One of the most difficult challenges many patients face is the effort to stop smoking. Some patients truly seem to enjoy smoking, but most have fallen victim to a habit they cannot shake. Most smokers genuinely would like to stop, but they have not been successful.
The many ill effects of smoking are well known. Emphysema, lung cancer, asthma, cardiovascular disease, premature aging of the skin, and many other health problems are clearly associated with smoking. Second-hand smoke extends the health risks to those in the nearby environment. Studies show a dramatic increase in respiratory problems involving children living in the same household as a smoker.
The first step in a successful effort to stop smoking is to understand some of the factors involved. First, nicotine is a very addictive drug. Some studies have compared this compound to cocaine in terms of the addictive potential. Smokeless tobacco users have become “hooked” with as few as one or two exposures. The exact reason for this is a topic of debate, but the currently accepted model involves the triggering of some “switch” in the brain, which once activated, can apparently never be turned back off. This is at least a psychological phenomenon and may be physical, as well. Former smokers who would never consider smoking again report still having occasional cravings, particularly during times of stress. This apparently is due to an anxiolytic action of the drug. I do not think it is coincidence that so many smokers also have anxiety concerns. This action in the central nervous system probably also explains the appetite suppressant effect many patients report. Further, nicotine is active at the neuromuscular junction. This is a purely physical action and leads to physical dependence. It takes about five days for the nicotine to clear the system after total smoking cessation, and patients may experience actual physical withdrawal symptoms during this time.
So, smokers wishing to stop face two separate battles. Most people can deal with either the physical side or the psychological side, but it is hard to deal with both at the same time. Our current smoking cessation efforts revolve around treating both aspects of this problem. Probably the most important factor is the patient’s determination to quit. Without a firm commitment, no effort will be successful.
The psychological side of the problem often proves to be the more difficult. Medications such as Zyban or Chantix seem to be helpful. Support groups can be helpful. Some have even advocated hypnosis as an adjunct in managing this situation. It is not appropriate to substitute “nerve pills” or alcohol for the nicotine in a misguided effort to make the smoking cessation easier. The same susceptibility that allows dependence on nicotine will cause problems with other substances, as well.
The physical side, though sometimes more dramatic, can actually be easier to address. If one has the willpower to walk away from nicotine for a week, the physical part is over. If not, then nicotine gum or patches can be used to “wean” the daily dose and help avoid the withdrawal symptoms.
As difficult as the process may be, it is entirely worthwhile. Your body and your family will thank you – not to mention your bank account!
Thomas L. Horton, MD