A.Thank you for your question Marie. There are great many smokers, who would like to have that answer to your question. Specifically, there are several million in the United States and over one billion worldwide. Most of them would like to stop smoking, but less than 5% are successful according to the US Surgeon General Report of several years ago. The low success rate for being able to kick the habit is blamed on the highly addictive properties of nicotine. I am sure you and your husband are well aware that the drive or need for a cigarette can often be associated with irritability, anger, impatience, insomnia, anxiety, and depression. During the past decade, considerable efforts have been made to better understand the nature of the addictive properties of nicotine. Nicotine when inhaled into the lungs, travels through the bloodstream, crosses the blood-brain barrier and enters the brain. Specifically, it attaches to nicotine receptors triggering the release of a chemical called dopamine. Dopamine is that remarkable neurotransmitter responsible for the calming effect of cigarettes and the demanding drive for cigarettes. The change in the receptor number, the avidity with which nicotine adheres to the receptors, and the explosion of dopamine release are all part of the biochemical choreography that we have come to understand as responsible for nicotines power and to the development of new approaches to treatment. In the past the general program has been to slowly reduce the amount of nicotine delivered with the use of nasal sprays, gums, or patches. These have not been particularly helpful. Nearly a decade ago, the antidepressant bupropion (brand name Wellbutrin or Zyban) was marketed as an agent that could reduce the urge associated with nicotine withdrawal.This was the first non-nicotine based therapeutic remedy for smoking cessation. It also has been only marginally successful. Most recently, a new drug called varenicline marketed as Chantix has been approved by the FDA and is currently being sold by prescription. The pill is taken twice daily for six months. This drug actually blocks the brain receptor from combining with nicotine. In this way, the sequence of events described above do not take place. Dopamine is not released, most importantly, and therefore you do not get the pleasurable effect associated with smoking. In addition, blocking the receptor also blunts cravings and withdrawals symptoms. This is certainly not the magic bullet, but it is helpful. Approximately, twenty five percent of patients on Chantix were able to truly stop smoking over the long haul. That is somewhat better than the nicotine patches and considerably more effective than Zyban. It does represent a significant step forward because of its specific approach in attacking the nicotine receptor in the brain. I would advise your husband to consider this medication.

A new development is that of a vaccine that leads to development of antibodies against nicotine. In this approach, nicotine is attached to a protein and an antibody is developed following several injections. The antibodies absorb nicotine in the bloodstream; therefore the nicotine does not reach the brain. Clinical trials are being carried out at the present time and the drug hopefully will be on the market in the next one to two years. The vaccine may be effective in over half the subjects trying to stop smoking.

The concept of vaccines for addictive substances is being investigated by the large pharmaceutical companies because of the tremendous potential and because of the damaging effects of drug addiction of all types. Vaccines are being developed against cocaine, methamphetamine, heroin, and other addictive drugs. Regarding cigarette smoking, the most addictive potential exists in the young people. Children between the ages of 6 and 18 can become addicted to nicotine by smoking only a single cigarette per month. Addiction can also occur within days of smoking a single cigarette. In a recent study in the Archives of Pediatric and Adolescent Medicine, researchers found that 10% of youth become addicted to nicotine within two days of first inhaling a cigarette and 25% are addicted within a month. Interestingly, the numbers of nicotine receptors in the brain increase in parallel with the frequency of smoking. Very early on in the smoking history, a single cigarette can contain enough nicotine to saturate all the nicotine receptors in the brain and withdrawal symptoms may not occur for weeks. Overtime, chain smoking develops because withdrawal symptoms can occur within several hours as nicotine levels fall and brain saturation of massive receptor numbers is reduced. This dynamic may be the reason your husbands more difficult situation this time around. Regarding children, will the day come when we will consider vaccinating our young people against addictive substances? If addiction is so easily developed in young people, might we do them a favor by preventing addiction with for example a nicotine vaccine? On the surface of it, it sounds like a good idea. . These are issues coming up as we develop a much more mature understanding of the biochemistry of nicotine addiction, other addictions, and begin to design new drugs to treat chemical addictions of all kinds.

I hope this information is helpful. Good luck to your husband in his efforts.