Tobacco Use Treatment at Kolmac Integrated Behavioral Health Centers

Yes. Like many other addictive substances, nicotine targets pleasure centers in the brain resulting in a pleasurable effect (1). Over time, this stimulation leads to increasing needs for nicotine and frequent cravings. These cravings along with nicotine withdrawal make quitting tobacco products difficult.

To gain a better understanding, this article by the Mayo clinic is very informative: https://newsnetwork.mayoclinic.org/discussion/smokers-brains-change-in-response-to-high-levels-of-nicotine/

Given the rise of anti-smoking media and mounting evidence, it is well known that tobacco use, including smoking, has harmful effects on physical health.

Looking at the latest research from the National Institute on Drug Abuse:

1. Smokers over 60 years old have a two-fold increase in mortality when compared to non-smokers. This is estimated to account for a 6-year life expectancy decrease in smokers over 60 (2).
2. Rate of death from cancer is twice as high in smokers than non-smokers (2). 
3. Other potential health consequences including COPD, heart disease, stroke, vascular disease, and aneurysm are increased in smokers (2).

Furthermore, in 2019, the CDC found that cigarette smoking is the “leading cause of preventable disease, disability, and death in the United States.” This accounts for 1 in 5 deaths per year in the general population (3). 

Looking beyond the health risks associated with tobacco use, there are also significant mental health effects including increased risk of depression and anxiety and interactions with mental health medications. There also seems to be a correlation to smoking and addiction based on data collected by the National Survey on Drug Use and Health, which found that a large percentage of adults who abuse substances also smoke at higher rates compared to the general population (25% vs 7%) (4). 

For more information on the health effects of tobacco use, visit: https://smokefree.gov/quit-smoking/why-you-should-quit/health-effects

Since these products contain nicotine, they have the same effect on the brain as other nicotine containing products. Given the fact that there is no smoke entering the lungs, like smoking tobacco products, many believe that e-cigarettes are a safe alternative. Unfortunately, while considered safer, e-cigarettes are still harmful and can contain harmful chemicals. Examples of such chemicals include diacetyl found in some flavorings, fine particles inhaled into the lungs, and heavy metals like lead, tine, or nickel(5). 

To learn more: https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping

Quitting tobacco products at any age no matter the length of time used can lead to significant improvement in health and increase life span. This is true even in patients with active health conditions caused by smoking and tobacco use, like chronic obstructive pulmonary disorder (COPD) or coronary heart disease. For example, in patients with COPD, quitting smoking has been shown to slow the progression of COPD immediately and reduce the risk of coronary heart disease 1-2 years after quitting (6). Other examples are seen with reduction in cancer risk, stroke, and developing respiratory infections (6). 

Additional information can be found at: https://www.cancer.org/latest-news/how-to-quit-smoking.html

There are 3 types of FDA-approved medications for the treatment of tobacco use disorder (7). Each type has its advantages and disadvantages, so it is important to be open to discussion and ask questions when discussing this with your medical provider. All forms of smoking cessation treatment are relatively safe when compared to nicotine containing products like cigarettes. 

Nicotine Replacement Therapy or NRT, provides exactly as the name suggests. Since nicotine is the substance associated with addiction and dependance in tobacco products, NRT provides an avenue to slowly taper nicotine production and avoid uncomfortable withdrawal. NRT products come in a variety of forms including skin patches, gum, lozenges, nose spray, and inhalers. It is available over the counter and by prescription depending on the type. NRT productions should be used with caution in patients with high blood pressure, recent heart attack, asthma, and irregular heartbeats. 

Varenicline (brand name Chantix) does not contain nicotine but instead attaches and blocks nicotine receptors in the brain. By blocking nicotine receptors, varenicline helps to reduce cravings and the rewarding effects of nicotine. The major downsides to varenicline are cost and possibility of mental health side effects. 

Bupropion hydrochloride or brand name Zyban also does not contain nicotine. It has shown to be helpful with cravings and some patients even report that it changes the taste of cigarettes. The way it helps with nicotine cravings is unknown. Bupropion hydrochloride is also used to treat depression but is marketed under the name of Wellbutrin. Bupropion should be avoided in patients with a history of seizures and psychosis. 

For more information on medications for tobacco cessation: https://www.fda.gov/consumers/consumer-updates/want-quit-smoking-fda-approved-products-can-help

Medications are an important part of treatment but just as important are lifestyle modifications, therapy, and cessation coaching. Lifestyle modifications like exercise, regular good quality sleep, social support, and a healthy diet can greatly ease symptoms of anxiety and stress associated with tobacco cessation (8). Individual and group therapy are both very effective at uncovering underlying issues that make stopping difficult, provide a supportive environment, assist with accountability, and help develop alternative coping skills. Alternative coping skills often include mindfulness activities like meditation and progressive muscle relaxation. In addition to the above, many states offer free smoking cessation counseling and support groups. 

Links to state smoking cessation programs: 

-Maryland https://smokingstopshere.com/

-Delaware https://www.dhss.delaware.gov/dhss/dph/dpc/quitline.html

-Virginia https://www.vdh.virginia.gov/tobacco-free-living/quit-now-virginia/

-District of Columbia https://www.dctfc.org/quitline

-Pennsylvania https://www.health.pa.gov/topics/programs/tobacco/Pages/Quitline.aspx