Pay Attention

In a 2008 letter to the editor of the medical journal, Schizophrenia Research, Yale University researchers Sacco, Creeden, Reuteunauer, and George stated, “We have found that cigarette smoking abstinence impairs and smoking reinstatement enhances spatial working memory and sustained attention.”

In a 2009 article in the journal Experimental and Clinical Psychopharmacology, researchers from Southern Illinois University said that nicotine replacement enhances spatial working memory and that this improvement is greatest in individuals with higher levels of depressive symptoms.

In a presentation at the Society for Neuroscience Annual Meeting in 2003, Alexandra Potter of the University of Vermont commented on the fact that youngsters with Attention Deficit Hyperactivity Disorder (ADHD) take up smoking at twice the rate noted that kids with ADHD take up smoking at twice the rate of other adolescents. "If these findings are substantiated," Dr. Potter said, "these cognitive improvements may explain the high rates of smoking initiation and maintenance in ADHD."

The bottom line is that for some smokers, there are only two ways they are able to maintain their brain’s abilities to sustain attention and remember what they have just seen moments before: Continue smoking or obtain adequate replacement of nicotine from other sources.

The patch, gum, and lozenges deliver nicotine at a much lower level than smoking. Many smokers have not been able to completely eliminate smoking using one of these Nicotine Replacement Therapy (NRT) products. The Central Sydney Area Health Service has achieved a 60% 3-month abstinence rate by combining products to replace more nicotine and provide more withdrawal relief. Other researchers have found combined therapies to be similarly more effective that one method of NRT.

Some people have—in many cases undiagnosed—chronic conditions for which nicotine is an effective treatment, and safer than many prescription medications. Yet, there seems to be a persistent antipathy toward using NRT on a long-term basis. The conditions are permanent. The treatment needs to be permanent.

The choice should not have to be between being a smoker or living in a permanent state of “brain fog.”

Long-term Nicotine Replacement

Tobacco smoking can cause serious damage. The smoker’s risks are greatly increased for heart attack, strokes, lung disease, and a variety of cancers. What about nicotine, the substance that keeps people coming back to tobacco? Isn’t that the source of tobacco’s harmfulness?
Smoking-related diseases are caused by the carcinogens, tar, particulates, and carbon monoxide in tobacco smoke, not the nicotine. A small percentage of smokers are able to give up nicotine with few ill-effects. Given the negative attitude seen toward smoking today, as well as the well-publicized health risks, it would seem reasonable to assume that those who can easily quit have already done so.

That leaves about 45 million U.S. smokers who experience depression, anxiety, cognitive impairments, and sleep disturbances so severe that they are unable to carry out their responsibilities whenever they totally abstain from nicotine. According to the smoking cessation propaganda, these “withdrawal symptoms” are supposed to disappear as soon as the nicotine is cleared out of the system—a couple of days to a week. But for many, these problems persist for months, and even years. Researchers are starting to find that many people with underlying conditions such as Attention Deficit Disorder, depression, anxiety, and other mental disorders, are keeping their conditions under control by self-medicating with nicotine.

These people could go to their doctors and receive prescriptions for anti-depressants, anti-anxiety medications, and/or amphetamines. But would they be better off?

According to one advertisement for an antidepressant medication, 70% of the people on antidepressants still experience symptoms. For some people, antidepressants trigger suicidal thoughts and/or behavior. Anti-anxiety medications are fine for temporary use during times of great stress, but they can be addictive and can cause dangerous side effects. Older adults who have high blood pressure are not good candidates for amphetamine-like medications. Furthermore, long-term use is discouraged by the FDA. Short-term treatment for a long-term problem is not a practical solution.

None of these medications causes cancer or lung disease, so a tobacco smoker might well be better off using them. But how do these medications compare with nicotine replacement products in terms of safety?

Nicotine, without the tobacco smoke, is a relatively benign drug. There may be a modest increase in heart rate and blood pressure, which poses a problem only for critically ill patients. When compared from a standpoint of safety, nicotine replacement therapy (NRT) would appear to pose fewer risks.

The question is whether society will allow people to medicate their conditions in the way that they find most effective. Chronic conditions call for long-term treatment.