Nicotine as Miracle Drug

 

leovapeDr. Anna Fels recently saw a patient who had an interesting method of self-medication. The psychiatrist wrote up the experience in the New York Times:

We talked for a long time about why she had come to see me. Then, as is my practice with a new patient, I asked what, if any, psychiatric medications and nonprescription, psychoactive substances — legal or illegal — she had used. Her answer was a new one for me. She stated that she chewed approximately 40 pieces of nicotine gum per day and had done so for well over a decade.

Responses to this question are often illuminating and can be rather humbling. Although doctors are trained to focus on prescription medications, there are and have always been nonprescription “remedies” for psychiatric conditions. And people’s preferences for one type of substance over another can give a glimpse into their symptoms and even their brain chemistry.

If a patient tells me he falls asleep on cocaine, I wonder if he might have attention deficit disorder. A patient who smokes marijuana to calm down before important business meetings leads me in the direction of social phobia or other anxiety disorders. I often wonder if people who take ketamine recreationally might be depressed, since this anesthetic has been shown to have antidepressant effects and is, in fact, being investigated for potential therapeutic use.

But tobacco is terrible, right? We’re all aware of the lung cancer risks of smoking and the various mouth cancers that strike people dipping Copenhagen. These dangers are real, but what causes cancer is not the nicotine but the tar and various chemicals found in the tobacco.

Nicotine is tobacco’s addictive component, which is why so many smokers wean themselves off those smelly old coffin nails with a nicotine patch, gum, or e-cigarettes. This gives them their fix without the serious cancer risks that come from tar.

Sorting through patients’ uses of psychoactive substances, from cocaine to alcohol to coffee, leaves me with an appreciation of the wildly different neurochemistry of people’s brains. One person will drink alcohol and feel euphoric, witty and extroverted, and the next will be logy and nauseated. In one patient, marijuana sharpened his focus and made it possible to pay attention in class, hugely improving his grades. Another felt paranoid and a third used it as a sleep aid. And presumably these substances all hit the same brain receptors in each of them.

My new patient explained that in her sophomore year at college she had started smoking. The effect, she said, was like “a key that fit perfectly into a lock.” Her brain felt clearer, her thoughts were more coherent, her mood and energy improved. Not wanting to damage her lungs, she soon switched over to nicotine gum and had been taking the same amount of it for well over a decade — a pattern of stable “dosing” that I discovered is typical in long-term nicotine users.

…But as I thought about our conversation later, I found her image of a key in a lock particularly striking; it was the very same one that psychiatrists and neurophysiologists use to describe the interactions in the brain between neurotransmitters and their receptors. And in fact, neurons do have receptors into which nicotine neatly fits, mimicking the actions of the brain’s own molecules.

Dr. Fels looked up some research and found that isolated nicotine does create positive effects in some people. It can improve brain functions, memory, and mood, and perhaps even decreases the potential for Parkinson’s disease. Eager to test these findings, she tried nicotine gum herself, but it only made her shaky and nervous. For her, the key didn’t fit the lock.

As you can see from my profile picture, my drug of choice is caffeine. If I don’t have a jolt of coffee first thing in the AM, I’m dragging through meetings, I think at half speed, and I’m distracted by nearly everything. By mid-afternoon, I get an all-over headache which is my brain’s way of reminding me to stop what I’m doing and guzzle a cup or three of joe. On the other hand, a Coke or cup of tea seems to tire me out, even though both have caffeine.

I’ve met people who use marijuana to enhance their creativity or just take the edge off (lots of comedians and musicians fit this profile), others who need a stiff drink at the end of the day to calm themselves, and others who can’t function without a constant supply of black tar heroin (your secret is safe with me, Peter Robinson).

I’m curious: Do you have a minor (hopefully legal) drug of choice that helps you function better?

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There are 59 comments.

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  1. Member

    None at the moment. It’s Lent.

    • #1
    • March 7, 2016, at 2:37 PM PDT
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  2. Member

    Ricochet–it’s still legal, right?

    • #2
    • March 7, 2016, at 2:38 PM PDT
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  3. Inactive

    Jon Gabriel, Ed.: As you can see from my profile picture, my drug of choice is caffeine. If I don’t have a jolt of coffee first thing in the AM

    I’ve read that most of the effect from coffee in the morning is from heading off the caffeine withdrawal, which starts while you’re sleeping. An interesting observation. I’m a coffee addict fan of coffee myself, btw.

    Nicotine as a cognitive enhancer

    1. Nicotine improves attention in a wide variety of tasks in healthy volunteers.

    2. Nicotine improves immediate and longer term memory in healthy volunteers.

    3. Nicotine improves attention in patients with probable Alzheimer’s Disease.

    4. While some of the memory effects of nicotine may be due to enhanced attention, others seem to be the result of improved consolidation as shown by post-trial dosing.

    • #3
    • March 7, 2016, at 2:40 PM PDT
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  4. Member

    I don’t know if it benefits me brain-chemistry wise – but I am hooked on chocolate. And I’m not much kidding. And my wife cannot get through a day without a Coca-Cola.

    • #4
    • March 7, 2016, at 2:42 PM PDT
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  5. Reagan
    iWe

    I am chemically addicted to coffee – it does not stimulate me, but withdrawal is miserable, so I drink my cup per day.

    I like a drink at the end of each week – a shot of superb scotch is a Shabbos treat.

    And I am addicted to naps. 1-2 naps each day are essential to my productivity.

    I am actually thinking of trying nicotine gum based on this thread. Huh.

    • #5
    • March 7, 2016, at 2:46 PM PDT
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  6. Inactive

    BTW, I smoked for a number of years. I started after avoiding them for many years, even though I had many friends who smoked. One day I just really wanted to smoke a cigarette. After a while, I lost interest.

    During that same period, I was developing an inflammatory bowel disease that ultimately led to surgery.

    I lost interest in smoking shortly after changing my diet in a way that led to resolution of the IBD

    It turns out that doctors will recommend smoking to patients with certain IBds, and they’re actually working on a drug now that contains what they think are the active ingredients from tobacco.

    So I strongly suspect that my smoking was an unknowing way of medicating myself.

    I don’t miss it.

    CONCLUSIONS: In smokers with UC who stop smoking, the severity of the disease increases after smoking cessation, with an increase in the disease activity and the need for hospital admission and major medical therapy. In addition, the need for azathioprine therapy becomes similar to that of nonsmokers.”

    • #6
    • March 7, 2016, at 2:50 PM PDT
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  7. Thatcher

    That which doesn’t kill you makes you stronger.epa01300520 Rolling Stones Guitarist Keith Richards smokes a cigarette at the World Premeire of 'Shine the Light' at the Ziegfeld Theater in New York USA, 30 March 2008. EPA/PETER FOLEY

    Until it kills you.

    • #7
    • March 7, 2016, at 2:53 PM PDT
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  8. Member

    Hah. Like I’d tell you guys.

    • #8
    • March 7, 2016, at 2:57 PM PDT
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  9. Member

    As a smoker, then nicotine gum chewer then vaper, let me add that nicotine is also a very effective anti-depressant.

    Which is why when a couple of my kids have smoked in their teens, I didn’t hassle them about it; as far as I’m concerned they were self-medicating. And if they’re going to self-medicate, nicotine is a lot better than the alternatives like pot or illegal or prescription drugs.

    My two Marine sons also ingest nicotine in one form or another – it helps them stay awake.

    No girl ever got pregnant on prom night after a cigarette; and no man ever beat his wife or jacked a liquor store.

    I’ve watched several devoted, long time smokers go into very deep depressions when they quit smoking – and as I’ve mentioned in a comment in a previous post, Mel Gibson went off the rails right after he gave it up.

    I have a very good friend where everyone in the family is on anti-depressants (and they are not all related). It is spoken of freely and recommended often. But if she found out her 22 year old son snuck a smoke in my backyard on Saturday night she’d kill him, then me.

    Ridiculous.

    Yes, there are risks associated with cigarette smoking. Just like there is with just about everything. Hopefully you can find the key that fits it your lock. And here’s hoping whatever it is legal and affordable and accessible.

    • #9
    • March 7, 2016, at 3:08 PM PDT
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  10. Inactive

    Smoking has also been known to help calm symptoms related to schizophrenia. My grandmother was schizophrenic and smoked like a chimney.

    Through college I lived very clean, no coffee, alcohol, drugs, etc. and I was very high functioning. However, slowly over time I have added coffee and alcohol to my habits. I have never tried nicotine myself, so I don’t know what it does for me.

    My real addiction is Ricochet.

    • #10
    • March 7, 2016, at 3:49 PM PDT
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  11. Inactive

    I’ve been saying this about nicotine in the PIT for some time now. Since nicotine is a stimulant it also helps with weight loss. My guess is once the science comes in on vaping you will start to see lot of folks vaping to stay thin.

    • #11
    • March 7, 2016, at 4:02 PM PDT
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  12. Member

    Hoyacon:Ricochet–it’s still legal, right?

    For now it is. By the second Clinton term I expect Ricochet to be outlawed as hate speech. Enjoy it while it lasts.

    • #12
    • March 7, 2016, at 4:23 PM PDT
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  13. Inactive

    Annefy: As a smoker, then nicotine gum chewer then vaper, let me add that nicotine is also a very effective anti-depressant.

    Annefy: I have a very good friend where everyone in the family is on anti-depressants (and they are not all related). It is spoken of freely and recommended often. But if she found out her 22 year old son snuck a smoke in my backyard on Saturday night she’d kill him, then me.

    This is very, very interesting.

    I’m a dipper, have been on and off since high school (I’ve gone years between cans), but I come from a depressing family family with a history of depression. My mom’s on anti-depressants, and I know one of my two sisters is as well. They may both be.

    I’m not. I was in a funk a couple years ago and for the first time visited a shrink: his conclusion was I didn’t have depression, just struggling to deal with a significant job issue from several years back. Two visits to effectively get it off my chest, and I was all better.

    But, when I feel stressed, I crave nicotine. It’s part a comfortable habit, but this conversation has me thinking there’s more to it than that. Maybe it’s the key my brain needs to process complex challenges more clearly.

    Hmmm…

    • #13
    • March 7, 2016, at 4:29 PM PDT
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  14. Member

    Exercise.

    • #14
    • March 7, 2016, at 4:30 PM PDT
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  15. Inactive

    The Darling Mrs. Yeah…OK shops. No, check that, she BUYS.

    • #15
    • March 7, 2016, at 4:34 PM PDT
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  16. Inactive

    Deleted because I misread the posters intentions…sorry.

    • #16
    • March 7, 2016, at 4:35 PM PDT
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  17. Member

    After several years of a pack a week cigarette habit, I quit in support of Mrs. Skinner. I quit drinking a few years ago in support of a friend who was going through his third 28-day spin dry. I prefer my caffeine cold and with lots of sugar, but now they went and lowered the diabetes guidelines, so I’ve had to quit that in the last month or so. I work in an office building where vaping is considered equal to smoking, so that is going to be hard to start.

    They seem to be making illegal substances a more attractive option.

    • #17
    • March 7, 2016, at 4:39 PM PDT
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  18. Inactive

    Caffeine in soft drinks, cold over ice. It does what coffee is never able to do, help me focus!

    • #18
    • March 7, 2016, at 4:47 PM PDT
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  19. Inactive

    And what about our own Dear Leader micro-dosing? The creative, RINO one.

    • #19
    • March 7, 2016, at 4:54 PM PDT
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  20. Member

    Z in MT:Smoking has also been known to help calm symptoms related to schizophrenia. My grandmother was schizophrenic and smoked like a chimney.

    -snip

    I think it’s criminal that smoking is not allowed for institutionalized (is that the right word?) mental health patients.

    Similarly in old folks’ homes. I regularly stop to visit with a couple of sweet old ladies sitting in their wheel chairs in the alley behind the home where my mom lives. $5,000 + /month and they’re sitting in an alley.

    • #20
    • March 7, 2016, at 5:14 PM PDT
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  21. Member

    Muleskinner:After several years of a pack a week cigarette habit, I quit in support of Mrs. Skinner. I quit drinking a few years ago in support of a friend who was going through his third 28-day spin dry. I prefer my caffeine cold and with lots of sugar, but now they went and lowered the diabetes guidelines, so I’ve had to quit that in the last month or so. I work in an office building where vaping is considered equal to smoking, so that is going to be hard to start.

    They seem to be making illegal substances a more attractive option.

    I vape everywhere, including movies. Never had a complaint. If they can’t see you doing it, they don’t know you are.

    • #21
    • March 7, 2016, at 5:16 PM PDT
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  22. Member

    RightAngles:Hah. Like I’d tell you guys.

    Not fair. At all.

    • #22
    • March 7, 2016, at 5:25 PM PDT
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  23. Member

    drlorentz:

    Hoyacon:Ricochet–it’s still legal, right?

    For now it is. By the second Clinton term I expect Ricochet to be outlawed as hate speech. Enjoy it while it lasts.

    At which point I’ll be seen running screaming down the main street of town (hopefully without disrobing). Ricochet is a wonderful release and I said that because I meant it. Not to get a free coffee mug. Still . . .

    • #23
    • March 7, 2016, at 5:38 PM PDT
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  24. Inactive

    Jon, thanks for this post.

    Please add “nicotine” and “tobacco” to your tags.

    • #24
    • March 7, 2016, at 5:51 PM PDT
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  25. Member

    Annefy:

    Z in MT:Smoking has also been known to help calm symptoms related to schizophrenia. My grandmother was schizophrenic and smoked like a chimney.

    -snip

    I think it’s criminal that smoking is not allowed for institutionalized (is that the right word?) mental health patients.

    Similarly in old folks’ homes. I regularly stop to visit with a couple of sweet old ladies sitting in their wheel chairs in the alley behind the home where my mom lives. $5,000 + /month and they’re sitting in an alley.

    I agree. It’s inhumane.

    • #25
    • March 7, 2016, at 6:20 PM PDT
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  26. Member

    Western Chauvinist:

    Annefy:

    I think it’s criminal that smoking is not allowed for institutionalized (is that the right word?) mental health patients.

    Similarly in old folks’ homes. I regularly stop to visit with a couple of sweet old ladies sitting in their wheel chairs in the alley behind the home where my mom lives. $5,000 + /month and they’re sitting in an alley.

    I agree. It’s inhumane.

    I remember in the 90s I saw the oldest woman in the world on the news. She was French, and she was 124 years old. They asked her to what she attributed her long life, and she said, “I quit smoking when I was 117.”

    • #26
    • March 7, 2016, at 7:02 PM PDT
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  27. Member

    That’s awesome RA

    I have a video kicking around somewhere of an Aunt in Australia wishing my mother a happy 80th BD. Aunt was probably 95 or so at the time.

    My cousin sent the entire video unedited and it begins with him hollering that he is starting to tape and telling her to put out her cigarette and move the whiskey out of the frame.

    She moves the bottle but keeps the glass. Puts out the cigarette but leaves the ashtray. All the while giving him a dirty look.

    • #27
    • March 7, 2016, at 7:10 PM PDT
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  28. Member

    Recently I was reading a blog piece by Dr. Michael Eades on his theory as to why obesity rates began to shoot up around 1980. The government has had its dirty little hands in this problem because its dietary guidelines almost certainly contributed to it. Then it occurred to me that the incidence of obesity might also have something to do with the fact that smoking rates had been declining. Sure enough I found that smoking rates took a drop around the time that obesity rates were climbing. So if my guess is correct, we exchanged one problem for another, and I think you could make a pretty good case for the proposition that obesity, especially morbid obesity, is a worse health hazard than smoking.

    17977982_14471758287420_rId9

    • #28
    • March 7, 2016, at 7:37 PM PDT
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  29. Coolidge

    My wife’s grandfather lived well into his ’90s. We don’t have a picture of him without a cigar, cigarette, chewing tobacco or a pipe. He had to quit when he entered a long term care unit when he was about 91 or so.

    If I have a long drive ahead of me, nothing is better than a fine cigar to keep me sharp.

    • #29
    • March 7, 2016, at 7:49 PM PDT
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  30. Member

    Sandy:Recently I was reading a blog piece by Dr. Michael Eades on his theory as to why obesity rates began to shoot up around 1980. The government has had its dirty little hands in this problem because its dietary guidelines almost certainly contributed to it. Then it occurred to me that the incidence of obesity might also have something to do with the fact that smoking rates had been declining. Sure enough I found that smoking rates took a drop around the time that obesity rates were climbing. So if my guess is correct, we exchanged one problem for another, and I think you could make a pretty good case for the proposition that obesity, especially morbid obesity, is a worse health hazard than smoking.

    17977982_14471758287420_rId9

    Very intereseting! I gained 12 pounds when I quit smoking.

    • #30
    • March 7, 2016, at 7:49 PM PDT
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