The drug bupropion (Zyban) is an option for people who have been unsuccessful using nicotine replacement. The drug was originally prescribed as an antidepressant, and its use in smoking cessation was discovered by accident. Researchers knew that smokers trying to quit were often depressed, so they began experimenting with bupropion as a means to fight depression, not addiction. It reduces the withdrawal symptoms associated with smoking cessation and can be used in conjunction with nicotine replacement therapy. Researchers suspect that bupropion works directly in the brain to disrupt the addictive power of nicotine by affecting the same chemical neurotransmitters or messengers (such as dopamine) that nicotine does. The pleasurable aspect of addictive drugs like nicotine and cocaine is triggered by the release of dopamine. Smok- ing f loods the brain with dopamine. The New England Journal of Medicine published the results of a study of more than 600 smokers taking bupropion. At the end of treatment, 44 percent of those who took the highest dose of the drug (300 mg) were not smoking, compared to 19 percent of the group who took a placebo. By the end of one year, 23 percent of the 300 mg group and 12 percent of the placebo group were still smoke-free. Using Zyban with nicotine replacement therapy seems to improve the quit rate a bit further. Fourweek quit rates from the study were 23 percent for placebo, 36 percent for the patch, 49 percent for Zyban, and 58 percent for the combination of Zyban and the patch. Avoiding Environmental Tobacco Smoke You don’t have to smoke to suffer from the effects of nicotine. Environmental tobacco smoke (ETS) causes health problems in nonsmokers. You can reduce the impact of this stress on yourself and others by taking some of these actions to avoid or help ban ETS: • Stop patronizing restaurants, bars, cafes, or similar businesses that allow smoking. Write to them to say they are losing your business for that reason. (If you really love the food, suggest smoking sections in a separately ventilated enclosure.) • Write letters to the editor, naming names and identifying a particular smoke-filled restaurant or other business. State your reasons for not patronizing the business. Negative press works wonders! • Make a point of congratulating restaurants, bars, cafes, or smaller businesses on creating smoke-free environments. Write letters, naming names to create positive press for their efforts. If you live with a smoker or are smoking in your home, here are some ways to avoid ETS: • Stop smoking inside the home. If you must smoke, go outdoors. • Create a separate smoking room with its own ventilation system and air seals to keep the smoke out of the rest of the house. • Install a more effective ventilation system with a supply of outside air and a special filter called a particulate filter.
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