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Alchemica

Battling nicotine addiction... a role for N-acetylcysteine?

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I've been addicted to nicotine for far too long... I've been free from tobacco for over a year but I'm now addicted to the 'step 1' (21mg) patch (cut in half) plus 40mg/day as gum :BANGHEAD2: It's time for me to quit this addiction. I haven't managed to step down successfully myself and think I might need some assistance. Is it worth going cold turkey? I've tried buproprion in the past but it wasn't that effective at the time. Here's an inspiring article I'm considering but I'm happy to hear from anyone who may have gotten in a similar situation.

The effects of N-Acetylcysteine on frontostriatal resting-state functional connectivity, withdrawal symptoms and smoking abstinence: A double-blind, placebo-controlled fMRI pilot study.

Chronic exposure to drugs of abuse disrupts frontostriatal glutamate transmission, which in turn meditates drug seeking. In animal models, N-Acetylcysteine normalizes dysregulated frontostriatal glutamatergic neurotransmission and prevents reinstated drug seeking; however, the effects of N-Acetylcysteine on human frontostriatal circuitry function and maintaining smoking abstinence is unknown. Thus, the current study tested the hypothesis that N-Acetylcysteine would be associated with stronger frontostriatal resting-state functional connectivity (rsFC), attenuated nicotine withdrawal and would help smokers to maintain abstinence over the study period. The present study examined the effects of N-Acetylcysteine on frontostriatal rsFC, nicotine-withdrawal symptoms and maintaining abstinence. Healthy adult, non-treatment seeking smokers (N=16; mean (SD) age 36.5±11.9; cigs/day 15.8±6.1; years/smoking 15.7±8.9) were randomized to a double-blind course of 2400mg N-Acetylcysteine (1200mg b.i.d.) or placebo over the course of 3½ days of monetary-incentivized smoking abstinence. On each abstinent day, measures of mood and craving were collected and participants attended a lab visit in order to assess smoking (i.e., expired-air carbon monoxide [CO]). On day 4, participants underwent fMRI scanning. As compared to placebo (n=8), smokers in the N-Acetylcysteine group (n=8) maintained abstinence, reported less craving and higher positive affect (all p's<.01), and concomitantly exhibited stronger rsFC between ventral striatal nodes, medial prefrontal cortex and precuneus-key default mode network nodes, and the cerebellum [p<.025; FWE]). Taken together, these findings suggest that N-Acetylcysteine may positively affect dysregulated corticostriatal connectivity, help to restructure reward processing, and help to maintain abstinence immediately following a quit attempt.

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Revisiting this. Still struggling with this one.... Rather than more exotic things, trying some food based cholinergics and anti-craving NAC.

 

Thing is I don't know if I want to quit, I find it a useful substance at times, until effects are negated by tolerance but use went up after Milly's passing. Decided it wasn't worth trying N. glauca for the moment, too risky.

 

Sometimes I wonder if my nicotine use goes up not just through stress but particularly when cholinergic activity isn't being addressed through diet. I got a bit slack with supplementing needed dietary choline intake recently, while I never thought highly of choline sources in noticing strong different effects really, I see them as potentially useful buffering pathology and in low intakes boosting issues, sometimes I wonder how detrimental that can be if, when particularly vulnerable, you don't get those choline sources into you? Anyone noted anything like that?

 

Going to get a little bit of a break/tolerance reset from nicotine, even though it's really unpleasant - I use it to help address cognitive concerns and mood issues but tolerance etc is problematic. Lately with Milly and trying to do more, the stress got to me, intake goes up, you end up using it to try and manage more than you should.

 

Decided to steer clear of all nicotinic alkaloids of other plants for the day, even though I earlier thought I'd try and taper with nicotine to keep some sanity, instead I'm trying to boost endogenous cholinergic activity and using anti-craving NAC to see how that goes

 

Drop of Spanish sage EO twice daily (strong AChE activity/neuroprotective etc: solid mood and cognitive improvements in studies in healthy individuals), couple of good doses of soy lecithin*, a dose of N-acetylcysteine (1.2g bd. which might offer a valid therapeutic approach for maintaining abstinence due to craving suppression, the safety profile of NAC and its favorable tolerability alongside superiority to placebo for craving reduction makes it useful)

 

*A positive influence of soy lecithin on memory, mood, and cognition was demonstrated among elderly test subjects. Short-term supplementation in patients with AD showed a stabilising effect on daily functioning, emotional state and self-reported general condition. Supplementation is encouraged in AD patients, the elderly or those with memory or cognition problems. Supplementation might be a safe and natural nutritional strategy for improving mental performance in young children suffering from ADHD. Supplementation may be beneficial for buffering stress responses.

 

~~~

 

Day three no (alright, one small dose to manage some worsening, quite severe pathology) nicotine. Firstly, it's worth considering why someone might use nicotine. In serious mental illness, there is an established therapeutic role that needs to be understood.

 

"Substantial evidence from preclinical and clinical studies indicated that dysregulation of α7 and β2-subunit containing nAChRs account for the cognitive and affective symptoms of major mental illness and nicotine use may represent a strategy to remediate these symptoms."

 

Importantly, nicotine can enhance cognitive function and regulate mood and affect in serious mental illness. It also plays a putative neuroprotective role, nicotine has long been considered a potent therapeutic agent for neuroprotection. The metabolite cotinine also has emerging evidence for the extinction of contextual fear memory and treatment of treatment-resistant depression (TRD) and PTSD.

 

Chronic nicotine significantly improved chronic stress-induced impairments of cognition, attenuation of neuroinflammation and the hippocampal synaptic plasticity relating to depressive and other CNS disorders.

 

In trying to reduce, I tried cold-turkey, what arises are some of the worst withdrawals, even from gum. In uncomplicated cases, it's straightforwardish, you can kindle will-power but still super challenging for a relatively healthy person. With psychiatric comorbidity, where there is some established therapeutic role for nAChR modulation in reducing symptoms and consequently the person uses it as self-medication, it's really hard.

 

Pharma options are often not desirable, things like some of the options there can worsen suicidality and cause strange violent behaviours, some are very mildly effective, but not standouts.

 

I've been going the Spanish sage EO, soy lecithin and N-acetylcysteine. The Spanish sage is mildly useful, it gives some stabilisation of the absolute rollercoaster of mood-destabilisation and affective issues that can be uncovered through dropping nicotine intake. Some mood lift, with some therapeutic saffron, you can get a little bit of coverage from strong serious mood declines. Some people I think almost need to stay on nicotine for safety's sake at times. You can't do these withdrawals lightly, from severe affective issues, to suicidal ideation to precipitation of major depressive/anhedonic crises... much of today was in a strange light headed impulsive flat out dysphoria, staring into space unable to do anything at all, mood flipping all over the place at the slightest provocation.

 

The N-acetylcysteine seems to mildly reduce impulsivity and craving at 1.2g bd. stop you from turning to trying to find anything, no matter how abhorrent containing nicotine, to take... it's not super effective but a slight help.

 

See how I go tomorrow.

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Caved in on attempting this after 3 and a bit days. The affective dysregulation of not using nicotine was too severe. Just got the tolerance down to a more manageable level. Might switch to patches or something... again

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Harden up bro

Nicotine got's nothing on you.

 

It's more of a choice than anything else.

I'd personally advice a good reason why nicotine is bad combined with a good reason why no nicotine is good over patches

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Tangential but I wonder if there is wisdom here on this subject:  I've been considering nicotine as an alternative ADHD medication, to replace the role of caffeine in my current needs.  Thoughts?

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What are the pro's and what are the cons?

 

I drink coffee all day like water. (For more reasons than just an energy boost)

Do i need it? not really. I think i'd notice things like change in weather or physical activity over a full stop in caffeine

 

Not saying caffeine is without effect, but it's well possible to adapt to changes.

 

Do you work out?

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Thanks for the input

I'm going to justify this addiction: :P Honestly, it's better to be on the nicotine that precipitating severe pathology.


It's not so much about hardening up when nicotine is addressing symptoms that can be lethally scary. I'm not using other more typical Western medicines to manage things, when before I was on ECT/ supratherapeutic doses of antidepressant, maximal doses of other potent psychotropics.  I haven't found superior ways to manage these sort aspects of my health, the other meds weren't doing it well.

 

Like I've said, I don't particularly want to give up because it is an effective medication and it keeps me from turning to worse things. I'd rather be in control more of my use. Sometimes I just need a break for a 'reset' I feel. Pressure from the external world to give up when I think more more people should appreciate it as viable medicine. I've always found that I need to just minimise the risk using it.

 

The pros are it works well, it is virtually devoid of side effects. Better tailorable PRN symptom reduction for affective issues than anything I've found that's readily available.

Cons cost and tolerance.

 

I do several walks a day but nothing too high intensity, could step that up.

 

7 hours ago, Mapacho said:

Tangential but I wonder if there is wisdom here on this subject:  I've been considering nicotine as an alternative ADHD medication, to replace the role of caffeine in my current needs.  Thoughts?

 

If you've been exposed to nicotine and seem to be able to manage your intake, it seems viable but I wouldn't risk a severe addiction by starting that as a medication in someone not exposed to nicotine, except as a more serious consideration.

@MapachoHave you considered proanthocyanidins like Pine Bark ?

I'd also consider something like galantamine if you can find it, or trying Spanish Sage EO, just to see if they help over nicotine.

 

On 2/27/2018 at 4:15 AM, Alchemica said:

 

One small randomised trial in ADHD suggests, despite various limitations, therapeutic benefit from herbal, polyphenol-rich extracts, particularly proanthocyanidins. Attention and concentration (as measured by tests before and after the experiment) improved just as much with a daily regimen of pine bark-derived OPCs as with traditional ADHD stimulant medications. Additionally, the subjects reported experiencing better sleep and improved mood while taking the OPC supplement, corroborating centuries’ worth of accumulated evidence from traditional systems of medicine that OPCs positively affect brain function. Pycnogenol, improved focus, decreased emotional volatility, and elevated mood. A study tested Pycnogenol on the cognitive abilities and emotional status of 53 healthy students aged 18–27. The students were tested before and after a regimen of Pycnogenol (100 mg/day) on measures of attention, memory, alertness, executive functioning, and mood, and showed significant improvements across-the-board after eight weeks of Pycnogenol supplementation. That said, while they're better options than psychostimulants, current evidence to support their use clinically is limited.

 

Edited by Alchemica
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7 hours ago, Alchemica said:

 

 

Like I've said, I don't particularly want to give up because it is an effective medication and it keeps me from turning to worse things. I'd rather be in control more of my use.

 

 

High dependence is defined by just such a sentence. Hard to give something up when you don't really want to though. The word addicition implies loss of control re use, and due to the pharmacological nature of nicotine (i.e. highly addictive whether you want it to be or not) control is going to be very hard to maintain with any kind of regular use (as addicition will be the result). True you could lessen cravings with various means, but you'll never stop unless you really want to, and that usually entails some sort of chronic/debilitating health  concern with nicotine unfortunately.

 

My 5c would be really try to be clear about what you want and why you want it. Unless you are it will be hard to know how close you are to your goals, so really examine those motivations. :wink: 

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I agree, fighting an addiction if you're not on board doesn't work.

I'm sitting with just a lower dose patch today - that's maintaining sanity and minimising symptoms, much less nicotine than usual but seems to address symptoms. At least I can't escalate patch doses easily while with gum, it's easy to do that.

See what a little while on patches is like, might be able to drop from there to minimal effective doses/none but for the moment, just stabilisation is needed.

 

I  like this view. How do we change from 'using and being used' by a substance in a detrimental way, to being in Plant Spirit symbiosis?

 

https://www.elephantjournal.com/2018/03/are-we-really-addicted-to-the-substances-or-to-the-feeling/

 

Do we want to fill a void or do we want to gain insights? Do we want to escape our pain or do we want to dive into it? Do we want to hide from ourselves or meet ourselves? This is the essential difference and the deciding factor to either create an addiction or experience the benefits of a symbiosis.

 

...we need to address the pain. We need to fill the inner void in other ways, or we can ask the plant to teach us how to properly fill it. It is never a question of controlling but it is about meeting an unmet need for ourselves that oftentimes hides so well that we are not even aware of it. It’s about changing the environment, it’s about feeling seen and received in relationships, it’s about creating a connection.

 

If our intention is to fully meet ourselves, we can enjoy the offerings without risking to fall into addiction. We can learn from them and enjoy their teachings, dive into our pain and have fun times, relax or feel blissful, and take new insights about ourselves and put the universe back into our reality.

 

Some stronger plants take us right into our pain. There is no more escape. The plants guide us to deal with the pain and show us how to fill the inner void.

 

The tobacco plant is a sacred plant, used in the Amazon by indigenous people for its protective spirit. It is a masculine energy that helps to ground us, eases anxiety and unrest. It calms us, helps us when we forget because we are anxious inside. Is it possible that people are actually searching for that inner peacefulness? Our fast-paced society that values productivity over emotional wellbeing causes many of us to feel uneasy and restless, and often, we are so used to these sensations that we are not even aware of them. The tobacco plant provides a feeling of inner safety and stillness.

Edited by Alchemica
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Totally agree. My feeling is when working with the vegetable realm it is VERY important to make clear, to the plant and yourself, what you want out of the interaction. Ask for nothing, then don't get suprised when you get nothing like what you wanted.

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