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'Extinction therapy' could help smokers quit

Treatment involving handling smoking paraphernalia helps smokers 'unlearn' their habit

Mark Gould

Monday, 06 February 2017

Scientists believe that lengthy exposure to environmental triggers for cravings, such as seeing a cigarette box or a lighter, could actually help smokers to quit. They studied a technique known as extinction therapy, targets the harmful Pavlovian associations that drive addiction with the aim of rapidly "unlearning" them.

Writing in Jama Psychiatry scientists at the Medical University of South Carolina, found that after two one-hour sessions people smoked significantly fewer cigarettes one month after treatment compared to a control group.

Although many participants still relapsed after treatment the authors feel the work could lead to new approaches to treating addiction.

The scientists gave 44 smokers a brief clip of people smoking, intended to activate and destabilise the smoking-related memory. Ten minutes later the participants began an hour-long exposure session in which they were repeatedly shown pictures and videos of people smoking and given cigarettes to play with but not allowed to smoke.

A similar control group of smokers were given the same hour-long exposure session, but without the initial smoking memory trigger – instead, they were shown a video clip of people washing dishes. Both group had two sessions on consecutive days.

After a month, the treatment group were smoking significantly fewer cigarettes on average each day (seven, compared to 10 for the control group). However, the treatment group did not have lower urine levels of cotinine (a proxy for nicotine intake) and did not manage to stay off cigarettes completely for significantly longer, leading some to express scepticism about the technique’s promise.

Michael Saladin, the psychologist who led the work, said: "When I initially saw the results from this study it was pretty eye-opening."

The researchers say that in smokers, environmental triggers have typically been reinforced thousands of times so that the sight of a lighter, for instance, becomes inextricably linked to the rush of nicotine that the brain has learned will shortly follow.

After quitting an addictive substance, these associations fade slowly over time, but people often flounder in the first days and weeks when cravings are most powerful.

Saladin and others believe it is possible to fast-track this process in carefully designed training sessions, to help people over the initial hurdle.

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