Transcript Wellness (IL 50+)

Breaking the Chain of Addiction:
Strategies to End Nicotine Dependence
“Quitting smoking is the
easiest thing in the
world. I know because I
have done it a thousand
times.”
Mark Twain
Discussion Topics for Today
• What is Nicotine?
• Understanding the Addictive Forces of Nicotine
– Nicotine and the Brain
– The Nicotine Addiction: Biological, Psychological and the
Social Addiction
• Breaking Free from the Nicotine Addiction: The Five
Roadblocks to Success
• Taking the Next Step to Nicotine Independence
What is Nicotine
Nicotine
• Nicotine is the addictive substance found in tobacco.
• It is a naturally occurring colorless or yellowish liquid that turns brown
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when burned and takes on the odor of tobacco when exposed to air.
The amount of nicotine which occurs in tobacco leaves ranges from
2% to 7%.
There are many species of tobacco plants, the tabacum species is the
major source of today's tobacco products.
It acts as a stimulant and is mainly responsible for the dependenceforming properties of tobacco smoking.
Nicotine is used in insecticides.
It is considered poisonous and highly addictive drug by the FDA.
Did You Know?
The cigarette is a highly engineered drug-delivery system.
Inhaling cigarette smoke produces a rapid distribution of nicotine to the
brain.
The drug levels peak within 10 seconds in the brain.
Acute affects dissipate within minutes, causing the smoker to continue
frequent dosing throughout the day.
The average smoker takes 200-300 boluses to the brain per day."
Sources: Am J of Medicine, 2009; Centers for Disease Control 2010
“Let’s face facts: Cigarette smoke is biologically
active. Nicotine is a potent pharmacological
agent. Every toxicologist, physiologist, medical
doctor and most chemists know that. It’s not a
secret”.
Source: Memo by Phillip Morris, October 1982; Congressional Panel on Tobacco, 1985
The Addictive Forces of Nicotine
How Does Nicotine Affect the
Brain?
• Nicotine mimics neurotransmitters: Acetylcholine and
Dopamine
• Acetylcholine
– Heart Rate
– Muscle Movement
– Cognition
• Dopamine
– Pleasure
– Reward Pathway
Biology of Nicotine Addiction, 2009
Dopamine Cycle
Dopamine theory:
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Addicts become accustomed to the high levels of dopamine
Dopamine plays an important role in regulation of pleasure
Over time, the brain develops a tolerance to nicotine
The body needs more and a continual supply of nicotine to have
the release of dopamine
The cycle repeats
Trapped by Nicotine
Nicotine
Addiction
(Biological)
Habit
(Social/Psychological)
Nicotine Habit
• Tobacco use can be an habit
– Automatic behavior
– May not even realize they are smoking or chewing
• Habits are usually linked to other habits
• Individuals can feel emotionally trapped by nicotine
– May feel lonely
– Tobacco may be their “best friend”
– Reliance
Breaking the Chain of Addiction
Did You Know…
According the Centers for Disease Control and
Prevention, seventy percent of smokers wish to stop
smoking while 13 million adult smokers (about 40%)
have quit for at least a day in the past year. About 50
million adults were successful in efforts to quit and
considered themselves former smokers in 2010.
Centers for Disease Control and Prevention, 2011
5 R’s:
Roadblocks to Living Nicotine Free
There are five common reasons often cited by tobacco users
for not attempting to break the addiction to nicotine
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5.
Fear - withdrawal and relapse
Negative moods
Being around other tobacco users
Triggers and cravings
Time pressures
Source: ALA, 2006, CDC, 2008
Roadblock Number One: Fear
Fear is the most common reason cited by tobacco dependent
individuals for not attempting nicotine withdrawal.
The two areas most associated with fear are:
»Withdrawal symptoms
»Failure/Relapse
Possible Nicotine Withdrawal
Symptoms
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Cravings
Physical discomfort
Depression
Insomnia
Irritability, frustration, anger
Anxiety, nervousness
Difficulty concentrating
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Increased appetite
Desire to smoke
Cravings for tobacco
Change in bowel habits
Fatigue
Cough, dry throat, nasal drip,
clearing throat
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Coping Skills for Withdrawal
The Five D's
Delay until the urge passes - usually 3 - 5 minutes
Distract yourself. Call a friend or go for a walk.
Drink water to fight off cravings.
Deep breaths - Relax! Close your eyes and take 10 slow,
deep breaths
Discuss your feelings with someone close to you or with in a
social support network.
Source: ACS, 2007
Dealing with Withdrawal
• Nicotine Replacement Therapy (NRT) can help lessen withdrawal
symptoms.
• The FDA has approved seven NRT's to assist with nicotine
dependence.
Over-the-counter NRTs
Prescribed Medications
Nicotine gum
Nicotine lozenge
Nicotine patch
Nicotine nasal spray
Bupropion
Varenicline tartrate (Chantix)
Relapse
• Adding psychosocial counseling can be helpful when
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addressing fears of relapse.
The greatest success rates are seen in a combination of
psychosocial counseling and the use of nicotine
replacement therapies.
Prepare for the potential “slips” when first attempting to
break the nicotine addiction.
Seek our support groups and social networks
Build your personal belief system and visualize yourself
free of nicotine.
Successful Addiction Quit Rates
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Quitting without any form of assistance:
Clinician advice to quit:
Pharmacological Treatment (NRTs) only:
Telephone/group counseling only:
Combination of Pharmacological and Counseling:
3%
5 - 10%
20 - 25%
20 -30%
75 - 90%
"The most effective method to break the tobacco dependence cycle
is a combination of
nicotine replacement therapies (NRTs)
and psychosocial counseling."
Source: American Journal of Psychology, 2008
Roadblock Number Two:
Negative Moods
• Biological action happening with the elimination of nicotine
• Dopamine is not being released; no feeling of pleasure.
• Feelings of anxiety, depression or nervousness can occur.
Coping with negative moods or thoughts:
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Suck on hard candy
Engage in physical activity
Express yourself (journaling, write, talk)
Relax
Think about pleasant, positive things
Ask others for support
Roadblock Number Three:
Other Tobacco Users
Breaking the addiction can be difficult if others around you
continue to use tobacco.
When you cannot avoid the tobacco, here are some
suggestions to help you cope:
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Ask a friend or relative to quit with you
Ask others not to smoke around you
Assign nonsmoking areas
Leave the room when others smoke
Keep hands and mouth busy
Roadblock Number Four:
Triggers and Cravings
Remember the Five D's when cravings hit hard
• Delay – remind yourself the reasons for quitting
• Cravings will lessen within a few weeks
• Anticipate “triggers”: coffee breaks, social gatherings, being on
the phone, waking up
• Change routine—for example, brush your teeth immediately after
eating
• Distract yourself with pleasant activities: garden, listen to music
.
Roadblock Number Five:
Time Pressures
Number one reason a quit attempt fails is due to a
stressful event.
Two ways to deal with time pressures and stress are:
• Change your lifestyle to reduce stress and anxiety
• Increase physical activity
Are You Ready to Break the
Nicotine Addiction?
Am I Ready?
• Do I want to quit?
• Have I tried to quit before? What happened?
• Am I committed to trying to quit?
• Do I have a support system in place to assist
me?
• Will I be patient with myself and keep trying if I
slip?
Preparation Tips
Follow the START PLAN
S = Set a quit date.
T = Tell family, friends, and co-workers
A = Anticipate and plan for the challenges
R = Remove cigarettes and other tobacco products from home, car, and
work.
T = Talk to a doctor about getting help to quit.
Your "Break Free" Day
On Your Quit Day, follow these suggestions:
• Do not smoke. This means none at all -- not even one puff!
• Keep active -- try walking, exercising, or doing other activities or
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hobbies.
Drink lots of water and juices.
Begin using nicotine replacement if that is your choice.
Attend stop-smoking class or follow your self-help plan.
Avoid situations where the urge to smoke is strong.
Reduce or avoid alcohol.
Change your routine.
Celebrate the Break
Staying Quit: Adherence
To help avoid Relapse:
– Review reasons for quitting - benefits to health, finances,
and family.
– Remember there is no such thing as just one cigarette -or even one puff.
– Ride out the desire to smoke.
– Avoid old habits that are associated with tobacco alcohol.
– If you are worried about gaining weight, put some energy
into eating a healthy diet and staying active with exercise.
Recovering from a Slip
• Slip versus Relapse:
– Slip – one mistake; get back on track
– Relapse – what caused the relapse back to tobacco; what did I
learn from the quit attempt; know that you can always try again
– Living free from nicotine is possible
Some Helpful Resources
• BCBS Lifestyle Management
Programs:
Tobacco and Weight Management
Call 1.800.462.3275 to enroll
• Centers for Disease Control and
Prevention (CDC)
– www.cdc.gov
• American Lung Association (ALA)
– www.lungusa.org
• www.mytimetoquit.com
– (866) 330-0600
• National Network of Tobacco
Cessation Quit lines
– (800) 784-8669 or (800)
QUITNOW
• Quit Net
– www.quitnet.com
• American Heart Association (AHA)
– www.americanheart.org
• American Cancer Society (ACS)
– www.cancer.org
Experience. Wellness. Everywhere.
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