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Unlike those of us having our own relapse history, who have our own evidence of the power of a puff, Joel's statement is built upon 32 years of living down in the trenches daily working with smokers and witnessing a couple of thouand relapses.
As for those millions of extra acetylcholine receptors that the brain grew in an attempt to protect itself from an endless steam of a powerful natural insecticide, the science in this area is still unfolding, Richard. Although we're told that receptor down-regulation and re-sensitization is fairly rapid as Joel notes active dependency does permanently alter the brain but is it more psychological and memory driven than physiological? Time will tell.
The act of relapse itself appears to be a combination of a memory that gradually suppresses just how horrible daily life as an addict was and how challenging recovery can be, an excuse to smoke nicotine, and either not yet knowing the law of addiction or rewriting it to make ourself an exception to it.
But once there and that first powerful puff strikes the brain, whether our acetylcholine receptor count in a host of pathways is back to normal or not (some regions with increased receptor sites and others with fewer ), nicotine will cause the release of dopamine and through cascading affect the flow of over 200 other neurochemicals. Logic tells us that, like kissing an old sweetheart, sensing that first puff will revive and bring to the forefront hundreds of thousands or even millions of tiny independent memories of having put a cigarette to our lips, of sucking upon it, of tasting its destructive cargo fill our mouth, of sucking it into our lungs, of waiting those 8 to 10 seconds and then feeling a rush of dopamine and an adrenaline surge, and then memories associated with all the sensations of exhaling.
Aside from any permanent nicotine imprints upon the brain's circuitry, we know that the initial dopamine relapse will be real yet it won't match the addict's thousands of replenishment aaahhhh sensation memories as we're told that the brain had fully adjusted to again functioning without nicotine (within 10 days to two weeks) , there was nothing missing and nothing that needed replacing. Yes, the neurochemical flow is real it comes up short of all those memories of badly needing a fix and the addict's moment of aaahhh glory in buying another 30 minutes to an hour before the mandatory replenishment cycle was repeated again.
In regard to immediate relapse, does this failure to match replenishment memories cause most relapsing to keep trying as they smoke cigarette after cigarette, or possibly even an entire pack, until they restore active dependency and their again junkie mind can say to itself, "see, I knew that my thousands of aaahhh replenishment memories were real as they're back!"
We also know that the circumstance under which the puff was taken are being compared against prior memories and that in all likelihood there will be a match to an old nicotine feeding cue (a trigger) that will likely be reinforced to some degree and that will likely be encountered again soon.
While pouring over piles of NRT studies back in 2000 I noticed a recurring statement by researchers along the lines that smoking one cigarette was the single most predictive factor of ultimate relapse. I think I may have cited two studies in some buried thread, one showing a 95% once cigarette relapse rate and the other an even higher figure which I recall as being 98%.
But I like the way Joel puts it. There are only two possible perceptions after taking that first puff: (1) digging through a pack with full and complete relapse back to your old level of intake or higher; and (2) a feeling that you've somehow gotten away with smoking just one - a feeling that will breed the false belief, and every addict's dream, that you can now control the uncontrollable. Gradually the dream itself will be their undoing. Sadly the group fails to learn the power of that first puff from the school of hard quitting knocks, and the price could be years of extra damage or the ultimate - life itself.
Richard, we check all the new studies coming out fairly regularly and as relapse science continues to unfold we'll share what we learn here on the boards. But it has been my experience these past five years, while watching new studies hit the street, that regardless of the ultimate answers associated with neuronal and neurochemical nicotine mechanics, that the answers will have no choice but to reinforce Joel's lifetime of "real-world" observations. I've now seen it so many times that my jaw no longer drops in awe. Instead I just smile and shake my head.
As Roger likes to remind us, it may not always be simple but certainly is easy. There's just one rule that 100% guarantees success for all. If we want to stay on this side of the bars and keep our now arrested dependency on the other, just one day at a time we need to Never Take Another Puff! John