Tobacco. Why We Smoke. How to Quit. Part I

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In last week’s blog, I noted that stopping tobacco was the single most important activity a person could perform to prolong life’s length and its quality.

Many young people figure they have all the time in the world to quit because, after all, they are, uh YOUNG. People in their 30s think they are at low risk of tobacco’s harms by virtue of their age. But if that 35-year-old is a smoker, “you can tell him that his risk of having a heart attack is the same as a 65-year-old man. That is meaningful.” This, from Ian Graham, MD, professor of cardiovascular medicine at Trinity College, You can’t be at low risk for the biggest killers, cardiovascular disease and cancer, if you smoke. Cardiovascular disease is the leading cause of premature death throughout the world, and tobacco is the most risky behavior on the short list of those activities that predict it.

Just two days ago, a major academic game-changer hit the medical news. Comprehensive new guidelines that are reader friendly and meant (gasp!) for the public were released. They are only 65 pages (guidelines usually have footnotes that are 65 pages long).

It’s back to the basics. Preventive efforts should be implemented from the womb and last until life’s end. Greater emphasis has been placed on the behavioral aspects of prevention, making it easier for patients to change their life styles. The majority of heart attacks are a direct result of the personal lifestyle choices. 90% of heart attacks worldwide may be prevented by people’s choices and doctors’ proactive advice. And the report gives hope to smokers. It’s never too late to change your mind, and your lifestyle to see odds slowly turn in your favor. Even when you’ve reached the point of needing secondary and tertiary prevention there’s room for hope. Quitting tobacco is the first on its list. It defines, more than any other factor, those people who wish to remain healthy. Here, is the full text article. It’s fit for an afternoon read or a periodic browse. While you are at it get a HeartScore that grades your chances of developing cardiovascular disease.

Lesson One
So, if you’ve never smoked it’s easy. Don’t start. Parents must carry the baton. There is no lesson more important and less negotiable than the, “Don’t smoke”, demand. Yes, demand. If parents don’t smoke the battle will be easier. If either mom or dad does smoke, the exhortations will fall of the deaf and skeptical ears of rebellious teens and pre-teens.

When my oldest son started smoking I simply pointed to the kids who were smoking as they stood across the street from the high school. I asked him how many of them were friends. How many would he want as friends? The answer? None. I also pointed out Wall Street folks, while walking with him along that fabled and cursed byway. We saw many millionaires who escaped their buildings to take a smoking break despite the fact  it was 11 degrees outside. They were huddled and hunched over, protecting themselves from the weather against alcoves and featureless cement walls. They looked pathetic and needy. Sorry I know many of you may smoke, but as I said there was no exaggerated display or faulty parallelism I was going to avoid stopping that first dreaded step toward dependency. Lie, cheat, beg and steal Your kids can’t start !

So, parents must quit to be believed. All others who smoke know they are killing themselves for the sake of a very weak addictive drug (nicotine). Wait, you didn’t know? It’s true. Some have even weighed in on its extremely weak addictive qualities. But addictive it is. Nicotine is an agent that both stimulates and relaxes. It induces euphoria with on a dose equivalency (not achieved with cigarettes) of cocaine and is harder to quit than heroin. It reduces stress and is a good appetite suppressant.

But it only requires 10 cigarettes a day to achieve blood levels that are going to ‘do the deed’ on brain neurochemistry. So why do people need more?

The chains of habit are too weak to be felt until they are too strong to be broken. It’s everything about the experience. Taking out the pack, making a deft wrist flick magically lifting only one cigarette, tapping it on the face of the watch to keep the tobacco packed, firing up the lighter ( the distinct click of the Dupont lighter is legendary) and then igniting the stick. That’s what makes people smoke more. Despite the knowledge it harms with every inhalation, smoking, for most, is just a great experience. Rituals such as drinking coffee, driving a car, talking on the phone or drinking alcohol at a party become inextricably linked with smoking. Once the patterns of smoking are set, they become regular from day to day and even from cigarette to cigarette.

How Others Quit
Some quit using Nicotine replacement therapies–gum, patches, lozenges, and nasal sprays. The prescription drugs, bupropion (Wellbutrin) and varenicline (Chantix) for some will calm the cravings. Some use a technique that makes smoking noxious. They smoke continuously until the becoming sickened. This technique is called multicomponent rapid smoking. It purports produce a lasting aversion to cigarettes. All of these have trade offs and side effects.

The good news is that Chantix has carried the Mark of Cain. Users were warned about the higher risk of death while using it. There’s a great incentive to quit…right? Hmmm, suicide, heart attacks or just light up another Camel and hope for the best. Well, as usually happens in medical research, it turns out that this warning was a “Woops, my bad. Looks like we were wrong. Sorry”. It turns out the added risk of Chantix is insignificant. So, for those who shied away, try again.

Telephone hotlines are about as effective as any other intervention..

Hookahs, smokeless tobacco are new replacement habits that try to run interference around older, and perhaps more dangerous tobacco addiction. But a Hookah session can be the equivalent of 100 cigarettes and smokeless tobacco is now regulated by the FDA. The jury on its safety is out. Here’s a web page for those who wish to keep up on all the news about tobacco updates.

And Despite All the Help Out There..
All the counseling and drugs in the world do an admirable job of doubling you chances of quitting. And yet, despite fewer than 20% succeed. Why? A. CDC survey found that only about half of smokers who saw a health professional in the previous year reported being advised to quit. Why?

· We are too busy.

· We can’t bill for the service.

· We are fatalistic regarding the success of our efforts.

Sometimes these pep sessions got hostile. When I spoke to patients, some became angry. “Hey I’m here for a colonoscopy not a lecture.” Thus, only one third of those who might want an intervention, get one.

Yet, 70% of current smokers indicated they wanted to stop smoking completely. But older we get the less likely we are to even try.

Have you tried and failed? Mark Twain said that quitting smoking is easy. “It’s easy to quit smoking. I’ve done it hundreds of times.”

How about something different? Something that works. At least for me. Tune in next week. I will post a personal experience about quitting tobacco. And I’m the guy who started with Gauloises and Gitanes. Unfiltered bliss. And now…free at last.

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2 Responses to “Tobacco. Why We Smoke. How to Quit. Part I”

  1. Katherine Sherry May 14, 2012 at 4:19 pm #

    Hi Dr Kussin,its Kathy.I need this!!! Been trying to quit on my own for 2 years.I always thought you were the reason I smoked.Ha Ha.

  2. Steven kussin June 1, 2012 at 4:57 pm #

    I may have well been. Check out next blog. You know how I quit. Say hello to your mom and dad

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