Daniel Pendick

Gene may explain why some smokers must fight to quit

Smokers struggling to quit may feel they are living the myth of Sisyphus, who was condemned for eternity to roll a boulder up a mountain and then watch it roll down again. Why is it so incredibly hard to quit—even when you are desperate to do so? For some people, the answer may be in their genes.

In a report published online in the American Journal of Psychiatry, a team led by Dr Li-Shiun Chen of the Washington University School of Medicine identified a “high risk” version of a nicotine receptor gene that is more common in heavy smokers. The scientists compared thousands of smokers with and without the gene who were enrolled in two different studies. Those with the high-risk gene took two years longer to quit smoking. However, there was one silver lining in the cloud of tobacco smoke: smokers with the high-risk gene were three times more likely to respond to smoking cessation therapies.

Try, try again

The study provides hope for even hardcore smokers, and is consistent with what doctors see in the clinic. “It does typically take repeated attempts to kick the habit, and past failures are not predictive of future success,” says Dr. William Kormos, editor in chief of Harvard Men’s Health Watch and a primary care doctor at Massachusetts General Hospital. “All smokers should try to quit as often as possible. Practice makes perfect.”

However long it takes, quitting is beneficial. In a study published in the current issue of Archives of Internal Medicine, researchers pooled results from multiple studies of how smoking affects one’s risk of premature death. Data from 17 studies conducted in seven countries showed that quitting smoking reduces the risk of dying—even in people in their 80s. “Even older people who smoked for a lifetime without negative health consequences should be encouraged and supported to quit,” the researchers wrote.

Don’t wait too long

A commentary in the same issue of the Archives pointed out that one in every two smokers will eventually die from the habit. And that doesn’t even include the impact on daily quality of life. Yet even smokers who try like crazy to quit still end up like Sisyphus. What can they do?

For one thing, don’t wait for a serious health crisis to seek help for smoking cessation. “All too often, the motivating factor for the successful quit attempt is a major health event, like cardiac bypass, stroke, or lung cancer,” Dr. Kormos says. “This finally motivates the patient to quit and they are usually successful.”

For others, the turning point is a “near miss,” such as admission to the hospital for chest pain. “So, the key is trying to get people to create the urgency that these health problems create, without having to wait for the health problem,” Dr. Kormos says.

Stubbornness: the key to success

Once you have decided to go for it and set a quit date, what’s next? First off, don’t be discouraged by past unsuccessful attempts. Just because nicotine replacement therapy didn’t work before doesn’t mean it won’t work this time.

The average person quits five to seven times before succeeding. To get there, it’s wise to try different things at the same time. For example, a form of counseling called cognitive behavioral therapy has helped many people to quit, especially in combination with smoking cessation tools like nicotine patches or medications.

Options to help you stop smoking:

  • Set a quit date; get rid of all cigarettes and tobacco products from your home, office, and car; don’t let people smoke around you; and once you quit, don’t smoke — not even a puff!
  • To avoid or reduce symptoms of withdrawal, use nicotine replacement aids including patches, inhalers, lozenges, and gum.
  • Ask your doctor about prescription smoking cessation tools such as bupropion (Wellbutrin, Zyban, generic) and Varenicline (Chantix).
  • A meditation technique called mindfulness training can help you weather the mood changes and cravings that come after quitting.
  • Get support from fellow quitters by finding group counseling and self-help programs for overcoming addictions and compulsions.
  • Some studies suggest that hypnosis might help you stop smoking by reducing cravings, bolstering willpower or increasing motivation to take care of your health.
Stop-smoking aids
Aid Advantages Disadvantages Cost
Nicotine patch Provides a stable level of nicotine in the blood for 16 to 24 hours; easy to use Takes two to four hours to hit peak level; user can’t adjust dose to meet cravings $3 to $4 a day
Nicotine gum Rapid rise in blood level of nicotine; user can control dose to respond to cravings; oral substitute for a cigarette Must be chewed properly to get nicotine and avoid upset stomach; can cause mouth soreness or indigestion $4 to $7 a day
Nicotine inhaler Rapid rise in nicotine; user controls the dose; hand-to-mouth substitute for smoking Requires frequent puffs; can irritate the mouth and throat $7 to $20 a day
Nicotine nasal spray Offers the quickest increase in blood nicotine levels; user controls the dose Can irritate the nose and throat; can cause cough $5 to $21 a day
Nicotine lozenge User controls the dose; oral substitute for smoking Can cause sore mouth, indigestion, hiccups $3 to $5 a day
Bupropion (Wellbutrin, Zyban, generic) Easy to use; no nicotine involved Can cause insomnia, dry mouth, agitation; shouldn’t be used by anyone with a seizure or eating disorder $2 to $19 a day*
Varenicline (Chantix) Easy to use; no nicotine involved Can cause nausea, headache, insomnia, and abnormal dreams; in rare cases, may cause suicidal thinking $6 a day*
*These prescription drugs may be covered by your health insurance plan and therefore require only the cost of your copay.

Source: Overcoming Addiction: Paths toward recovery (Harvard Health Publications, 2011)

Comments:

  1. Fr. Jack Kearney

    Great article. You might want to add something to the list of stop-smoking aids: electronic cigarettes. Latest research shows they are relatively safe and more effective than the other aids. Much more research has to be done, but so far they have kept me off “analog” cigarettes for 8 months…far longer than any of the other aids ever did for me…

  2. Ern

    I do smoke, heavily. And my late father too. The longest ‘quit’ that I was able to do for myself was six months and then when I started smoking again my cigarette consumption doubled. Yes, kicking the habit is like Sisyphus pushing that rock on top of the hill. Hard but it is well worth it if you can quit soon. Ern

  3. IAS

    I think its very hard to stop smoking habbit. If you really want to quit this then you should need to keep busy your self in work or don’t think about this. Because smoking is very bad for your health. Whether you’re a teen smoker or a lifetime pack-a-day smoker, quitting can be tough. But with the right game plan tailored to your needs, you can replace your smoking habits, manage your cravings, and join the millions of people who have kicked the habit for good.

  4. insomnia symptoms

    It is very difficult to stop smoking, it needs the support of family and of course the strong will of thesmokers.smoking does have its own pleasure, but pleasure is not balanced with the risk that we must take.government’s regulation about the place where it really should not smoke help us for the second-hand smoke, which means we do not smoke but we inhale secondhand smoke from smokers.
    The article is good for health to ask permission for the share
    thank you

  5. Anonymous

    i’ve been smoking since ’95 and it’s really hard to quit. at least for now i lessen it and using nicotine gum for me not to crave for it

  6. Virgil

    What is really disappointing to this former counselor for children and former smoker/bed-wetter, Harvard gives physical reasons for both conditions, which in my experience is wrong. DR. K has excused bed-wetting and smoking as gene related when it is 100% parent indused, smoking by family menbers, bed wetting from some form of mental and/or abuse.

  7. Jeff

    I smoked for 7 years, beginning by second year of college. As a professional, I found that my smoking habit increased steadily and almost uncontrollably with stressful situations. 7 years hardly seems like a long time, but considering the amount of recovery time for ones lungs per year of smoking, that time is considerable!

    One day I just quit “cold turkey,” leaving the unfinished pack of smokes available in the car, then finally threw them away weeks later. Cold turkey doesn’t mean it was easy… There was a fair amount of rationalizing those things that would have previously caused me to “light up.”

    Thanks for the article… I wonder if I have that gene?

    • Virgil

      Jeff, that ‘gene’ is a made up excuse given by researchers to justify their continued support $$$grants!! It’s a habit, nature didn’t know what smoking was when we developed through evolution to what we are today. No, there is no gene my friend. This from a former counselor for children and families, AND a former smoker, I quit just as you did, cold turkey.

  8. nahid naznin

    Thanks for the nice,informative article.As a father/mother,a smoker can think about his/her children.For children,second-hand smoke((smoke from their parents)is very harmful.they have higher the risk of chest illnesses and getting lung cancer in later life compared with children who live with non-smokers.

  9. Josie

    I wonder if this explains why I can never totally give up. I can give up for 2 years and then suddenly start going it again! It must be the one of the worst drugs out! By the looks of this – I only have to give up another 3 times before I can kick it for good!

    Josie

  10. James Andrey

    Try Nicotine Gum – This is a drug in gum form, with enough nicotine to reduce your urge to smoke. The gum releases small amounts of nicotine, which is absorbed into the body through the mucous membranes of the mouth. This cuts down on withdrawal symptoms and makes it easier to break the smoking addiction.

    James Andrey

  11. Matt

    Has Harvard done any studies on herbs for quitting smoking? I noticed hypnosis was mentioned, that is pretty alternative. Something like Quit Tea has some benefits to smokers, I think.

  12. Adrianne

    Do you know the SNP reference number they were discussing by any chance?

    • Dan Pendick

      Yes! You can find those details here:
      http://www.theheart.org/article/1414093/print.do

      “The high-risk haplotype, which is associated with heavy smoking, was defined as “high-smoking-risk allele at rs16969968 and low-mRNA-expression allele at rs680244.” In the ARIC study, the highly correlated single-nucleotide polymorphism (SNP) rs951266 was used as a proxy for rs16969968, and rs6495306 was used for rs680244.”