Scientists Say NOW is the Time to Stop Smoking
After reviewing the literature on smoking cessation programs and other issues related to smoking, scientists from the University of Wisconsin and the University of Minnesota say that because evidence-based assistance to help individuals battle nicotine dependence is at an all-time high, there has been no better time than the present to try to stop smoking.
In an article in the October 9, 2002 issue of the Journal of the American Medical
Association the authors claim that if the smoking interventions that have been proven to be effective were broadly implemented, a larger proportion of the 46 million U.S. adult smokers would try to quit. They add that among those who would attempt to quit, the likelihood of success would be substantial.
Among the factors that clinicians can use to promote treatment of nicotine dependence,
the investigators cite:
- Assurance to their patients that stopping smoking can lead to marked improvement in current and future health, even among older smokers;
Evidence that low tar or low nicotine cigarettes do not significantly reduce health risks;
The availability of at least 5 medications for smoking cessation that have been approved by the Food and Drug Administration; and
Evidence that adolescents who smoke can experience nicotine dependence with relatively low levels of tobacco use.
The authors recommend that the 2000 U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, should be used as a roadmap for intervention at the clinical level.
- WHAT IT MEANS: Numerous strategies now exist producing reliable and substantial increases in smoking cessation. Their availability underscore the responsibility of every physician to counsel every tobacco user about the risks of smoking, the benefits of quitting, and how to quit.
The paper was published by Drs. Michael Fiore and Timothy Baker from the University of Wisconsin Center for Tobacco Research and Intervention and Dr. Dorothy Hatsukami of the University of Minnesota. All of the authors are participants in the Transdisciplinary Tobacco Use Research Center (TTURC) program. Seven TTURC centers are funded by the National Cancer Institute and NIDA to investigate new ways of combating tobacco use and nicotine addiction.
Cocaine Use May Cause Increase in Coronary Calcium, an Indicator of Arteriosclerosis
Researchers from Johns Hopkins School of Public Hygiene and Public Health found a significant association between cocaine use and the presence of calcium in the coronary arteries, a finding that suggests that cocaine use might promote subclinical arteriosclerosis. The presence of calcium in the coronary arteries is a known marker for arteriosclerosis.
In Baltimore, Maryland, researchers recruited 139 adults between the ages of 25 and 45 who had no clinical evidence of coronary artery disease or hypertension. Participants were interviewed about their drug use behavior, and 76 percent reported using cocaine.
A variety of tests, including an echocardiogram, spiral computed tomography (CT) scans, and blood tests, were performed on all of the subjects to measure coronary artery calcium. About one-third had detectable levels of coronary calcium.
After adjusting for age and sex, the researchers found a significant association between cocaine use and coronary calcium.
- WHAT IT MEANS: These findings suggest that cocaine use may play a role in the development of subclinical arteriosclerosis. Strategies to reduce drug abuse may be critical in the early prevention of cardiovascular disease.
Dr. Shenghan Lai published the study in the August 1, 2002, issue of The American Journal of Cardiology.
Anti-depressant Bupropion May Alleviate Negative Mood Associated With Quitting Smoking
A NIDA-funded study at the University of Pennsylvania Transdisciplinary Tobacco Use Research Center has found that the anti-depressant bupropion may help people stop smoking by alleviating negative moods, such as depression and despair, often experienced during nicotine withdrawal. This is the first study to find that such psychological changes may contribute to bupropion's effects on smoking cessation outcomes in a clinical setting.
Dr. Caryn Lerman of the Abramson Cancer Center of the University of Pennsylvania led the research team that examined 251 male and female smokers ages 18 and older. Participants were randomly assigned to receive 10 weeks of treatment with bupropion or a placebo, plus behavioral counseling. Bupropion was initiated on the day of the first counseling session, two weeks before the target quit date. Counseling included nicotine fading (slowly decreasing nicotine intake), coping with cues that trigger smoking, stress management, and relapse prevention. During treatment, participants regularly completed questionnaires about their withdrawal symptoms and positive and negative feelings.
At the end of treatment, 48 percent of bupropion participants were abstinent from smoking, versus 29 percent of those receiving the placebo. The bupropion group exhibited a decrease in negative mood, while those receiving placebo showed an increase in negative mood. Although bupropion reduced the severity of the symptoms of withdrawal, negative mood was more strongly related to smoking relapse.
- WHAT IT MEANS: Bupropion may be beneficial for smokers who experience negative moods and who smoke, in part, to manage these symptoms.
This study was published in Drug and Alcohol Dependence 67(2002):219-223.
Favorable Outcomes Linked to Treatment Compliance
A study supported by the National Institute on Drug Abuse (NIDA) assessing patient outcomes following treatment for cocaine dependence found that long-term outcome was related to the severity of the patients drug problem upon entering treatment and to their level of involvement in treatment. The severity of the patients drug problem was gauged by several measures, including multiple drug use, alcohol dependence, criminal activity, employment status, level of family support, socioeconomic status, and diagnosis of depression or anxiety.
Subjects were drawn from the NIDA-funded Drug Abuse Treatment Outcome Study (DATOS) that followed more than 10,000 patients admitted to 96 drug treatment programs during 1991 to 1993 in 11 cities. The present study looked specifically at a subgroup of cocaine-dependent patients included in the DATOS study of outcomes after the first year following treatment. Interviews were conducted one and five years after treatment with 708 subjects from 45 treatment programs in eight cities.
The patterns of outcomes after five years were similar to those reported for the first year after treatment. Cocainedependent patients with comparatively less severe problems at the beginning of treatment generally had the most favorable outcomes, regardless of the type or duration of treatment provided. The patients who were back in treatment at the five-year followup had the worst outcomes. These patients typically had more severe drug problems to start with and had left their DATOS treatment program before completion. In contrast, patients with severe problems who met or exceeded DATOS therapeutic treatment thresholds maintained significant improvements on all outcome measures.
- WHAT IT MEANS: Although severity of drug and psychosocial problems at the onset of treatment was predictive of long-term recovery, outcomes improved in direct relation to the level of exposure to treatment, reinforcing the importance of compliance with treatment.
Dr. D. Dwayne Simpson and colleagues from Texas Christian University reported the study in the June 2002 issue of the journal Archives of General Psychiatry.
Special Supplement to Journal of Clinical Pharmacology Features Latest NIDA Research on Marijuana
The November issue of the Journal of Clinical Pharmacology will feature a Special Supplement on Clinical
Consequences of Marijuana Use. While most studies deal with the psychosocial consequences of marijuana use, this supplement focuses on the clinical consequences of marijuana use.
The supplement is comprised of papers presented at a workshop held last year by the National Institute on Drug Abuse (NIDA). Research reported there suggests that marijuana use has many subtle effects on the bodys major systems, including temporary impairment of cognitive function, increased heart rate, increased prevalence of chronic cough and acute bronchitis, lower sperm count, and increased neurobehavioral abnormalities for children exposed in utero.
It is estimated that almost 14 million Americans, or 6.3 percent of the population age 12 or older, admit to illegal
drug use, with marijuana being the most commonly used illicit drug.
- WHAT IT MEANS: The research reported in this supplement describes how marijuana affects nearly every organ system in the body. These findings add to the evidence that marijuana use is associated with significant health hazards.
The special supplement was edited by guest editors Jag H. Khalsa, PhD, Sander Genser, MD, MPH, and Henry
Francis MD, all from NIDA's Center on AIDS and Other Medical Consequences of Drug Abuse (CAMCODA), and Billy
Martin, PhD, of Virginia Commonwealth University.
The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on the health effects of drugs of abuse and further information on NIDA research can be found on the NIDA web site at http://www.drugabuse.gov.
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