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2016
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Nicotine Receptors & NRT's

Posted by Giulia Champion Jun 20, 2016

Found this very interesting (cannot vouch for the authenticity): Whomever AlGiordino is, he seems quite knowledgeable:    https://www.reddit.com/r/stopsmoking/comments/1wvcft/how_long_after_quitting_until_neurotransmitters/

  

[–]AlGiordino08 6 points

2 years ago *     
   
    

With no tobacco use, it takes about 3-4 months for the billions of nicotinic acetylcholine receptors that have grown in our brains to return to normal levels. Some research has suggested that the unique spike of nicotine from tobacco leaves an "indelible memory" on the receptors that remain permanently. Exposure to high levels of "free-based nicotine", which only tobacco provides, can cause the billions of receptors to quickly up-regulate again. This idea explains why someone trying to quit can find themselves right back were they started after the addiction tells them, "you can have just one".

    

I make sure to use the term "free-based nicotine" because addiction in tobacco develops due primarily to three things: genetic disposition (two nicotine genes have been ID'd in human genome), delivery mechanism of a cigarette (faster than IV administration), and the thousands of chemicals added to tobacco (cigs, dip, pipe tobacco, etc). These chemicals essentially make nicotine more volatile when it hits the bloodstream, allowing for almost instantaneous absorption. This is a similar process to how crack is created from cocaine.

    

Interestingly, nicotine replacement therapy does not have the speed or power (not free-based) to sustain the billions of up-regulated receptors. Research shows that people on cessation medication are losing these receptors at the same rate as if they quit cold turkey. This is why doctors and counselors recommend medications in tobacco treatment -they helps manage withdrawal while allowing the addiction to continue dying away uninterrupted. The only thing that can cause these billions of nicotine receptors to return is tobacco use.

    

tl;dr: With or without cessation medications, nicotine receptors return to non-smoker levels after 3-4 months of no tobacco use.

    

EDIT: Cleaned up sentence structure

   
  
 

  

[–]Missedirection901 days 2 points

2 years ago     
   
    

Thanks for this. Great response.

    

But why do you think that people who quit cold turkey tend to have better success rates if the receptors are being lost at the same rates for those who take medication and have lesser withdrawal symptoms to deal with?

   
  
 

  

[–]AlGiordino08 2 points

2 years ago     
   
    

I appreciate the question, it's one I get often from folks with whom I meet.

    

To answer this, we can view quitting at the population level and the individual level. On a larger scale, quitting cold turkey is the most popular approach and a high number of people in survey's report that this is how they quit smoking. On an individual level, quitting cold turkey is statistically the least effective method for quitting. Studies find that 3-5% of people that quit this way are still smoke-free after 6 months compared to those who use counseling and treatment medications (between 25-36%).

    

But since cold turkey is so frequently tried, the following situation takes place every year: if you have 100,000 people quitting cold turkey and 1,000 quitting with treatment meds/counseling, the group that quit cold turkey will have an overall higher number of total ex-smokers (3000-5000) than the treatment group (250-360), even though the cold turkey group had an abysmal success rate. Despite the poor success rate, people who are considering quitting are led to believe that "just putting them down" is the best way to go.

    

This is why tobacco professionals (on the treatment side, anyway) push for better coverage of counseling and medications. If you gave those 100,000 people who were quitting cold turkey access to effective treatments, we could see 25,000-36,000 of that group quitting, instead of a tenth of that number.

    

As a former tobacco user, one of the hardest parts of quitting was building up the motivation to make another attempt. As a counselor working to help others now, I know the time, mental energy, and motivation it takes for someone to come into my office and express a readiness to quit. Everyone has to find a plan that they are most comfortable with so I never tell them what the need to do. Rather, my goal is simply to share the most effective, up-to-date strategies available that will give them the best chance to quit.

    

This was harder to put into written words than I thought so let me know if any part needs further clarification.

   
  
 

  

[–]Missedirection901 days 2 points

2 years ago     
   
    

Thank you for the reply, I think you explained it perfectly.

    

So essentially, the misconception that quitting cold turkey is the most effective is simply because the sample size is much bigger?

   
  
 

[–]AlGiordino08 2 points

2 years ago

 

 
  
   

From a statistical point of view, yes. I certainly do not want to take away from the level of motivation, preparation, and commitment people put into their quit attempts when they stop cold turkey. However, I've personally found that using treatment medications and counseling can be stigmatized - "you should be strong enough to do this on your own". I fear this mentality can keep some folks from seeking helpful treatment.

   

The fact is, tobacco addiction while having common characteristics, is a very individualized. Some people need more intensive approaches, such as inpatient treatment:

  

I’ve stolen most of the material from Bonnie Katz.  It’s for actors.  But I’ve bastardized it, written my words into it., edited and adapted it for us quitters, as I see many similarities.  But 99% of it is hers.  So give HER the credit.
Most successful quitters pour their focus into quitting.  They roll up their sleeves and do the work necessary to make their dream come true.  That’s a great start, but that is just the beginning.
Challenges are a normal part of life.  There is a way to not only get through challenges, but actually experience them as valuable events that have great benefit. It takes work, but oh how much better you’re going to feel when you come through your challenges stronger and wiser, not deflated and defeated.
Follow these steps to start creating the valuable tools needed to weather the storms.
1.  Self-awareness is necessary to create change.
We all have behaviors we’re not proud of. So what? It doesn’t mean anything. It just means that you’re like the rest of the human race. Welcome. Bad habits of blame keep you locked in shame. Accept your weaknesses, so that you can let them go. First own it, so you can begin to disown it.   Catch yourself in the act of self-defeating talk and instead replace it with, “Wow, I just noticed how harsh I was with myself. I made an effort and that’s good enough.” Letting go of self-judgment is good practice for those times ......
Fear and frustration does not help you to think clearly and access your memory. In fact, if you start to make matters worse by criticizing yourself, you will only feel more stressed and cause your body to go in fight or flight mode. That means your body will react as if there is something life threatening present. It will automatically send all your blood to the legs so that you can run from the threat. It’s the antithesis of what you need to handle the situation, namely calm, so that you can access your memory and focus. This is a good example of how self-defeating behaviors make your external circumstances more difficult than they need be.
Solution: When you’ve made a mistake, take three deep breaths, which lets your brain know that you are safe and secure. This will lower your blood pressure and your heart rate. Stop all self-criticism if it tries to sneak in, which it will, and replace it with kind, calming self-talk. You’ve just pulled yourself together, now you’re ready to proceed. You hit a bump in the road. This is what happens when you put yourself out there and live your life. Good for you. You’re a brave soul.
2.  Know and be responsible for your view.
Your brain is built to change, but change only occurs when you create new experiences for yourself. Begin with your view. Are you aware of your views? Are they negative or positive? Do you see the cup half empty or half full? Remember, you’ve got to know yourself really well in order to let go of what is no longer serving you. Your view is just a habit. If you tend to have a negative view, it is not your fault. Your past is a map for your present behavior. For example, if you happen to have a parent who was fear based and saw the world as a dangerous place, you may have been told, “Be careful,” every time you set foot out the door. Those messages in childhood may have given you the view that things are a lot more dangerous out there than they really are. Those views make your life more difficult.
Solution: Be completely honest and assess your view so that you may let it go. Instead, catch yourself when you go to the fear-based place and say, “Oh, fear is here now.” (Notice there is no judgment in this observation, it’s just an observation, nothing more, nothing less.) Then, replace it with reality. “Right now, I am safe and secure, there is no danger present.”
Replace this negative thought with something positive. Create a delicious excitement of anticipation. You are about to have the opportunity to walk into a new smoke-free YOU
where you will get to do what you love! You’re making a conscious choice to create a state of excitement instead of anxiety. Congratulations, you are now practicing having more control over your mind. It feels better to empower yourself rather than stay a victim.
3.  Trust that you are enough.
When my first grandchild was born and my daughter was worried that the baby wasn’t getting enough food the first 24 hours, a wise nurse told her, “Don’t worry, they come with a packed lunch.” Along those lines, you’re equipped to handle what comes your way. You’re not missing anything. It’s all there inside of you, trust that. You just need to work on your tools to access all the goodies inside you. When you find yourself in a challenging situation, stop, breathe, and find your way home within yourself. Whisper reassuring words of encouragement to yourself. “I’ve got a good track record.” Or “I’ve made it this far, haven’t I?”  No need to melt into a puddle when A CRAVING COMES ALONG.
(Reference:  The Conscious Actor: Shelter From the Storm by Bonnie Katz 5/2/1616)
 

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