How I Fooled Myself into Quitting Smoking

[This story was corrected on April 14 to accurately reflect the research and views of Dr. Edward Levin of Duke University.]

"There's no talking during the treatment," she says as I close my eyes and lean back into the chair. I can feel the wand run over my forehead, my temples, around my ears. The lights are flashing as I squint my eyes shut.

"Light clears away demons," my friend Lawrence said when he made the pitch.

"Demons?"

"Yeah."

Smoking, for the past 15 years, has been my demon. It owned me. I hunched with my cigarettes in alleys in the freezing rain. I got kicked out of a nightclub for smoking in the bathroom. I almost started a fire at an airstrip because I tried to sneak a cigarette during a ground transfer in Seattle. I'll never forget the panicked look on the tarmac worker's face as he screamed at me to put it out. And when it started to hurt when I breathed deeply, I denied the connection. I admit it, I would have run over my grandmother for a cigarette.

I remember my first drag. I was nine years old and my mother left a cigarette burning in the ashtray on the coffee table. When she left the room to answer the phone I picked it up and put it in my mouth as my younger sister watched in awe. I felt grown-up important, like it looked in the commercials. By junior high I smoked a pack a day. My main concern when organizing my modest finances was having the money to support my habit. That feeling of euphoria that you feel when you inhale deeply and the chemicals course through your veins. Only a smoker knows it.

I open my eyes and watch the woman run her wand in circles again and again under my nose. She tells me, "I'm going to stimulate glands in your brain that will help you stop smoking." And now she is saying, "I'm stimulating your appetite suppression gland. I'll give you an extra hit. You're a thin girl. Don't let yourself go. Don't ever get fat." I suppress my laughter.

We are in an unkempt office on the east side of Vancouver, and this bizarre procedure is nothing like a regulated, proven medical treatment for addiction. But I'm desperate. When it's over the woman instructs me to drink as much water as possible and take vitamin C for cleansing. "I want the nicotine out of your system."

Lawrence drops me off at home and kisses my cheek. "Good luck," he says, "I'll check up on you tomorrow."

Demons be gone

Within an hour, the craving hits. The magic laser hasn't killed it. I've never had the cravings and not given in to them. "I don't smoke. I don't smoke. I don't smoke," I tell myself. I decide my patio needs a good scrub and set to it. By seven at night I am beginning to pace the floor and feel like crawling out of my own skin.

By midnight I am almost in tears I want a cigarette so bad. There's no possible way I can sleep so I put on a movie. There are people smoking in the movie so I have to turn it off. I sit on the couch in the dark and think that I haven't smoked in 14 hours, the longest I've gone without a cigarette probably since I was 15. I feel panicky. I think about the next day, which I will have to face without cigarettes. I am afraid.

The next day I feel like a freight train is running through my veins. I pace like a caged animal. I start to sweat and chug water like a camel. I can't think straight. I can't remember basic information and can't carry on a conversation. I am in complete meltdown. I remember being a teenager and watching a movie where someone was coming off heroin, and they lie in a pool of their own sweat, shaking and convulsing. That's how it feels inside my head.

A week later, the worst of it has subsided. Except for the depression. For weeks more, I want to throw myself off the Burrard Street Bridge. I figure out why Zyban is such a lucrative niche market. My sister comes to visit and I am so horrible to her that she checks into a hotel to get away from me. I go to her room and we lie on the floor, drinking a bottle of wine. "I'm sorry," I tell her. "You don't know what I'm going through."

Out of addiction

I graduate from university and quit smoking in the same month. I am more proud of myself for quitting than for graduating because quitting was harder. My lungs feel naked, like they have been stripped bare without nicotine. And 10 months after that bizarre laser "treatment" and new-agey mumbo jumbo, I have not smoked another cigarette.

This makes me want to know why I was able to quit and why three of my friends who underwent the same procedure were able to quit, when so many people can't and wind up dying from smoking related illnesses.

Could the laser lights have seeped into my brain and de-programmed my addiction?

What the hell was that anyway?

The East Vancouver laser clinic's website claims an over 80 per cent success rate, and out of the four people I know who got the treatment only one has started smoking again. And that's only because he went to Europe, got drunk on cheap wine and said "Screw it. When in Rome . . ."

I find a research study by Duke University psychiatry professor Edward Levin that reveals a mental illness/smoking correlation. I knew that, I saw One Flew Over the Cuckoo's Nest. One of the most memorable moments in the film was when one of the patients begged nurse Ratchet to give him his cigarettes. According to Levin, 25 per cent of the general population smokes, while 90 per cent of schizophrenics smoke. This suggests that "nicotine may counteract some of the cognitive deficits of schizophrenia."

Treatment or trick?

My doctor tells me the laser was "just placebo," but I don't know what that means. I find Dr. Raymond Lam, head of clinical neuroscience at the UBC psychiatry department. He studies the biological effects of light, so I figure he'll know something about the laser treatment. He doesn't. His light therapy studies what happens to cancer patients when they have light beams shone into their retinas. This has helped cancer patients. The light clears away their demons, too.

Lam says that everything that goes through the brain has an effect on the brain. "There are many things that contribute to why people get better," he says. "When we talk about placebo effect, we are talking about non-specific factors that go into why people improve." We tend to think about placebo as a pill and forget there are other factors such as interactions that contribute to the placebo process, like relationships with a care provider. I think of how the woman wielding the laser told me that if I put my mind to it, I would never smoke again. And how I wanted to believe it.

Lam says scientists wouldn't consider laser light therapy a viable treatment option until it had been the subject of a "controlled placebo trial," and patients had been given the treatment without them realizing it and then quit smoking.

When placebos are 'real'

I call Dr. Jon Stoessl, a neuroscientist at UBC who is acknowledged as the foremost placebo expert in his field.

He thinks that placebos could be useful for addictions, but hasn't conducted experiments to prove it. He says "with Parkinson's disease or pain or depression, there can be a placebo factor of 40 to 80 per cent." In theory, this means that people who are in pain or are depressed only think they have pain or depression. The conditions are not "real" in the tangible sense -- rather they are perceived in the mind to be real.

Stoessl notes the placebo effect can skew experiments designed to test a drug's effects. "A large portion of patients . . . respond to placebo, and they may respond with very large magnitude. So if you are testing something and you haven't tested it against a placebo, you haven't demonstrated any effect," he said.

He explains that scientists, when testing medications on patients, will give a portion of the patients the actual pill, and others a sugar pill. In placebo trials, many people respond to the sugar pill because it "has a physiological effect on pain." So if people take a pill and believe it's going to help them, more often than not it actually does because they believe it will regardless of what's in it.

Sarah Lidstone is a PhD candidate at the Pacific Parkinson's Research Centre who has studied the placebo/addiction connection. She asks me how the laser therapy works. "Uh, lights stimulate glands in the brain" is my brilliant reply. "Oh, placebo," she says. I am, by this point, pretty sure I was duped. There likely is no magic laser cure whose secret I must share with the world.

The way it works

Lidstone explains how placebo works. "The basic idea is that it all taps into the same circuits. The parts of the brain that responds to all addictive drugs, whether it be nicotine or alcohol or cocaine, act to create dopamine in the brain. What we are seeing is that patients who expect that they are going to get drugs and get placebo, they release dopamine in those same areas of the brain. Dopamine is a neurotransmitter in the brain. It gets released, and you feel good. It's the drive that craves food, sex.

"Placebo is governed by expectation," she says. "Conceptually it's the same response, the same parts of the brain that are involved. If a person is going to get better, it has to be because your brain expects to get better. . . . When placebo is given, it's always given under the guise of a drug" she says. Or a laser beam, I think to myself.

"If a person has gone in expecting that the treatment is going to make you quit smoking. . . that expectation is happening in the same part of the brain that is expecting to get reward from a drug. 'The history of medicine is the history of placebo,'" she says, quoting Raouel de la Fuentes.

I ask her if she thinks the laser beam held any special power to cure my addiction. She doesn't. "If we had that capability, then we would be using it to get rid of brain tumors. That would be a really powerful technology to have," she says.

Happily fooled

None of the scientists have heard of the magic laser therapy treatment. But when I explain it to them, they all agree that it is placebo. So according to them the laser was a dud. It did nothing. I only believed it was going to make me stop smoking and so I stopped. Just like that.

They do acknowledge the connection between placebo and curing addiction. But my addiction isn't cured. Like the alcoholic who can never have another drink, I can never have another cigarette.

I don't think I would have been able to quit unless I'd had my friends tell me the laser would work. I wouldn't have been able to quit without the woman waving the laser telling me I'd never smoke again if I believed I could be a non-smoker. I wouldn't have done it if I hadn't believed the laser was working its magic on my brain. And when I took those vitamins, I believed they were purging my system of toxins. I believed in it, and it worked.

The experts have convinced me my "treatment" was merely a placebo.

Should I feel foolish about that? I don't. I'm a non-smoker.

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