Clear the air on addiction

Article Highlights

  • To be successful, most quitters must be highly attuned to their environment

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  • The changes in an addict's brain do not render him helpless.

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  • By breaking established patterns, [addicts] help subdue cravings.

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The biggest class action suit in Canadian legal history is under way at the Quebec Superior Court in Montreal. At stake are billions in damages and penalties sought from three tobacco companies – Imperial Tobacco Canada Ltd., Rothmans, Benson & Hedges; and JTI-Macdonald. Justice Brian Riordan is hearing cases representing almost two million victims of lung, larynx and throat cancer, and emphysema caused by smoking cigarettes.

In an unusual act, the Non-Smokers’ Rights Association has filed a complaint with the Collège des médecins du Québec against a key expert who testified last week. The complaint accuses Dominique Bourget, a forensic psychiatrist at the Royal Ottawa Mental Health Centre, of breaching the college’s ethics code by “minimizing the gravity of, if not denying the existence of, tobacco dependence.”

What did Dr. Bourget say to provoke such a charge? According to François Damphousse, the Quebec director of the Non-Smokers’ Rights Association, Dr. Bourget just “brushe[d] aside all the science on nicotine addiction and the neurophysiological effects of nicotine on the brain.” In the same interview with the Montreal Gazette last week, he said that Dr. Bourget played down tobacco’s addictive potential: She “reject[ed] current scientific knowledge about addiction and she is not allowed to do that as a member of the Collège.”

I can understand why the plaintiffs (and their supporters) reject Dr. Bourget’s view of addiction. It is inconsistent with the narrative of enslavement: that once people become addicted to nicotine, they are helpless to quit.

As a psychiatrist specializing in addiction, I routinely hear that addiction leads to changes in the brain that “hijack” the smoker’s capacity to change his behaviour. Yet, insisting that the biological changes produced by addiction do not prevent recovery is entirely consistent with what we know about addiction.

Without a doubt, addiction leads to changes in the function of several brain areas. But, unlike the brain changes we see in, for example, Alzheimer’s – neurological alterations that destroy the patient’s memory in ways that are beyond his control – the changes in an addict’s brain do not render him helpless. True, most smokers find quitting difficult, but by no means do the nicotine-induced changes in their brains prevent them from making a decision to quit, summoning the motivation to do so and adopting strategies to manage craving.

To be successful, most quitters must be highly attuned to their environment: what are the times, places, or states of mind that are linked to a desire to smoke. By breaking established patterns – for example, never lingering at the dinner table – they help subdue cravings.

As well, they can try anti-smoking medications (e.g., Wellbutrin, Chantix), nicotine gum and patches, smokeless Swedish snus (tobacco pouches that have negligible risk of oral cancer.) In the U.S., people can use electronic cigarettes, which pose a much lower hazard than conventional cigarettes.

I treat heroin addicts. Talk about brain changes! Heroin is not only addictive, it is intoxicating. Do brain changes make it hard to quit? Yes. But by no means do they make it impossible. Indeed, we can give our patients hope precisely because heroin (or cocaine, alcohol and so on) do not cripple their brains. With motivation and guidance, they can and do free themselves. So can smokers.

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