Addiction to nicotine has reached a 15 year high in the United States, where nearly three quarters of people asking to be treated for tobacco dependence are classed as highly dependent, said lung disease researchers at a conference in Philadelphia on Tuesday. They suggested that the less nicotine-dependent smokers have already given up, leaving a hard core of highly nicotine-dependent smokers who can only be helped with new smoking cessation strategies.
Lead author Dr David P Sachs from the Palo Alto Center for Pulmonary Disease Prevention in California, and other colleagues from the Palo Alto Center and also the St Helena Hospital in Napa, California, investigated whether there had been a real shift in nicotine dependence in the last 15 years.
They found that the severity of nicotine dependence has gone up 12 per cent between 1989 and 2006 while the percentage of people classed as highly nicotine dependent has gone up by 32 per cent.
Sachs, who has been conducting trials on treatments for tobacco dependence and treating tobacco-dependent patients for the last 25 years, presented the findings at CHEST 2008, the 74th annual international scientific assembly of the American College of Chest Physicians (ACCP) in Philadelphia on the 28th of October. Sachs said he was not surprised by the results:
“I began to see a shift in severity of physical, nicotine dependence that required me to develop more intensive treatment plans for my patients,” said Sachs.
For the study, Sachs and colleagues examined the pre-treatment severity of nicotine dependence of participants in three studies carried out between 1989 and 2006. All three studies used the same questionnaire to assess pre-treatment nicotine dependence: the Fagerström Tolerance Questionnaire (FTQ), which has a scale of 0 to 11.
The three studies were:
- Nicotine Patch Study (NPS) with 220 participants enrolled from Dec 89 to Apr 90
- Bupropion SR Study (BSRS) with 206 participants enrolled from Sep 94 to Dec 94
- St. Helena Hospital Center for a Smoke-Free Life (CSFL) with 206 participants enrolled from Feb 05 to Oct 06
The results showed that:
- The pre-treatment FTQ scores went up by 12 per cent over the 15 years covered by the three studies.
- The mean score for the NPS study (1989) was 6.65 plus or minus 1.72.
- The mean score for the BSRS study (1994) was 7.02 plus or minus 1.80.
- The mean score for the CSFL study (2006) was 7.44 plus or minus 1.80.
- The proportion of patients with a high score (7 to 11 FQ points) went up by 32 per cent from 1989 to 2006.
Although they found a definite increase in tobacco dependence, the researchers didn’t identify the reason behind these figures. However, Sachs suggested that previous research had shown:
“Individuals who have less severe nicotine dependence have already been successful at quitting smoking, which leaves a larger percentage of patients who are highly nicotine dependent among the greater tobacco -using community.”
Highly nicotine-dependent smokers may not even realize they are addicted, said Sachs. They may label their tobacco use as a “bad habit” and never try to give up, either by themselves or with the help of cessation programs.
“A person cannot know what his or her blood pressure is without measuring it,” said Sachs.
“Similarly, a cigarette user cannot know how severe his or her nicotine dependence is without measuring it,” he added, explaining there are many ways to tell if someone is highly nicotine addicted.
A quick “bedside” test is if you have to have your first cigarette of the day within half an hour of waking up in the morning you are probably highly nicotine dependent, said Sachs.
Sachs and colleagues concluded that more individualized treatments are needed to help people who are highly addicted to nicotine to give up tobacco.
“The more severely nicotine dependent a person is, the greater the medical need for more intensive tobacco-dependent therapies,” said Sachs.
“Today’s severely nicotine-dependent patient may not respond to the current ‘standard’ in tobacco dependence treatment, much of which is based on nicotine dependence data and outmoded treatment concepts from 15 years ago,” he added.
One approach Sachs suggested could be to increase the dose and duration of medications, or to try different combinations of drugs and put more emphasis on minimizing withdrawal symptoms.
Sources: ACCP.
Written by: Catharine Paddock, PhD.