Medication Assisted Treatment, or MAT, is the evidence-based practice of combining traditional behavioral health treatment with prescription medications. The combination leads to improved outcomes for clients. For opioid use disorders, it more than doubles the rates of success. For tobacco dependence/disorders, it can quadruple it. Medication, combined with working with a tobacco cessation professional, can increase your odds of quitting for good by up to four times, according to the Mayo Clinic.

“Truth be told, smoking kills more people every year than heroin and meth combined,” said Dr. Krista Brucker, an Oaklawn MAT prescriber and emergency medicine physician. Medication for smoking cessation “without a doubt helps people quit smoking at higher rates,” she said.

Nicotine changes your brain over time by stimulating the reward center and reinforcing behavior.

“Nicotine actually releases dopamine at rates as high as alcohol and sometimes cocaine,” said Addictions Team Leader Brooke Marshall, MSW, LCSW, LCAC. “Dopamine is your reward center – the more you do it, the more your brain says you need it.”

That’s also why when you quit, you’ll experience cravings and other physical withdrawal symptoms.

Medication helps manage what’s going on in your brain, lessening your dependence on nicotine over time, or regulating neurotransmitters and receptors so you don’t need nicotine. They can often be used in combination.

Smoking cessation & psychiatric concerns

Some smoking cessation medications have been linked to psychiatric symptoms, which are rare but can be severe.

At one time, both varenicline and bupropion carried black box labels warning of suicidal thoughts and behaviors, agitation and hostility. These were believed to be worse among those who had pre-existing mental health conditions. The black box label was removed in 2016 after further research showed that the medication did not worsen any of those reported symptoms compared to a placebo.

“Every medication has risks,” said Dr. Brucker. “There are some reports of increased psych symptoms that need to be monitored carefully. They are overall very rare, but patients should know to look out for them and call [their physician] if they experience any of them.”

She said it’s often the case that doctors can decrease the dose, giving patients the benefit of the medication while lessening the side effects.

For smokers who have a mental health diagnosis and may already be taking psychiatric medications, their tobacco cessation care should be coordinated with their psychiatric prescriber, but can also typically benefit from smoking cessation medication.