Part of my persona, if you like, in this blog so far has been to be anti-drug. Not just anti-recreational-drug or anti-illegal-drug, but at least somewhat anti-medical-drug as well.
In practice, I’m not really like that. I’ll take headache remedies if I think I need to, and antibiotics if my doctor prescribes them. My wife, who has rheumatoid arthritis, practically has her own miniature pharmacy. I don’t trust large drug companies (or large anything companies) as far as I could throw them, and I have a very weak throwing arm, but I do believe that drugs should be used when they’re the best solution. I do, however, also believe that this is less often than a lot of people think, and that if there’s a viable non-drug alternative that’s as effective or almost so, that’s to be preferred.
What I was tending to do in the blog, though, was rant against drugs, specifically drug-based smoking cessation techniques, as if on principle. And I’ve realized that this was the “my therapy is better than your therapy” thing which I really despise when I see it in other people. I’m going to try not to do that any more. I’ll still look with scientific skepticism at miracle claims, but I’ll try to be more even-handed.
What’s brought this about? Well, as I mentioned in my previous post, last week I went on the NZ National Heart Foundation’s Smoking Cessation Practitioner course. This is a course which trains people of all medical backgrounds and none in best practice for assisting people who want to stop smoking. And it spends quite a bit of time on nicotine replacement therapy (NRT) – the patches, gum, lozenges and so forth.
One reason that it does so is that it’s based on work by doctors, and we all know that many doctors think about medicine first, surgery second, and there is no third. But a major reason that NRT gets so much focus is that years and years of practice and rigorous clinical trials have shown that it really does help people to stop smoking.
It’s not a magic bullet. There is no magic bullet for stopping smoking. But NRT can make a significant difference to people’s chances, and for me to refuse to use it based on some short-sighted ideological turf war would be to fail my clients badly.
The reason it works is this. When people become addicted to nicotine, their brains actually change, adding receptors to nerves to deal with the incoming nicotine alongside existing receptors for acetylcholine, a naturally occurring brain chemical. When those receptors are stimulated by nicotine, the nerves concerned release other chemicals which increase concentration and give a feeling of reward and enjoyment.
When people try to stop smoking “cold turkey”, those receptors don’t get stimulated any more, and this contributes to the withdrawal symptoms (recovery effects) that I’ve described before. What NRT does is give the receptors some nicotine – less, and more slowly, than from a cigarette – so that the symptoms are more tolerable while people get their behavioural changes underway, rather than trying to change while they can’t concentrate and don’t feel right.
Now, nicotine is poisonous in sufficient quantities. It’s the tobacco plant’s natural insecticide. Enough of it will kill a human – but the amounts in NRT are much smaller than the lethal dose, and it is cleared out of the system very rapidly. As far as we know, nicotine is not itself directly implicated in the many diseases associated with smoking. It’s all the other rubbish in the cigarettes – tar, carbon monoxide, the various carcinogens and so forth – that do the damage, but the nicotine is what keeps people addicted so that they will keep smoking even though they know it’s harmful. This isn’t weakness or stupidity; it’s their brains being hijacked by an addictive drug.
So the idea with NRT is that you give smaller quantities of nicotine, enough to keep the brain from losing it while withdrawal and behaviour change proceed, and then you stop once the person is able to do so. Even if this turns out to be “never”, as is the case with a few very addicted people, it’s still healthier to be taking NRT for the rest of your life than smoking. Almost anything apart from actually shooting yourself in the vital organs is healthier than smoking.
So I’ve applied to be a Quit Card provider, which once I’m approved will mean that I can give clients vouchers for Government-subsidized NRT from pharmacies – it’ll cost them $5 a month instead of $120-$200. I’ll also be going back over my blog posts today and moderating or balancing some of the stuff I’ve said in the past.
Technorati Tags: nicotine replacement therapy, NRT, smoking, smoking cessation, quitting, stop smoking, Quit Card, addiction, non-drug, drug therapies, blogging
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