Everyone realizes the benefits that ensue when a longtime smoker is able to stop. Epidemiologic studies suggest that about one-third of smokers are nicotine-dependent (i.e., they have the brain reward system dysregulation associated with not being able to quit). But it appears that the number of people who have difficulty quitting is much higher. Not only is nicotine dependence producing, but the smoking "habit" (smoking while drinking, or after a meal, or wanting to have something to do with one's hands) often can be very difficult to break, as well. Some people don't even want to quit, because they either deny that any serious consequences could occur for them, are afraid of withdrawal, or don't want to gain weight.
Many treatment centers are becoming smoke-free, and effective evidence-based methods now exist for getting people off both their drug of choice and tobacco during the same treatment period. I remember the days when treatment centers refused to push smoking cessation programs for alcoholics for fear of losing patients. The idea of an alcoholic becoming abstinent on two drugs at one time was amazingly not popular, and some of that old stigma still exists. But now we often see patients requesting nicotine patches when they enter treatment for alcohol and other drug dependence.
Several antismoking aids are now on the market or on the horizon. In addition to nicotine replacement therapy (NRT), the medications bupropion (Zyban) and the newly approved varenicline (Chantix) are now available. Also, a drug that has shown promise in Europe will likely be approved in the near future. Rimonabant (Acomplia, with a possible U.S. trade name Zimulti) and varenicline now merit the field's attention.
Varenicline studies promising
Varenicline is pharmacologically known as an alpha4beta2 nicotinic acetylcholine receptor partial agonist, which means that it activates the brain's nicotinic receptors in a manner similar to nicotine, but with less affinity (effect). Its therapeutic usefulness comes from the idea that by activating the same receptor as nicotine, varenicline will reduce nicotine craving and withdrawal. Indeed, one of three randomized studies on varenicline published in the July 2006 issue of the Journal of the American Medical Association reported that varenicline is more effective than bupropion or placebo for smoking cessation. …