BREAKING THE ADDICTION

Multi-Focused Smoking Cessation ProgramsCan Help

by Alison Ruffin

Laurie Hewett celebrated the first anniversary of a breakup in March.

 

Her friends called to congratulate her, and she splurged on a shopping trip. She finally tossed off a bad relationship, one that could have cost her her life.

 

She stopped smoking.

 

"Cigarettes were my friends. They never let me down," Hewett says, adding that this feeling may contribute to the depression many smokers feel when they are trying to quit.

 

This one-year commemoration is a milestone for Hewett. After 26 years of smoking and several unsuccessful attempts to stop, the 46-year-old opera and ballet usher finally made it.

 

After 26 years of smoking, Laurie Hewett is breathing easier and enjoying life.

 

Hewett credits group counseling sessions at M. D. Anderson, in conjunction with a Department of Behavioral Science research study on nicotine addiction, with helping her become smoke-free.

 

The successes attributed to these approaches have led M. D. Anderson's Cancer Prevention Center to launch a Tobacco Cessation Clinic, staffed with a full-time counselor, Martha Berry. Services are available to everyone, including patients, visitors, employees and the general public.

 

"Since most smokers want to stop, their stay or employment here may present a critical, teachable moment for quitting smoking," says Dr. Bernard Levin, M. D. Anderson's vice president for cancer prevention and holder of the Betty B. Marcus Chair in Cancer Prevention.

 

In the clinic, Berry meets with individuals motivated to stop using tobacco products. "Together, we devise a cessation and relapse prevention plan that may include nicotine replacement, antidepressant medication and individual or group counseling," she says.

 

Since smoking is as much an addiction as it is a learned behavior, "counseling is an essential component to our smoking cessation program because it helps individuals identify situations where they feel the urge to light up. It then enables them to develop new responses that don't include cigarettes or smokeless tobacco," says Dr. Therese Bevers, medical director of the Cancer Prevention Center.

 

Knowing the difficulties smokers face, cancer prevention researchers continue to find new ways to assist tobacco users in their desire to quit. Currently, they are testing whether a lightweight, hand-held computer that delivers up to 80 smoking cessation messages can prevent relapse.

 

"The menu of messages is tailored to address a variety of circumstances in which one may feel the need to smoke -- such as at times when they are relaxing, drinking alcohol, feeling tired or angry, or when they are around other smokers -- and offer positive alternatives to those smoking-associated situations," says Dr. David W. Wetter, assistant professor of behavioral science.

 

While behavioral counseling alone can help many people swear off cigarettes, a combination of this intervention along with nicotine replacement products and an antidepressant seems to enhance the quit rate, says Dr. Paul Cinciripini, director of the Tobacco Research and Treatment Program in M. D. Anderson's Department of Behavioral Science.

 

According to Dr. Cinciripini, negative mood is a major factor in preventing people from quitting and causing relapse. Smoking, he says, often helps people cope with life's stresses because the nicotine in cigarettes and other tobacco products increases the levels of key neurotransmitters in the brain that are responsible for mood and pleasure. When this drug is taken away, the amount of dopamine, serotonin and norepinephrine drops. In some people, this depletion may result in depression and anxiety.

 

Adding an antidepressant that simulates nicotine's effects on the brain to a cessation program, therefore, can be most effective, says Dr. Cinciripini, associate professor of behavioral science.

 

In fact, a study evaluating the effects of the antidepressant venlafaxine (Effexor) on smoking cessation suggested this approach may help the most nicotine-dependent smoker become abstinent.

 

Testing its effectiveness as an adjunct to a program of behavior and nicotine replacement therapy, Dr. Cinciripini and his colleagues found that smokers taking venlafaxine were more likely to have refrained from smoking at the end of the drug period -- 18 weeks post-cessation -- than those taking a placebo. In addition, a reduction in dysphoric mood was observed.

 

"These findings have implications for future smoking treatment since they demonstrate an effect over and above traditional therapy," Dr. Cinciripini says.

 

"It must be understood," he adds, "that tobacco use is not simply a habit, but an addiction. Treatment of nicotine dependence may require the same type of behavioral, societal and pharmacologic strategies used to help people stop abusing other substances such as alcohol and illegal drugs."

 

Just ask Hewett who, like many smokers, first toyed with cigarettes in adolescence and never intended to become dependent on nicotine.

 

"When I was going to college, I thought it was cool to smoke. But by the time I decided to quit smoking about two or three years later, I was hooked," says Hewett. "Smoking is so much a part of your life that you can't imagine getting through a day without cigarettes.

 

While widespread anti-smoking campaigns that have resulted in smoking stigmatization contributed largely to her decision to give up cigarettes, concern for her health finally drove her determination to quit.

 

"I think most smokers are terrified of getting cancer. I knew that if I developed lung cancer, I would have given it to myself," she says.

 

Hewett had tried quitting in the past, but always relapsed.

 

"I was missing the key ingredient to quitting, which was a strong inner personal commitment," she recalls.

 

Contact from an M. D. Anderson researcher regarding a study examining the effects of nicotine withdrawal on sleep disturbances in women in 1997, however, finally strengthened her will to become a "former smoker."

 

Hewett also didn't want to be one of the more than 171,000 people expected to be diagnosed with lung cancer this year.

 

"It was a wake-up call," she says of being asked to participate in the study. "When you're afraid of lung cancer, you'll take whatever steps necessary not to get it."

 

Calling her success "miraculous," Hewett remains convinced that, with assistance, anyone can break the addiction.

 

"If you really want to and you believe you can, you can stop smoking," she says. "I did!"

 

For information about quitting cigarettes and smokeless tobacco, call the Tobacco Cessation Clinic at the Cancer Prevention Center at (713) 745-8040 or (800) 438-6434. To participate in any of M. D. Anderson's ongoing research studies on nicotine addiction, call (713) 792-2265.

 

When Quitting is Good

 

No matter how long you have been smoking, it's never too late to stop and improve your health. The benefits begin as soon as you take your last puff.

 

For people undergoing cancer treatment, quitting smoking decreases the:

 

· Risk of a second cancer.

 

· Side effects of chemotherapy.

 

· Adverse reactions of radiation therapy to the head and neck.

 

For everyone, kicking the habit:

 

· Reduces the risk of heart disease and lung, head and neck, bladder, colon, rectal, cervical and pancreatic cancers.

 

· Improves wound healing, circulation, breathing and lung capacity.

 

· Decreases family respiratory illnesses.

 

· Reduces health care costs.