them filter out irrelevant stimuli. They can focus better," McIntosh says. So a drug aimed at certain nicotinic receptors might treat schizophrenia.

New Neurotoxin is a Key for Designing New Medicines

McIntosh says the new toxin itself is unlikely to become a drug because it blocks rather than stimulates nicotinic receptors. But because it can act on some types of nicotinic receptors and not others like a key that opens some locks but not others it has great potential as a tool for precisely identifying the shape and structure of the receptor "locks," thus making it easier to design new medicines or "keys" to fit those receptors and trigger them to release desired neurotransmitters....


Posted by: Kelly Source: http://www.unews.utah.edu/

New Drug For Smokers

First there was Wellbutrin, an antidepressant which helped cut down on the cravings and nicotine withdrawal symptoms for many addicted smokers when it was marketed as the smoking cessation aid Zyban. In May, the Food and Drug Administration (FDA) okayed a second medication for the treatment of nicotine addiction. Chantix, the trade name for varenicline tartrate, works on the dopamine system to reduce withdrawal and craving symptoms, like Zyban. In randomized, placebo-controlled clinical studies involving more than 3,500 smokers, Chantix outperformed both placebos and Zyban. Common side effects included nausea, headache and vomiting. Two studies published in the Journal of the American Medical Association (JAMA) showed that about 22 per cent of smokers on Chantix were abstinent at the one-year mark, compared to 15 per cent for Zyban, and 9 per cent for placebos.

Zyban and Chantix are frequently used by doctors in combination with nicotine replacement therapy, such as gum or patches. Zyban was the first major success story in the burgeoning field of pharmacological treatments for addiction--fighting fire with fire.

According to the Centers of Disease Control and Prevention (CDC), more than 44 million American adults continue to smoke cigarettes, a fifth of whom suffer from smoking-related illnesses.

See more on anti-craving drugs at http://dirkhanson.org

Sources:

--”FDA Approves Novel Medication for Smoking Cessation.” U.S. Food and Drug Administration. www.fda.gov/bbs/topics/NEWS/2006/NEW1370.html. May 11, 2006.

Kotulak, Ronald. “New Drug Shows Promise in Helping Smokers Quit.” Chicago Tribune July 5 2006.

Smokers Drink More

It’s no secret that smoking and drinking go together like salt and pepper. No comes further evidence that smoking helps drinkers hold more liquor. Put simply, “Cigarette smoking appears to promote the consumption of alcohol,” says Wei-Jeun Chen of the Texas A&M Health Science Center.

Nicotine seems to slow the movement of alcohol through the intestines, leaving more alcohol molecules backed up and metabolised before reaching the bloodstream by means of intestinal absorption. In animal studies, in which rats were given stomache injections of alcohol and nicotine, clinicians found that “smoking” rats exhibited lower blood-alcohol levels than rats given the same amount of alcohol without the addiction of nicotine.

Dr. David Ball of the Institute of Psychiatry in London, told BBC news: This is a really interesting study. I’m surprised nobody has done it before.”

Chen, an associate professor of neuroscience and experimental therapeutics at Texas A&M College of Medicine, stressed that the results of such “cross tolerance” between alcohol and nicotine could be to “encourage drinkers to drink more to achieve the pleasurable or expected effect.”*

Susan Maier, a spokesperson for the National Institutes of Health (NIH), which sponsored the research, pointed to the potential for harm among young binge drinkers who choose to smoke, and who could “develop chronic alcohol-related diseases earlier in life because of it.”

Conceivably, other drugs might interact with alcohol in a similar fashion. Scientists are beginning to take a look at popular gastric upset products like Pepcid and Tagamet. “Individuals who abuse alcohol are likely to use other drugs,” Chen said. “The potential interactive effects of alcohol and other drugs needs to be considered. For example, the co-use of alcohol and cocaine will result in the formation of cocaethylene, which is highly toxic and has led to a higher mortality rate in animal studies.”

*Coffee and cigarettes go very naturally together as well. This is probably true for as many different reasons as there are coffee drinkers and cigarette smokers, but as we previously noted in the case of alcohol and tobacco, there is a metabolic synergism at work. The two drugs really do seem to have been made for each other. Rats on caffeine will self-administer nicotine faster and more steadily than decaffeinated control rats. This is because nicotine causes caffeine to clear the body at twice the normal rate, thereby allowing coffee or tea drinkers to imbibe larger amounts than usual, whether consciously aware of it or not. In turn, caffeine has an equivalent reinforcing effect on nicotine. The more you smoke, the more coffee you can drink, and vice versa. At the chemical level, smokers may be drinking caffeine in order to more finely balance the mood-altering effects of nicotine. A moment’s reflection brings us to the coffee house, an ancient establishment wherein tobacco and coffee are combined to maximum effect. Coffee and cigarettes, to be sure, are the least psychoactive of the psychoactive drugs—more proof that the sheer intensity of the drug high is not the primary determinant of addiction.

--excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.

Sources:

--Scott E Parnell, James R West, Wei-Jung A Chen. “Nicotine Decreases Blood Alcohol Concentrations in Adult Rats: A Phenomenon Potentially Related to Gastric Function” Alcoholism: Clinical and Experimental Research 30 (8), 2006 1408–1413.

--”Smoking ‘reduces alcohol effect.’” BBC News, July 24, 2006. http://news.bbc.co.uk/go/pr/fr/-/2/hi/5209990.stm.