Quitting smoking is among the top New Year’s resolutions for 2023, but as statistics show, most people have trouble keeping their resolutions beyond a few weeks.
The CDC is encouraging people to drop addictive habits with its “Resolve to be Smokefree in ’23” initiative, outlining tips on how to be successful when hitting the reset button for this year.
Shedding light on why this habit is so hard to shake is Dr. Colleen Hanlon of BrainsWay, who spoke to DocWire News about the addiction space, the complications of smoking addiction, and how our brains are working against us to kick the habit.
DocWire News: Can you provide us with some background on yourself?
Dr. Colleen Hanlon: So my name is Colleen Hanlon. I’m the Vice President of Medical Affairs at BrainsWay. But for the last 17 years I’ve been, before joining BrainsWay, I was a scientist. I worked at Wake Forest University and Medical University of South Carolina. I’ve really devoted my career to studying the brain mechanisms involved in addiction with an emphasis on smoking, as well as stimulants and alcohol use. I use a lot of neuroimaging tools to look at patterns of brain that are active when people are using cigarettes and drinking alcohol as well as patterns that predict good outcomes in treatment programs.
I sort of became, my love of brain stimulation came after I was looking at a lot of brain images, and I could see that my friends that were in preclinical science lab were able to use really fancy technological ways to stimulate certain brain regions and cause animals to stop self-administering drugs. And then a technique called TMS, Transcranial Magnetic Stimulation, came along and was FDA-cleared as a treatment for depression. So TMS is a non-invasive way of stimulating neural circuits.
And so really in 2020, 1 of the best things that happened in my opinion is that TMS became FDA-cleared as a treatment tool for smoking cessation. So it was a first TMS indication in the addiction space. And so that makes people like me really excited because we have a new evidence-based tool to help people quit smoking. So that’s really great for people out there that are struggling.
Talk to us about smoking addiction – approximately, how many people are addicted to cigarette smoking, and why is the habit so hard to shake?
Yeah, it’s actually an astounding 34 million adults are regular smokers and so that’s a lot of people out there. But about 68% of those adults say that they want to quit. That’s about 23 million people. But if you’re a smoker out there you know very well that it’s actually incredibly hard. In fact, of all of the substances used, smoking appears to be one of the hardest habits to break. So per your question about why is it so hard to break, nicotine is the primary ingredient in tobacco cigarettes, and it’s really [inaudible 00:02:49] way of modulating our reward systems in our brain.
Sometimes we say that nicotine sort of hijacks the reward systems in the brain. Usually people start smoking when they’re younger, and usually, when you use drugs when you’re younger, it’s because of the rewarding aspects. But over time, repetitive use just becomes a habit. And so that behavior that it was initially just reward actually starts to take over multiple neural circuits that are not only involved in reward, but they’re also involved in motor behavior and sensory information. Anybody that’s a smoker knows that just being exposed to some cues automatically makes you sort of feel like you are looking for your lighter perhaps or looking around for your cigarettes. All of these sensory motor cues along with the drive to use, make it incredibly hard to quit because it’s kind of taken over many circuits in your brain.
What are some useful tips and tricks for kicking a smoking habit?
One of the biggest things is to avoid triggers. And I know that’s really hard to do. Many people that are smokers, they have these habits, they smoke when they drive to work, and so merely just walking out of the front door itself is a trigger. But other triggers like stress or being around friends or other environments that are associated with smoking, they are a little bit easier to avoid. And so one of the best ways to sort of stop yourself from craving is to try to avoid places that you would normally smoke or people you would normally smoke with, if that’s possible. Again, that’s not always possible.
So one of the other best strategies for trying to cut the habit is when you have that strong urge, try to delay using, try to just tell yourself, “Okay, I can smoke if I just wait 10 more minutes.” And then in that 10 minutes, try to distract yourself and engage in other activities. Maybe call a friend, maybe go just like walk up a few sets of stairs or walk around the neighborhood, maybe start cooking a meal, and you may just find that you’ve now forgotten about the desire to smoke.
And then finally, one last one, in addition to avoiding triggers, trying to delay the use, is don’t give in to the temptation to just have one. That’s something that a lot of people start to do. We know this is true with things that are not smoking just like cookies at Christmas time or a piece of chocolate cake. If you have just one bite that seems to whet your appetite for more, and that’s not just true with tasty desserts, but it’s also true with cigarettes. Just a little bit exposure to that first cigarette makes it extremely hard to not smoke the next one.
How can BrainsWay’s Deep TMS treatment help with smoking addiction?
Yeah, so BrainsWay, as I mentioned earlier, in 2020 gained a FDA clearance to use TMS, Transcranial Magnetic Stimulation, as a tool to promote acute smoking cessation. So it’s actually, I mentioned before that when you use cigarettes over time, especially over many, many years, the act of smoking takes over multiple brain circuits. And so deep TMS is a really unique way to modulate multiple neural areas at the same time that are involved in craving for cigarettes and the actual act of drug taking.
TMS itself is FDA-cleared as a treatment for depression and obsessive compulsive disorder and anxious depression, as well as smoking cessation. It’s generally given by psychiatrists all over the world and patients typically come in, been smoking for five sessions a day, or I’m sorry, five sessions per week, one session per day for three weeks, followed by three weekly sessions. And data from a randomized controlled study of 14 sites showed that 15 sessions of TMS given over three weeks, followed by three weekly sessions, significantly increase the rates of quitting smoking for four continuous weeks. So in that study that individuals that received active TMS were twice as likely to quit smoking for a full month than the individuals that receive sham TMS.
What are some key takeaways to leave our audience with today?
Yeah, to anybody out there that has a New Year’s resolution to quit smoking, I applaud you right away because it’s one of the biggest steps towards full sort of cessation of smoking is just having the desire to quit. So you’ve already kind of won. We know that the first week of breaking any habit is the hardest. And so if you’ve just started on your journey, getting past the first week is the hardest so just keep on pushing through. If you can get through the second week, you’re probably over the hardest part. But to many people that try and then they relapse and they try again and they relapse, don’t worry, you’re not alone. And there are several pharmaceutical treatments as well as this noninvasive deep TMS treatment, which can be effective for significantly improving smoking cessation.