Control of Cigarette Cravings with Cranial Electrotherapy Stimulation
Download Article The Townsend Letter for Doctors, 311(6): 81-85, 2009
This open clinical trial evaluated the efficacy of CES to control cravings in 1,000 cigarette smokers in a medical practice. Smokers who craved a cigarette were given a single 20 minute treatment of CES at 0.5 Hz, at a comfortable level of current just below where vertigo is experienced; usually in the 200 to 300 µA range. The subjects were diverse varying in age, education, race, national origin, and financial status. There were more males than females. Pregnant woman and people with implanted cardiac devices were excluded. Most of the smokers were not actively trying to stop smoking at the time they were treated with CES. Recruitment took place after the patient or companion was already at the medical office. Most smokers achieved a state of relaxation. About half noticed a more relaxed state within 1 minute. Most of the others felt a relaxing effect within 5 to 15 minutes.
Of 1,000 cigarette smokers treated between July 2006 and January 2008, 972 (97.2%) lost their craving for cigarettes within 1 to 5 minutes into a 20 minute session of CES. In those who were in the process of quitting and often at the height of their withdrawal symptoms, cravings started to diminish within 2 minutes of initiating CES and usually disappeared within 10 minutes. Several were 2 or 3 weeks into quitting and still experienced cravings. One still craved a cigarette after 3 months. Another still had cravings after 18 months, and 2 after 2 years. The longest period of no smoking where craving persisted was 4 years. The lack of need for a cigarette usually occurred within 2 minutes, and sometimes literally within seconds of beginning the treatment. In some, the very idea of smoking a cigarette became temporarily repulsive. Typical responses to the question, “How is your craving or need for a cigarette now?” usually asked after 2 or 3 minutes into the CES session were: “I don’t even want a cigarette, now,” or “I’m not thinking about a cigarette now,” accompanied by a surprised look. Cravings typically returned in 2 to 8 hours (range of 30 minutes to 16 hours).
Additional benefits of relaxation and pain relief were reported by most subjects. Some of the smokers who also craved other addictive drugs reported a reduced desire for other substances. Other cravings included alcohol, opiates, cocaine, methamphetamine, and xanax. In each case, cravings disappeared within minutes. Many headaches were relieved. Pain and muscle tension in the neck, shoulder, and upper back was generally diminished as well. Anxiety was greatly reduced in most cases. Two of the patients craving a cigarette were in psychiatric emergency states. In both cases, their states of emotional turmoil/agitation calmed down to near normal, one in 2 minutes, the other in 10 minutes. Numerous patients who desired to quit smoking were provided a prescription to purchase a CES device, and those who did were usually able to quit successfully. Some medical patients who were prescribed CES for treatment of other problems, without the specific intent to quit smoking, also reported that they greatly reduced their cigarette consumption without effort.
The author hypothesized that CES may achieve parasympathetic nervous system dominance by stimulating the auricular branch of the vagus nerve. Withdrawal symptoms are basically manifestations of sympathetic nervous system overactivity (e.g., tremors, sweating, tearing). The addictive craving has also been hypothesized to involve an expression of receptors. Research has shown that, in rats, chronic nicotine use triggers the extrahypothalamic corticotropin releasing factor (CRF) system, a major brain stress system, which contributes to continued tobacco use by exacerbating anxiety and cravings upon withdrawal. That study found that administering a compound that blocked the receptors involved in this stress system alleviated withdrawal symptoms. It is possible that am effective CES waveform alters the receptor electrically instead of chemically.
The author concluded that elimination of cravings in a single trial was nearly universal. The potential of this therapy as a treatment for cigarette addiction appears to be very high. The short-term benefits of CES applications to reduce cravings are widespread. It could prove invaluable in hospitals and other high stress situations where smoking is prohibited. Cigarette smoking in a hospital is dangerous in many ways. By having CES available with standing orders to control cravings, patients may be better able to withstand the wait for medical care and be more helpful when seen. Smokers who do not smoke while in a hospital will likely realize better outcomes than those who continue to smoke, resulting in reduced morbidity and mortality. Some smokers who purchased the CES device to treat their cravings when they arose reported a complete cessation of cravings after 1 to 6 weeks. Making it easy to quit smoking could take a huge burden off the health care system as the enormous cost of treating diseases caused by smoking is well established. The consequence of smoking a pack of cigarettes is estimated to cost the United States economy $7.18 per pack in medical care and lost productivity, or about $157 billion and 440,000 premature deaths each year. The therapy appears to have immediate benefits for patients, with little or no adverse effects. These preliminary observations represent a promising addition to the treatment armamentarium for addiction. Widespread application could have a dramatic impact on health care outcomes and costs. Such robust results warrant further research to confirm and expand on the results of this study and to examine the long term effects of CES for smoking cessation. No adverse effects were observed or reported in any of these 1,000 individuals, with the exception of 3 (0.3%) who were unable to tolerate the treatment due to vertigo.
