TMS for Smoking Addiction

Millions of people want to quit smoking, but it’s not easy. Transcranial magnetic stimulation is an innovative treatment for smoking cessation approved by the Food and Drug Administration (FDA) and available from health providers nationwide. TMS for smoking addiction can help people who’ve tried to quit without success, or people who want to quit on the first try, and make it stick. 

Cigarette Smoking in the U.S.: Fifty Years of Change

The story of cigarette smoking in the United States is instructive for us all.

In the mid-20^th century, smoking was common. Most people were completely unaware of the significant health risks of smoking. It was a perfectly acceptable way to relax and pass the time. People had their morning smoke, their after-lunch smoke, and their after-dinner smoke. They had a smoke with drinks late in the evening. Some smoked all the time. Think of the iconic image of an old man talking with a cigarette dangling from his lips, somehow not falling out onto the ground. People smoked everywhere, in almost all public spaces: from restaurants to offices to banks, smoking was everywhere.

Then things changed.

Slowly, over time, the general public got the news that smoking was bad for you in myriad ways. It began with consistent public messaging about the health risks of smoking, as the result of the Federal Cigarette Labeling Act of 1965, which required every package of cigarettes to bear one of the following messages on the outside:

SURGEON GENERAL’S WARNING:

Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy. 

 

SURGEON GENERAL’S WARNING:

Quitting Smoking Now Greatly Reduces Serious Risks to Your Health. 

 

SURGEON GENERAL’S WARNING:

Smoking By Pregnant Women May Result in Fetal

Injury, Premature Birth, And Low Birth Weight. 

 

SURGEON GENERAL’S WARNING:

Cigarette Smoke Contains Carbon Monoxide.

 

More importantly, it required similar warnings on all forms of advertisements for cigarettes, from print ads to outdoor billboards. Then, in 1969, congress passed the Public Health Cigarette Smoking Act, which required more stringent warnings, and banned television commercials advertising cigarettes. In 1969, tobacco companies were the largest television advertisers in the country. But in 1971, the last TV ad for cigarettes played during The Tonight Show – and thus began the instructive nature of the cigarette story we mention above.

We’ll explain, with this set of statistics on rates of cigarette smoking in the U.S. between 1965 and 2018, which we retrieved from the American Lung Association:

53-Year Trend in Daily Cigarette Use Among Adults: United States 1965-2018

• 1965: 42.4%
• 1970: 37.4%
• 1975: 37.1%
• 1980: 33.2%
• 1985: 30.1%
• 1990: 25.5%
• 2000: 24.7%
• 2005: 20.9%
• 2010: 19.3%
• 2015: 15.7%
• 2018: 13.7%

That’s close to a 70 percent reduction since 1965. We can trace the reduction directly to evidence-based decision-making about tobacco use on the part of our public policymakers. Scientists presented the data to congress– and though it took time – our leaders made the right choice, and enacted measures to protect the health of the public. That’s why the story of tobacco is instructive: it teaches us that we can change our attitudes and our behavior in response to scientific evidence – and save millions of lives while doing so.

In 2023, when we face multiple public health challenges – the opioid epidemic, the youth mental health and suicide epidemic, the loneliness epidemic – we would do well to remember that public awareness campaigns can work, and change the lives of people for the better.

Cigarette and Tobacco Use Now

Despite over fifty years of targeted public messaging and increasing public awareness of the negative health consequences of smoking, millions of people in the U.S. and around the world still smoke or use tobacco products.

In fact, smoking is the leading cause of preventable death in the world. Smoking is associated with:

• 7,000,000 million deaths per year worldwide
• 480,000 deaths per year in the U.S.

Tobacco smoking also has a significant financial cost both for individuals and the general public. Experts estimate that in the U.S.:

• People spend 170 billion dollars per year on medical care related to smoking cigarettes and using tobacco. That’s billion with a “b,” the number with nine zeros: $170,000,000,000.
• Businesses/the economy/people lose the equivalent of 160 billion dollars a year in productivity due to tobacco smoking. Again, that’s billion with a “b”: $160,000,000,000.

In addition to premature/preventable mortality – which means early death that can be avoided – smoking cigarettes and general tobacco use is associated with a wide range of health problems. Here’s what smoking can cause:

• Cardiovascular Disease: Stroke, coronary heart disease
• Lung Disease: Chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis
• Cancer: Lung, bladder, leukemia, cervix, colon and rectum, esophagus, kidney and ureter, larynx, liver, mouth, pancreas, stomach
• Additional smoking/tobacco related complications: Problems for mother and fetus during pregnancy, decreased sperm production in men, poor bone health, elevated risk of eye problems, diabetes, arthritis, dental/gum problems.

When people become addicted to using tobacco or smoking cigarettes, they have what physicians call tobacco use disorder (TUD). Once TUD develops, it’s difficult to stop using tobacco/smoking, and many people need help.

That’s what this article is about: an innovative approach to smoking cessation – a.k.a. quitting tobacco/cigarettes – called transcranial magnetic stimulation (TMS). Before we get to our discussion of TMS, we’ll define exactly what we mean by smoking addiction.

What is Smoking Addiction?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines smoking addiction as tobacco use disorder (TUD). TUD is defined as:

“A problematic pattern of tobacco use leading to clinically significant impairment or distress over a 12-month period, and the presence of two or more clinical symptoms over a 12-month period”

DSM-5 Symptom Criteria for Tobacco Use Disorder

• Smoking/using tobacco in larger amounts or over a longer period than initially planned/intended.
• A strong desire to stop using tobacco
• Multiple unsuccessful attempts control, reduce, or stop using tobacco
• Spending a significant time engaged in activities related to obtaining tobacco
• Strong cravings, desire, or urge to use tobacco.
• Continued tobacco use that prevents an individual from fulfilling obligations related to work, school, or family/home.
• Continued tobacco use despite social/relationship problems caused by or made worse by the effects of tobacco.
• Giving up social, occupational, or recreational activities due to tobacco use.
• Recurring tobacco use in dangerous situations, e.g., smoking in bed
• Continued tobacco use despite physical or psychological problems caused by or made worse by tobacco use.
• Tolerance to nicotine, as defined by either of the following:
  • Experiencing a need for increased amounts of tobacco to achieve the same effect.
  • Experiencing a diminished effect with use of the same amount of tobacco.
• Withdrawal, defined as daily tobacco use for several weeks, then abrupt cessation, followed by:
  • Irritability, frustration, anger
  • Anxiety
  • Difficulty concentrating
  • Restlessness
  • Lower heart rate
  • Increased appetite/eating
  • Significant weight gain
  • Depressed mood/sadness
  • Insomnia
  • Using tobacco to avoid the symptoms listed above

To reiterate, in order to meet clinical criteria for tobacco use disorder, an individual must display at least two (2) of the symptoms listed above during a 12-month period, which must be accompanied by the “significant impairment or distress” also listed above.

We’ve presented the latest information on the negative consequences of tobacco use disorder and the clinical criteria for tobacco use disorder, a.k.a. smoking addiction. Next, we’ll discuss the most common ways to treat tobacco use disorder, but first, we’ll report the latest prevalence rates on tobacco use and tobacco use disorder in the U.S.

Tobacco and Nicotine Use: Facts and Figures

Here’s the latest data on tobacco and nicotine use in the U.S, as reported in the 2021 National Survey on Drug Use and Health (2021 NSDUH). We include this information to point out that while we’ve made progress in reducing cigarette and tobacco use in the U.S., we still have a long way to go.

Past Month Tobacco/Nicotine Vaping

• Total age 12+: 22% (61.6 million)
• 12-17: 6.7% (1.7 million)
  • 60.5% vaped only
  • 21.2% used tobacco products only
• 18-25: 24.7% (8.3 million)
  • 32.2% vaped only
  • 42.8% used tobacco products only
• 26+: 23.4% (51.6 million)
  • 6.3% vaped only
  • 86.2% used tobacco products only

Past Month Cigarette Smoking

• Total age 12+: 6% (43.6 million)
• 12-17: 1.5% (392,000)
• 18-25: 11.5% (3.8 million)
• 26+: 17.9% (39.4 million)

Daily Cigarette Smoking Among Current Cigarette Smokers

• Total age 12+: 9% (27 million)
  • One or more packs (20 cigarettes) per day: 41.9% (11.3 million)
• 12-17: n/a
• 18-25: 27.6% (1.1 million)
  • One or more packs (20 cigarettes) per day: 24.2% (266,000)
• 26+: 65.8% (25.9 million)
  • One or more packs (20 cigarettes) per day: 42.7% (11.1 million)

That’s the prevalence data – but that’s only part of the story. Data from the Centers for Disease Control (CDC) indicates that among the millions of adults who smoke, a large percentage want and try to quit:

• Close to 70% of adult smokers say they want to stop
• Over 50% adult smokers tried to stop in the past
• Less than 10% stopped successfully

Let’s focus on that last bullet point for a moment: less than one in ten were able to stop. Among those who tried to stop, just over thirty percent tried counseling and medication, under ten percent tried counseling only, just under thirty percent tried medication, and about five percent tried counseling and medication.

That’s why we’re writing this article. Fewer than 10 percent of people who try to stop succeed – 7.5 percent, to be exact. It’s clear the most common, traditional methods – going cold turkey, using a nicotine patch, going to counseling, or combining a patch with counseling – are not effective for a majority of people who want to quit smoking.

However, evidence shows that the new, innovative method we mention above – transcranial magnetic stimulation (TMS) – might work where all other approaches to smoking cessation fail.

TMS for Smoking Addiction: Effective Treatment, New Technology

The publication “Transcranial Magnetic Stimulation Treatment for Smoking Cessation: An Introduction for Primary Care Clinicians” offers an excellent introduction to TMS for smoking cessation. TMS is a non-invasive technique that has several advantages over traditional methods of smoking cessation, which include:

1. It has a high success rate, compared to old methods.

• At four weeks post-treatment, people who use TMS have triple the success rate of people who do not use TMS
• At four months post-treatment, people who use TMS have two and half times the success rate of people who do not use TMS

2. It’s non-invasive, does not require medication, and has no systemic side effects.

• The most common delivery method for TMS is with BrainsWay technology in an outpatient, office setting.
• Patients sit in a comfortable chair while a clinician places an electromagnetic coil or cap on their scalp, which stimulates brain areas related to smoking and addiction with tiny electromagnetic pulses.
• Some patients experience tingling at the stimulation sight, and some experience mild headaches that fade soon after treatment

3. It’s fast acting.

• Patients report reductions in craving for tobacco/nicotine after one session
• Reductions in craving increase with two or more sessions
• Reduction in craving predicted successful cessation

Here’s how the authors of this paper summarize TMS for smoking addiction:

“The clinical benefits, including the fast onset and minor side effects, outweigh the minimal risks involved. The treatment may be particularly of help in patients with a DSM5 diagnosis of tobacco use disorder who have a long history of smoking and have made several failed attempts to quit using currently available options.”

TMS for Smoking Addiction: A Path Forward

The data above shows that 27 million people smoke cigarettes every day. On average, 22 million people each year try – but fail – to quit. That’s almost 80 percent of current smokers, and that’s why the TMS for smoking addiction is an important development in public health. The math tells us the following:

• If 80% of people worldwide quit smoking successfully, we could prevent 5.6 million deaths per year: that’s 80% of the 7,000,000 million deaths attributed to smoking each year.
• If 80% of the people in the U.S. quite smoking successfully, we could prevent 384,000 deaths per year: that’s 80% of the 480,000 deaths attributed to smoking each year.

That’s the health side of the equation, which – in our minds – is the most important. There’s also a financial side:

• If we reduced the amount of money we spend on tobacco-related health care by 80%, we could save 136 billion dollars a year: that’s 80% of the 170 billion dollars we spend on smoking-related medical care each year.
• If we reduced the productivity lost to smoking by 80%, we could save 128 billion dollars per year: that’s 80% of the 160 billion dollars in lost productivity attributable to smoking each year.

The benefits of quitting smoking far outweigh the risks, which we detail above: cancer, lung disease, heart disease, complications during pregnancy, poor bone health, diabetes, and arthritis, among others. Recent evidence also suggests an association between cigarette/tobacco use and anxiety and an association between cigarette/tobacco use and depression.

The evidence is overwhelming: there is every reason to stop smoking, and virtually no good reason to continue smoking. With TMS for smoking addiction, quitting may be within reach for millions of people who want to live a healthier life – without smoking.