Dr. Bankole Johnson on Quitting Smoking

Bankole Johnson, M.D., is a practicing physician and psychiatrist whose pioneering research is changing the field of addiction medicine, and can be applied to quitting smoking. He currently serves as chairman of the Department of Psychiatric Medicine and a professor in the Neurology Department at the University of Virginia. He has conducted groundbreaking research in the field of neuroscience, studying how behavior and the brain create and break addictions. He has served on NIH committees, been published in more than 200 journals, and in 2006 he was honored with the American Psychiatric Association’s Distinguished Psychiatrist Lecturer Award. Here, Johnson addresses what it takes to break the addiction and quit smoking.

How do habits like smoking become addictions, and how can they be broken?

Eating releases a flood of dopamine, which activates our brain and creates a feeling of pleasure. When people use other substances, like nicotine or alcohol, it’s as though the normal dopamine brain-activation process has been hijacked by a stronger degree of the same process. It’s not all about dopamine, though. When a substance is consumed repeatedly, it actually changes the genetic pathways, which is the reason why not all substance users become addicted. Using the same drug repeatedly changes the brain to become more dependent on it, which is incidentally one of the reasons that it can be so challenging to quit. We also know that two factors—stress and impulse—can make the potential for addiction significantly worse.

However, the process can be reversed. If we can modify the brain to become more addicted, we could also modify it to go a few steps back to an earlier point when there were no problems with using the substance. After all, the same neurochemical pathways that create a sensation of pleasure with smoking or alcohol also create the sensations of pleasure in food and sex and other perfectly healthy experiences, and we don’t want to lose the ability to enjoy those as well. The key is just changing our associations and ceasing to reinforce the behaviors that lead to addiction.

What is your best recommendation for someone who is quitting smoking?

Get a physical evaluation from your doctor. Too many people overlook this step and try to go through the process alone, but we know that success rates are better for those who get help. A proper evaluation from a doctor can help a lot, especially in the first week or two. Working with a doctor or other clinician can help you develop a treatment program, which greatly increases your likelihood of success.

Treatment programs are usually two-pronged. You have to address both the physical addiction to nicotine as well as the reasons for the psychological habit. Many treatment programs will use newer medications, like Chantix (varenicline) or Zyban (bupropion), to address the physical aspects of breaking the smoking addiction. These medications act as a sort of middle ground between the effects of nicotine and nothing at all, which can provide a good “step down,” much like methadone for opiate addicts.

How can someone who cheats and has a cigarette within the first 30 days get back on track to quit smoking?

Keep in mind that the next day is an opportunity for a new start.

What are some of the psychological reasons associated with smoking?

We have found that there is a significant incidence of depression in smokers and other addicts. Depressed individuals may be attempting to self-medicate with nicotine or other substances. Few people quitting smoking are necessarily aware that they may be depressed, which can make them experience the process as more challenging or unpleasant, simply due to the depression. A physician may be trained to recognize depression and therefore able to prescribe medications or other forms of therapy to address [it], which is often the most crucial component. Once people treat depression, they find it much easier to break their addictions.

Many smokers believe that smoking relieves stress or that it otherwise functions as a coping mechanism, but obviously that relief strategy wasn’t in place before they took up the smoking habit. Therefore, what we often have to do is just help them to remember what coping mechanisms they used before they started smoking. If they can’t recall what those were or their prior coping mechanisms were also unhealthy, we have to help them develop new ones. But, we always start with the easiest and simplest strategies first.

Aside from medication, what can people do to quit smoking?

Having adequate support is always crucial. It makes it much easier when the individual has support of a spouse. For example, if both spouses smoke, it’s much better when both decide to quit at the same time so that the efforts of one are not undone by the other. Sometimes the support person isn’t necessarily going to be the spouse or partner, though. And, if both spouses do not decide to quit together, the one who is still actively smoking may make it more difficult for the one trying to quit. When one partner tries to quit his habit, the one who isn’t trying to quit may feel threatened by that change. So, in cases like that, the individual will need to find support sources from elsewhere.

A good clinician can help you come up with alternative behaviors to put in place of the habits associated with smoking. These alternative behaviors can be tough to prescribe because they will vary by individual, but the most successful ones replace the negative behavior of smoking with something more positive and enjoyable, such as taking up sports.

Breaking any addiction, including smoking, can be done. The brain just needs to be retrained to lose the habit, the same way it was trained to create the habit. This will take time and patience, and can be achieved much more readily with the help and support of others. It’s very possible and worthwhile to take control of your habits.

SIGNATURE QUESTIONS

What is the belief that you personally go to during times of change?

I have no fixed belief system.

The best thing about change is…

…it produces new opportunities.

What is the best change you have ever made?

To always follow my beliefs and convictions.

To learn more about Dr. Bankole Johnson, visit www.virginia.edu.