Quitting smoking is not a one-size-fits-all proposition, and researchers are finally beginning to figure out why, say Yale scientists in a study published in the January issue of Trends in Pharmacological Sciences.
"Different smokers respond to different medication treatments because of different biological subtypes of nicotine dependence," says lead author Dr. Tony P. George, assistant professor of psychiatry at the School of Medicine. "For example, nicotine replacement therapy doesn't seem to work as well for women as it does for men. Women may respond better to buproprion or naltrexone. In this article, we review all the relevant medications and weight the evidence for and against their use as smoking cessation aids."
George, an investigator with the Transdisciplinary Tobacco Use Research Center (TTURC) at Yale, points out that many people who still smoke -- about 23% of the population in the United States and about 1.1 billion people worldwide -- may also have psychiatric or other drug-abuse disorders that make it harder for them to quit. For example, people suffering from schizophrenia, major depression or alcoholism might smoke as a form of self-medication or have a specific biological vulnerability to tobacco addiction due to the nature of their illness, he says.
There is increasing evidence that medications can be matched to anti-smoking strategies for those who still smoke, George says, adding that the information could prove particularly useful to psychiatrists and other physicians who help treat patients who smoke.
The article is co-authored by Dr. Stephanie O'Malley, the TTURC principal investigator and a leading expert on naltrexone, an opioid antagonist that is used as therapy for alcoholism. O'Malley, who is currently investigating how naltrexone might help smokers quit, says the article reflects the core mission of the TTURC. "We have a heavy emphasis on translating basic biological mechanisms to treatment, with a focus on helping smokers who find it hard to quit."
TTURC is part of the Center for Nicotine and Tobacco Use Research at Yale (CENTURY). CENTURY is funded by the National Institute on Drug Abuse, the National Cancer Institute and the Robert Wood Johnson Foundation.
-- By Pem McNerney
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