Nicotine patches can enhance cognitive function among newly recovering alcoholics with a history of smoking

Detoxified alcoholics in the early stages of recovery tend to have impaired cognitive functioning.

Many alcoholics also smoke, and nicotine is known to have enhancing effects on attentional processes. New findings indicate that nicotine patches can enhance cognitive function among newly recovering alcoholics with a history of smoking.

Results are published in the December issue of Alcoholism: Clinical & Experimental Research.

"The majority of newly recovering alcoholics, between 50 and 85 percent, demonstrate significant problems in a wide array of tasks including visual-spatial, perceptual motor, learning and memory, attention/vigilance and abstracting and problem-solving," said Sara Jo Nixon, a professor in the department of psychiatry at the University of Florida and corresponding author for the study. "Although these deficits often fail to reach levels of 'clinical impairment,' they represent a subtle, mild dysfunction when compared with community controls."

"There is a rather large body of literature supporting the beneficial effects of nicotine under certain circumstances," noted Edith V. Sullivan, a professor in the department of psychiatry and behavioural sciences at Stanford University School of Medicine. "While smoking has many known untoward effects on numerous organs of the body, nicotine can have positive effects. Indeed, a recent study from the California Parkinson's Disease Institute indicated that nicotine adjunctive treatment with anti-Parkinsonian medication reduced tremor. Other studies have noted that patients with schizophrenia who are treated with certain antipsychotic medication have reduced motor side-effects by smoking cigarettes."

Nixon agreed. "The literature on acute administration of nicotine in both animals and humans strongly suggests that nicotine is a cognitive enhancer," she said. "The cognitive benefit is often observed in studies where non-smokers are administered nicotine. Furthermore, it appears that this effect is most effectively achieved through nicotine's effects on attention processes. However, when considering the potentially positive effects of nicotine, it is critical that we separate the effects of nicotine from those associated with smoking or other tobacco use."

Nixon and her colleagues examined two groups, ranging from 21 to 59 years of age: both groups -- alcoholics (n=28) and community 'controls' (n=27) -- were randomly assigned to two doses of the transdermal nicotine patch, Nicoderm CQ, low (7 mg.) and high (21 mg. for men, 14 mg. for women). Participants were then given a battery of neurocognitive tests to determine the differential effects of the different nicotine doses on attentional efficiency.

"The most innovative aspect of our study was that alcoholics who smoked were more sensitive to the drug dose of nicotine than were community controls who also smoked," said Nixon. "That is, when given a higher dose, alcoholics benefited from the extra amount more than controls did. Furthermore, this differential response was most obvious on the cognitive tasks which rely heavily on attentional processes." This apparently heightened sensitivity to the cognition-enhancing effects of nicotine may also help to explain why alcoholics have so much difficulty when trying to stop their nicotine use, usually in the form of smoking.

Both Sullivan and Nixon pointed out that the means of nicotine administration in this study, by patch rather than by smoking tobacco enriched with nicotine, was not only a key element of the study's design but also has practical implications for alcohol treatment.

"Rather than providing an 'excuse' to continue smoking, which is associated with a variety of negative biomedical consequences, including negative changes in brain structure and function," said Nixon, "these findings speak to the need for aggressive behavioral and/or pharmacologic treatment for nicotine withdrawal, particularly in individuals who may suffer additional behavioral compromise when deprived of nicotine."