Smoking Cessation

SMOKING CESSATION A REASON TO QUIT.

COURSE OBJECTIVES:

On completion of this course the student will have a greater understanding of the hazards of cigarette smoking, its fatal consequences, and their role as an individual and health professional.

LEARNING OBJECTIVES:

  1. The student will be able to describe the physiological process and progression of cigarette smoking and be able to educate their patients.
  2. The student will have a verbal knowledge of currant statistics and its relationship to the increasing numbers of patients with related diseases.
  3. The student will have a verbal knowledge and be able to identify the diseases related to smoking .
  4. The student will have a verbal knowledge of the dangers in smoking while pregnant and the effects of second hand smoke & be able to educate other people.
  5. The student will have a verbal knowledge of the addiction potential of cigarettes & will be able to offer knowledge and support to other people.
  6. Student will be able to identify at least 3 important tools used when quitting cigarettes & staying quit.

INTRODUCTION:

Cigarette's are one of the deadliest drugs known to man, one of the hardest habits to quit, right next to heroin. The verdict is in, we know cigarettes will kill you. We have known this for over a hundred years; this is confirmed by the following article. There is no escaping the fact. So lets all quit. Yeah Right!

Why isn’t it easy to quit when we know cigarettes will kill us ?

In 1895, physician R. V. Pierce wrote,

“Tobacco, itself, when its use becomes habitual and excessive, give rise to the most unpleasant and dangerous pathological conditions. Oppressive torpor, weakness, or loss of intellect, softening of the brain, paralysis, nervous debility, dyspepsia, functional derangement of the heart, and diseases of the liver and kidneys are not uncommon consequences of the excessive employment of this plant.
A sense of faintness, nausea, giddiness, dryness of throat, trembling, feelings of fear, disquietude, and general nervous prostration must warn persons addicted to this habit that they are sapping the very foundation of health."

ANATOMY AND PHYSIOLOGY

Every body system is effected, each and every time we inhale the smoke of a cigarette..

Lets look at a few examples.

The brain- receives less oxygen due to the constriction of the blood vessels carry blood to and from. This deprives the brain cells of there needed nutrients and oxygen supply. The dizziness one may feel when they first start, or restart smoking is a direct result of a decrease in oxygen to their brain.

Nicotine, which is one of the main and most addicting parts of the cigarette, is a substance that is responsible for fooling your brain into releasing a “pleasure” chemical called,” dopamine. Nicotine receptors on the nerve endings, ( Synapse), receive the Dopamine and create, “Happy,” nerve cells.

It is Dopamine that gives you a false sense of well-being, and soon the body wants more and more Dopamine, if this happens on a regular schedule, it is no longer a desire; it is a NEED; an ADDICTION !

The eyes- They also do not receive the needed blood supply with each inhalation of a cigarette, this can affect the retina, which affect the vision.

The mouth- this is a wonderful place to harbor cancer cells, and provide a nice yellow tint to the teeth, which is caused by the large amount of nicotine.

The throat (trachea) - The smoke must travel up and down the airway, leaving behind many toxins, allowing cancer cells to harbor here also. The voice box, (larynx), may become involved and than a person becomes dependent on a small box to vibrate their words for the rest of their lives.

The bronchial tree to bronchioles- This is where we have fine hairs called cilia, these fine hairs help cleanse the lung by moving trapped particles. In the smoker the cilia lay down, no movement, no help; the nicotine paralyzes them. So all the unwanted materials stay in the lungs, in a moist dark warm place, to grow all kinds of bacterium.

The Alveoli- these are well designed grape like clusters found at the bottom of each of our lungs; they have an elastic quality to them and they assist in the inhalation, exhalation, and air exchange in the lungs. In with the good air, (O2), out with the bad,(C02). In smokers the elasticity blows itself out and it causes a disease call emphysema. When this occurs there is no returning; and to exhale a single breath becomes a huge chore. Life changes drastically and there is no return!

The stomach- The stomach is affected again by decreased blood supply but also increased gastric juices..

The kidneys- Decreased blood flow from the inhalation of cigarette smoke leaves damage throughout the renal system.

The cardiovascular system- With each inhalation of smoke the blood vessels of the body constrict and stops blood flow to all areas of the body. As people get older their small capillaries diminish on there own; with cigarette’s constricting help, this happens a lot more and a lot quicker. Numb toes, fingers, tingling, and a burning sensation to toes and fingers can also occur.

STATISTICS

  1. Tobacco is the single greatest cause of premature death in America today.
  2. Cigarette smoking kills over 430,000 people each year in the United States.
  3. 90% of all lung cancer are caused by Cigarettes
  4. There is a 50% higher risk of developing mouth cancer, if you chew.
  5. Financial costs to the USA each year 100 billion dollars in health care and loss of productivity.
  6. Most current smokers began around 16 years of age.
  7. Seventy % of smokers say they would like to quit smoking, but only one half of those have ever been encouraged by their MD’s.
  8. A lot of patients in the hospital have one thing in common, they use to smoke or they do smoke.

There are over 4,000 chemicals in cigarette tobacco. There are 43 known carcinogens. The lung of a person who smokes 20 to 60 regular tar cigarettes daily, collects an annual deposit of one-quarter to one and a half pounds of gooey black material to their lungs.

Within the thousands of chemicals you will find things that kill plant's, things that kill rats, and most of all that will kill you. When you combine these chemicals together you’re chances of continued health is poor.

WHY DO PEOPLE SMOKE?

We hear all the dangers related to cigarette smoking, so why do people smoke ?

  1. Crutch- About 30 % of smokers say they use cigarettes in times of stress, pressure, discomfort, fear and other similar feelings.
  2. Craving- 25 % of smokers said they use cigarettes constantly, and are always aware of their need for a cigarette. These people need to stop cold turkey and may benefit from the gum or the patch. The cravings may last longer for these smokers but they will lessen.
  3. Relaxation- 15 % of smokers get actual pleasure from their cigarettes. They often smoke after meals, as a reward.
  4. Stimulation- 10 % said their cigarette “jump started” them in the morning, no food, low blood sugar, just coffee and cigarettes.
  5. Handling- 10 % said they enjoy playing with their cigarette and it gave them something to do with their hands.
  6. Habit- 10 % (I question this one, I believe this percentage is much higher). These smokers receive little satisfaction from smoking, they smoke out of habit.

The Bottom Line; Smoking is a powerful habit, it is a learned behavior, it becomes an automatic. It often becomes a triggered behavior. Smoking gives the smoker almost instant gratification.

THE FOUR STAGES OF QUITTING and THEIR COMPONENTS.

1.) Hanging on: This involves pre-contemplation; no reason to change, resist change, DENIAL is present.

2.) Letting go: This can have several components.

First component- contemplation: To think of the possibility of change; maybe open to “giving up” behaviors, but still no strong desire to change. Second component- Desire: The individual WANTS to change and may seek the magic potion or may talk about it a lot, but is still ambivalent. Third component- Action: One begins to DO something. They take specific steps and actions to change, they begin to learn, and practice new behaviors. Third component- Maintenance: This is the most difficult and involves practice and maintenance of new behaviors. The individual is engaged in change and struggles with cravings. A person may slip or they may relapse .

3.) Starting over: This can be the second half of maintenance, or a slip; temporarily reverts, feels guilty, remembers goal, and accepts self- response-ability.” Reclaims change, learns lesson!!!!!

4.) Restabilizing: A slip can fall under this heading, as well as relapse. One reverts or forgets their course and becomes discouraged. Externalizes blame, powerless, helpless, and hopeless; experiences shame, they may not attempt change again soon.

STAGES OF LOSS, By Elisabeth Kubler-Ross’ Loss Theory..

This refers to loss of any kind, and can be used in many situations, it fits quite well with the intense feeling of loss from nicotine. “A Best Friend “.

Denial: Our minds have a way of protecting us from a sudden loss or change. Some people say they feel numb in this stage; this is a psychological defense mechanism, and all mentally healthy people have these. They know how bad cigarettes are yet they deny it to themselves.

Anger: When we begin to accept a loss we often feel angry. When we think about having to lose or change we become angry. Resentment and irritability = anger.

Bargaining : Making a deal. I will only smoke some times; or in a sad case to little to late, if my cancer goes a way I’ll quit.

Depression: When we lose something we feel an emptiness, and it causes us to become depressed. When something or someone we are used to having around all the time and now it is gone, it is depressing.

Acceptance: A healthy person who has suffered a loss eventually accepts its reality, and life goes on. This is a wonderful stage to reach.

These stages are very real and you can adapt them to many areas in your life, from the loss of a loved one to losing your car keys. Here we are relating it to cigarettes, they are a loss, and one of the hardest many people may ever face. These stages do not follow an order, and once you reach one doesn’t mean you will never go back to that stage again. People are individuals, the way a person goes through these stages is up to them, but just be there for them, help them reach acceptance.

Some Excuses:

It won’t happen to me.

I don’t smoke enough to hurt me.

It’s too hard for me to quit, I will never make it.

I will just smoke light cigarettes.

It relaxes me.

I will gain weight if I quit.

Air pollution is just as bad.

I have smoked so long now, what is the point?

We can use all the excuses and reasoning we want, but it all lead to:

DISEASES RELATED TO CIGARETTE SMOKING

COPD- Chronic Obstructive Pulmonary Disease. 82 % caused by cigarettes. This covers a lot of long term pulmonary disease’s; EMPHYSEMA (destruction of the alveoli with over inflation. Loss of elasticity and decreased gas exchange.) ASTHMA (wheezing on expiration/inspiration caused by constriction of bronchi. CHRONIC BRONCHITIS (Inflammation, irritation, infection of the bronchial tubes.).. End stages of these disorders, are very life constricting. Medications, Oxygen, fatigue, and anxiety RULE ONE’S LIFE..

Hypertension, Stroke, Heart Attack- All of these are in the cardiovascular system. These are all affected by smoking. With each inhalation of smoke, vessels constrict, blood doesn’t get to the needed areas. You end up with blood pushing too hard to get through (Hypertension). Blood not getting through to the brain, causing cell death, stroke. Blood not getting to the heart muscle, causing chest pain (angina) and cell death (heart attack). We touched lightly before on the many other diseases associated with cigarette smoking. The renal system, the GI system, and so on. There is no cell in the entire body that is not affected by smoke. When I refer to smoke, this smoke comes from tobacco, it can be in a rolled cigarette form, a pipe , second hand smoke, through the placenta, even in a form of chew. Tobacco kills. Second hand smoke is just as dangerous as first hand smoke; some scientists say it is worse. It is not fair to you or to children to inhale other peoples smoke.

Pregnant women think the baby is not being affected by their smoking, yet with each inhalation their vessels constrict, cutting off blood supply to the unborn child; this cuts off their nutrients and oxygen, with each drag. It has been shown that babies born to mothers who smoke have a lower birth rate, and all around lower apgar scores.

LETS QUIT, BUT HOW?

Set a date, and say it each time you smoke, on that day don’t pick up.

Wean your self off, this allows the nicotine level to gradually drop.

Join a support group.

Reward yourself frequently, this is the hardest thing you may ever do.

Consult your doctor regarding; Medication- bupropion ( Zyban/Wellbutrin. Nicotine gum, A nicotine inhaler, A nicotine nasal spray, Nicotine patches. 10 Tips for the first week;

1.) Drink a lot of liquids, especially water (try teas or juices, avoid coffee)

2.) Avoid sugar and fatty foods. Try low calorie foods for snacking.

3.) Exercise regularly and moderately.

4.) Get more sleep.

5.) Deep breathe, Distract your self when the craving hits, it will only last about 10 seconds.

6.) Change your habits, use different route to work, eat breakfast in a different place.

7.) Do something to reduce your stress, take a hot bath, read a book.

Psychological Needs;

1.) Remind yourself daily why you’re quitting.

2.) Avoid places you associate with smoking.

3.) Develop a plan for relieving stress.

4.) Listen to relaxing music.

5.) Watch a funny movie.

6.) Go for a walk.

7.) Ask God for Help. 11

I feel it is a doctor's obligation to ask his patients “Do you smoke?”, and “Do you want to quit?”, and then work with them on quitting.

Staying free from smoking for good will be much easier if the person sees themselves as a NONSMOKER.

Remember to be loving and supportive to your patient, family or friend who is going through one of the hardest things they have ever done. They might get a bit stressed, act a bit silly, but it gets better. You will help them give quality back to there lives.. Sitting around for the second half of your life stuck to a 02 machine doesn't sound like a way of life any of us wish on anyone.. You can make a difference.

For many people, quitting is only a part of the changes they are making in their life. It can be the hardest, but remember if you can conquer this one, you can conquer just about any thing..

The smoker needs to know what a gift this is to them and to all of those who love them,, they are giving themselves the best present they ever could of imagined.. “LIFE”

Thank You and God Bless You.

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