22 Apr Links Between PTSD and Smoking
Post-traumatic stress disorder, commonly known as PTSD, is a major form of medically serious anxiety that can occur in the aftermath of dangerous or life-threatening events or situations. Specific types of events and situations associated with the disorder include exposure to combat or a combat zone, sexual abuse, physical abuse, and threats of severe physical violence. Doctors and researchers have known for some time that people with PTSD smoke both relatively frequently and relatively heavily. In 2012, a group of researchers from Duke University uncovered part of the reason for this pattern of nicotine use with the help a modern brain imaging technology known as functional magnetic resonance imaging, or fMRI.
In the U.S., post-traumatic stress disorder is officially recognized and defined by the American Psychiatric Assn., a nationwide professional organization that issues guidelines for a wide range of mental health issues. Symptoms found in people with PTSD include the repeated and undesirable reliving of a previously experienced traumatic event, an inability to recall prominent features of a traumatic event, a strong urge to avoid anything that evokes memories related to a traumatic event, heightened efforts to detect future traumatic threats (hypervigilance) and sleep disturbances. While the majority of affected individuals recover from the disorder in three months to a year, some people develop persistent forms of post-traumatic stress that last can last a lifetime.
Smoking Habits in PTSD Sufferers
Roughly 19 percent of American adults smoke. By comparison, several studies conducted in the 1990s and 2000s indicate that 40 percent to 65 percent of people with a PTSD diagnosis smoke. In an addition to smoking more frequently than the average population, PTSD sufferers also smoke more heavily and have a greater likelihood of going through at least 25 cigarettes on any given day. In addition, according to the results of a study published in 2005 in the journal Addictive Behaviors, the average person with PTSD inhales more cigarette smoke per puff than the a person without PTSD.
Reasons for Smoking
When encountering situations that trigger their symptoms, people with PTSD often display a mental trait that psychiatrists and psychologists refer to as negative affect. This term describes a range of emotional states—including nervousness, fear, disgust, contempt, anger and guilt—that creates feelings of aversion or avoidance when they arise in the mind. The presence (or absence) of significant negative affect in a PTSD sufferer can act as rough guide to his or her current state of mental and emotional well-being. In a pair of studies published in 2005 and 2008, separate teams of researchers concluded that people with PTSD typically increase their nicotine intake when they feel negative affect levels rising in their minds, and report decreased amounts of negative affect following cigarette use.
In a study published in 2012 in the journal Advances in Pharmacological Sciences, a team of Duke University researchers used fMRI testing to examine the differences in the ways that smoking affects the brains of people with PTSD. fMRI technology shows changes in the brain’s activity levels by tracking closely associated changes in the movement of the brain’s blood supply. Half of the participants in the study were given nicotine patches and subjected to fMRI testing after the patches’ nicotine content had time to circulate in their bloodstreams. The other half of the participants underwent fMRI testing after receiving fake (placebo) nicotine patches.
The authors of the study concluded that smokers with PTSD have unusually increased levels of activity in parts of the brain called the amygdala and the prefrontal cortex, which play critical roles in the processing of emotion (in the case of the amygdala) and the exercise of higher-level functions such as judgment, impulse control, and decision making (in the case of the prefrontal cortex). When presented with stressful emotional cues, smokers with PTSD who did not receive nicotine during testing exhibited a significant rise in their reactive or aversive responses in these brain areas. Conversely, smokers with PTSD who did receive nicotine showed signs of brain activity that eased or limited these reactive responses and decreased the scope of negative affect.
In comparing the fMRI results of smokers with PTSD to the results of smokers without PTSD, the authors of the study in Advances in Pharmacological Sciences concluded that people with PTSD rely on the mental effects of smoking in ways that make it much harder for them to quit smoking. In turn, this difficulty in quitting smoking likely increases the long-term smoking-related health risks in people suffering from long-term PTSD.
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