Transcript Tobacco Addiction - Southeast Missouri State University

Tobacco
Addiction
NS184
K Farwell, PhD, RN, CARN-AP
Statistics
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An estimated 66.5 million Americans reported current use
(past month use) of a tobacco product in 2001, a prevalence
rate of 29.5 percent for the population aged 12 or older.
Among that same population, 56.3 million (24.9 percent of the
total population aged 12 or older) smoked cigarettes, 12.1
million (5.4 percent) smoked cigars, 7.3 million (3.2 percent)
used smokeless tobacco, and 2.3 million (1.0 percent)
smoked tobacco in pipes (Figure 4.1). Between 2000 and
2001, the percentage reporting past month cigar smoking
increased from 4.8 to 5.4 percent, which was similar to the
rate reported in 1999 (5.5 percent). There were no other
significant changes in the rates of current use of other
tobacco products.
Source: .S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2002,
September 4). Results from the 2001 National Household Survey on Drug Abuse: Volume I. Summary of National Findings
Potency
 Nicotine
is:
1000 X more potent than alcohol
 10-100 X more potent than barbiturates
 5-10 X more potent than cocaine or
morphine
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Aspects of Nicotine Addiction
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Physiological Dependence
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Psychological Dependence
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Tolerance, dependence, & withdrawal
Stimulation,  tension, craving, habit, relaxation
Socio-cultural Factors
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Tied to rituals, select activities, family of origin,
and cultural practices
Body’s Response to Smoking
(within 7-10 seconds)
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Short-term  bp
Short-term  pulse
Short-term  blood flow from heart
Causes arteries to narrow
Carbon monoxide,  oxygen
Acts on reward center in the brain
Neurotransmitter Effects
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Dopamine: Pleasure, suppress appetite
Norepinephrine: Arousal, suppress appetite
Acetylcholine: Arousal, cognitive enhancement
Vasopressin: Memory improvement
Serotonin: Mood modulation, suppress appetite
Beta-endorphin: Reduce anxiety / tension
How long does nicotine stay in
the body?
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From 85– 90 percent of nicotine in the blood is
metabolized by the liver and excreted from the
kidney rapidly.
The estimated half-life for nicotine in the blood is
two hours. However, smoking represents a
multiple dosing situation with considerable
accumulation during smoking.
Therefore, it can be expected that blood
nicotine would persist at significant levels for six
to eight hours after smoking stopped
Increased Risk of Heart Attack
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Carbon monoxide may damage the inner walls of
the arteries, encouraging fatty buildups in them.
Over time, this causes the vessels to narrow and
harden. Nicotine may also contribute to this
process.
Smoking also causes several changes in the
blood that make clots — and heart attack — more
likely.
Lung Comparison
Lung: Smoking Pack
Per Day
Lung: After 90
Days Smoke Free
About Secondhand Smoke:
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Cigarette smoke hurts many more people than
just the smoker. Children under the age of one
whose parents smoke are more than 2 times as
likely than children of nonsmokers to suffer
asthma, bronchitis, pneumonia, and other
respiratory tract illnesses
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Source: Committee on Passive Smoking, Board of
Environmental Studies and Toxicology, National Research
Council. (1986). Environmental tobacco smoke:
Measuring exposures and assessing health effects.
Washington, DC: National Academy Press.
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A child’s lung tissue is especially vulnerable to
damage, even when the concentration of
secondhand smoke is relatively low
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Source: Pedreira, FA, Guandolo, VL, & Feroli, EJ. (1985).
Involuntary smoking and incidence of respiratory illness during the
first year of life. Pediatrics. 75, 594-595.
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This means that smoking in a car, even with the
windows open, is still dangerous to a child. The
younger the child, the more vulnerable the lung
tissue
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Source: Guyatt, GH, & Newhouse, MT. (1985). Are active and
passive smoking harmful? Determining causation. Chest, 88,
445-451.
Alcohol Use & Smoking
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per person, smokers drink about twice as much alcohol as
non-smokers
people who drink heavily are more likely to smoke heavily too
reducing drinking helps people quit smoking?
quitting smoking helps with sobriety among alcoholics
relapse to drinking may cause smoking relapse
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Source: National Institute on Alcohol Abuse and
Alcoholism. Alcohol Alerts. No. 39: Alcohol and Tobacco. Site
accessed
11/1/01. http://www.niaaa.nih.gov/publications/aa39.jtml
The Big Three Health Benefits
Of Quitting
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Greatly reduced risk of premature death:
Quitting lowers your risk of dying early by 50%
within 5 years of quitting. After 15 years the risk is
the same as if you had never smoked
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Source: Benowitz, N.L. (1996). Pharmacology of
nicotine: addiction and therapeutics. Annual Review of
Pharmacology and Toxicology, 36, 597-613.
Reduced risk of lung cancer, emphysema,
and bronchitis:
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Your risk of lung cancer drops by 30%-50% after 10
years of being smoke-free. The longer you stay
quit, the lower the risk. If you’ve begun to develop
emphysema and or chronic bronchitis, quitting will
essentially stop the progression of the disease and
allow your respiratory system to compensate for
damaged tissue.
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Source: Benowitz, N.L. (1996). Pharmacology of
nicotine: addiction and therapeutics. Annual Review
of Pharmacology and Toxicology, 36, 597-613.
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Reduced risk of coronary heart disease:
The potential for smoking-related heart disease is
cut in half one year after quitting. Within 15 years
the risk is the same as that of someone who
never smoked
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Source: American Lung Association. What are the benefits
of quitting smoking? Site accessed 11/1/01.
http://www.lungusa.org/tobacco/quit_ben.jtmll
Quitting Cold Turkey
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91.2% of all successful long-term quitters
are today quitting entirely on their own
They have done so without using Zyban,
Wellbutrin, hypnosis, acupuncture, magic
herbs, and without toying with any gradual
nicotine weaning products like the patch,
gum, lozenge, spray, or inhaler.
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Source: Cancer Facts & Figures 2003
Possible Withdrawal
Symptoms
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irritability
anger
hostility
anxiety
nervousness
panic
poor concentration
disorientation
lightheadedness
sleep disturbances
constipation
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mouth ulcers
dry mouth
sore throat-gums- or tongue
pain in limbs
sweating
depression
fatigue
fearfulness
sense of loss,
craving tobacco –May persist for 6
months or longer
hunger
coughing
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(body getting rid of the mucus clogging
the lungs).
100% Nicotine Free for 72
Hours:
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Blood is now 100% nicotine-clean
90% of nicotine's metabolites have passed
through their urine
Chemical withdrawal has peaked in intensity and
is now beginning to gradually subside.
Any nicotine use at this point constitutes chemical
relapse that will require them to repeat nicotine
detox all over again
If you had stopped smoking last
week, you would have already:
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Lowered your blood pressure and pulse
Normalized your carbon monoxide and oxygen levels in your
blood
Decreased your chances of having a heart attack
Improve your sense of taste and smell
Increased your lung capacity
Made your breathing easier
Improved your circulation
Began the process of your lungs cleaning themselves
Reduced your coughing
Increased your energy level
Quitting
Interventions
Source for information:
Accessed 2/10/06 at
http://www.quitnet.com/library/guides/Quitnet/B/getting_r
eady.jtml#methodsofquitting
Nicotine Replacement Therapy
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On average, all nicotine replacement
products are equally effective, roughly
doubling the chances of quitting
successfully
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NRT minimizes withdrawal symptoms and
helps control cigarette cravings to allow you
to concentrate on using behavioral
techniques to stay smoke-free
4 different types of nicotine
replacement therapies
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nicotine patch
nicotine gum
nicotine spray*
nicotine inhaler*
*Require prescription from your physician
What NRT does not do
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It doesn't work equally well for everyone.
It doesn't eliminate withdrawal symptoms
entirely.
It doesn't give you any more willpower.
What NRT does do:
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It does let you concentrate on your habit
before breaking the physical addiction to
nicotine.
Medication: Zyban:™
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Zyban is a prescription medication that was
originally used to treat depression
Zyban is at least, if not more, effective than
the nicotine patch
Zyban is thought to work by blocking
nicotine withdrawal, making smoking less
reinforcing by stimulating certain centers of
the brain, and improving mood.
Other Quitting Aids:
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Counseling – Individual or Group, Telephone or Internet
Support and Self-Help Groups
Nicotine fading:
Rate fading and brand fading are two strategies of gradually
reducing the amount of nicotine in your system before you
quit. They are different than the approach of cutting back
since the ultimate goal is quitting, not continued smoking at a
lower level. Smoking fewer cigarettes and smoking low
nicotine cigarettes are still hazardous to your health.
Note: Naltrexone (Trexan) is NOT used to help people quit
smoking----it must have been my wishful thinking!
Nicotine Anonymous
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Non-Profit 12 Step Fellowship of men and women
helping each other live nicotine-free lives.
Welcomes all those seeking freedom from
nicotine addiction, including those using cessation
programs and nicotine withdrawal aids.
The primary purpose of Nicotine Anonymous is to
help all those who would like to cease using
tobacco and nicotine products in any form.
The Fellowship offers group support and recovery
using the 12 Steps as adapted from Alcoholics
Anonymous to achieve abstinence from nicotine.
Helpful Nicotine Links
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http://www.quitnet.com/libr
ary/guides/Quitnet/B/gettin
g_ready.jtml#methodsofqu
itting
http://www.nlm.nih.gov
/medlineplus/smoking.
html
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http://www.nicotineanonymous.org/
http://www.nida.nih.go
v/researchreports/nico
tine/nicotine.html