Quit Smoking - Tobacco Withdrawal

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	There are many methods for helping patients quit smoking. Many patients quit cold turkey by setting a quit date. Remember, nicotine is more addictive than crack cocaine and heroin and you may need help. The most successful smoking cessation programs include support groups and counseling.		70% of smokers want to quit.
	Most smokers will try to quit 7 to 9 times.

Download Brochure on Why to Quite Smoking -- 276.5 Megs.

The QuitGuide is a free application developed by MMG, Inc., for the Tobacco Control Research Branch of the National Cancer Institute (NCI). Written by tobacco control professionals and cessation counselors, with the help of ex-smokers and experts, this app is designed to help you prepare to quit smoking and support you in the days and weeks after you quit.
-- Available from I-Tunes

Your health risks will reduce if you quit.

After 20 minutes your heart rate slows.

After 12 hours the carbon monoxide in your blood returns to a normal level.

Between 2 weeks to 3 months your lung functions improve and your risk of heart attacks declines.

Between 1 to 9 months your coughing and shortness of breath reduces.

After 1 year your risk of a heart attack in one half that of a smoker's.

Between 5 to 15 years your risk of stroke is the same as someone who does not smoke.

After 10 years your risk of lung cancer is one half that of a smoker's.

After 15 years your risk of a heart attack is that of a non-smoker's.

Health risks are not appreciably reduced by smoking cigarettes with less tar. The risk of lung cancer is similar in those who smoke very low, low or medium tar cigarettes. View Article The terms " 'light' and 'ultra light' (cigarettes) are misleading because they imply less health risk but do not correspond to less hazardous cigarettes" -- Michael J. Thun, MD, MS

Trying to smoke fewer cigarettes is often not effective because the patient will compensate his or hers behavior to get more smoke and nicotine out of the cigarettes that are smoked. Thus, the reduction in health risk is not as great as one would expect. View Article.

The Table below shows the success rate of quitting the addiction of Alcohol, Smoking and Heron.

Only 3% of young people have long term success at quitting
Preventing Tobacco Use Among Young People, 1994 Surgeon General's Report

There are three basic steps to quitting smoking. Want IT, Plan IT, and Do IT.

Set a quit date and stick to it.

Make a list of trigger situations and have a strategy to avoid or deal with them. Anything to keep your mind off of smoking for at least two minutes will often work. Many use Physical Training or exercise for this purpose.

Reward yourself when you don't smoke.

Ask others not to smoke around you.

There are a number of tobacco programs designed to help you quit

TobaccoDependenceTreatment ToolKit -- American College of Chest Physicians.

There are also a number of medications which can help the smoker quit. However, they are not nearly as effective when used alone than they are in combination with counseling and support groups. These medications include:

Mint Snuff Over-the-counter (A smokeless tobacco substitute).

Nicotine Patches - Over-the-counter

Nicotine Gum - Over-the-counter (Used to give a relatively rapid boost in nicotine levels to control sudden cravings.)

Nicotine inhalers - Prescription (Used to give a rapid boost in nicotine levels to control sudden cravings.)

Chantix is the newest prescription medication to suppress cravings. Chantix blocks the nicotine receptors of the brain, blocking the effects of nicotine. Patients loose their craving for nicotine and many even develop a repulsion to it.

Warning: Posted 7/19/2008: Report of Increased Cardiovascular Risk in Patients Taking Chantix to Stop Smoking
http://www.medscape.com/viewarticle/745762?sssdmh=dm1.700724&src=nldne

France Pulls Subsidy for Chantix
http://www.forexyard.com/en/news/France-pulls-subsidy-for-Pfizer-stop-smoking-drug-2011-05-31T105429Z

Important Safety Information (accessed 1/4/2008) : "CHANTIX is indicated as an aid to smoking cessation treatment in adults. Patients may benefit from behavioral modification and support during their quit attempt. Patients should be encouraged to continue to attempt to quit if they have early lapses after quit day.

The most common adverse reactions include nausea, sleep disturbance, constipation, flatulence, and vomiting. Nausea occurred in 30% of patients; 3% discontinued due to nausea.

Safety and efficacy of CHANTIX in combination with other smoking cessation drug therapies have not been studied. Dosage adjustment with CHANTIX is recommended in patients with severe renal impairment or in patients undergoing hemodialysis.

Smoking cessation may alter the pharmacokinetics or pharrmacodynamics of drugs such as theophylline, warfarin and insulin, for which a dosage adjustment of these drugs may be necessary.

Patients should be advised to use caution driving or operating machinery until they know how quitting smoking with CHANTIX may affect them." (Source Chantix Website)

Chantix appears to have the highest success rate to aid in smoking cessation with the lowest rates of complications. Cessation rates of 44% vs 18% placebo (Source Chantix Website)

Zyban - Prescription (Acts on the brain to control cravings). Zyban main effect is to suppress withdrawal symptoms. Zyban is also the same drug as Wellbutrin an antidepressant. It works by affecting the levels of the Neurotransmitters dopamine and norepinephrine. The main advantage of Zyban is that it avoids giving the pateint added nicotine.

Side Effect (accessed 1/4/2008) : "Don't take with MAOIs, or medicines that contain bupropion. When used with a nicotine patch or alone, there is a risk of increased blood pressure, sometimes severe. To reduce risk of serious side effects, tell your doctor if you have liver or kidney problems. Other side effects may include weight loss, dry mouth, nausea, difficulty sleeping, dizziness, sore throat, constipation, or flatulence." (Source Wellbutrin Website)

Common side effects include dry mouth and difficulty sleeping.

Wellbutrin or Zyban should not be used in children under the age of 18 years because of the risk of suicidal thoughts or actions.

Success rates with this medication in my practice has been around 20%. This is consistent with that observed by other. (Ref: www.quitsmoking.com )

ALL MEDICAL SUPPLEMENTS SHOULD BE COMBINED WITH A SUPPORT GROUP.

Symptoms Encountered During Tobacco Withdrawal

Learn more about tobacco and addiction: Search PubMed for Nicotine and Addiction

Read More About It: Tobacco Control In the Wake of the 1998 Master Settlement Agreement

Above all Relax avoid stressful situations and find ways to release tension and keep your mind off smoking. You may even want to try to popping virtual-bobble warp. I am not sure if it will help but it is fun.

Learn more about tobacco and addiction: Search PubMed for Nicotine and Addiction

Read More About It: Tobacco Control In the Wake of the 1998 Master Settlement Agreement