Smoking cessation means "to quit smoking," or "withdrawal from nicotine." Because smoking is highly addictive, quitting the habit often involves irritability, headache, mood swings, and cravings associated with the sudden cessation or reduction of tobacco use by a nicotine-dependent individual.
There are many good reasons to stop smoking; not the least is that smoking cessation may speed post-surgery recovery. Smoking cessation helps a person heal and recover faster, especially in the incision area, or if the surgery involved any bones. Research shows that patients who underwent hip and knee replacements, or surgery on other bone joints, healed better and recovered more quickly if they had quit or cut down their tobacco intake several weeks before the operation. Smoking weakens the bone mineral that keeps the skeleton strong and undermines tissue and vessel health. One study suggested that even quitting tobacco for a few days could improve tissue blood flow and oxygenation, and might have a positive effect on wound healing. If a patient has had a history of heart problems, his chances of having a second heart attack will be lowered. Quitting may also reduce wound complications, and lower the risk of cardiovascular trouble after surgery. If surgery was performed to remove cancerous tumors, quitting will reduce the risk of a second tumor, especially if cancer in the lung, head, or neck has been successfully treated.
Quitting smoking is one of the best things a person can do to increase their life expectancy. On average, male smokers who quit at 35 years old can be expected to live to be 76 years old instead of 69 years if they were still smoking. Women who quit would live to be 80 years old instead of 74 years.
Nicotine acts as both a stimulant and a depressant on the body. Saliva and bronchial secretions increase along with bowel tone. Some inexperienced smokers may experience tremors or even convulsions with high doses of nicotine because of the stimulation of the central nervous system. The respiratory muscles are then depressed following stimulation.
Nicotine causes arousal as well as relaxation from stressful situations. Tobacco use increases the heart rate about 10–20 beats per minute; and because it constricts the blood vessels, it increases the blood pressure reading by 5–10 mm Hg.
Sweating, nausea, and diarrhea may also increase because of the effects of nicotine upon the central nervous system. Hormonal activities of the body are also affected. Nicotine elevates the blood glucose levels and increases insulin production; it can also lead to blood clots. Smoking does have some positive effects on the body by stimulating memory and alertness, and enhancing cognitive skills that require speed, reaction time, vigilance, and work performance. Smoking tends to alleviate boredom and reduce stress as well as reduce aggressive responses to stressful events because of its mood-altering ability. It also acts as an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets) and inhibiting the efficiency with which food is metabolized. The fear of weight gain prevents some people from quitting smoking. The addictive effects of tobacco have been well documented. It is considered mood-and behavior-altering, psychoactive, and abusable. Tobacco's addictive potential is believed to be comparable to alcohol, cocaine, and morphine.
In general, chronic use of nicotine may cause an acceleration of coronary artery disease, hypertension, reproductive disturbances, esophageal reflux, peptic ulcer disease, fetal illnesses and death, and delayed wound healing. The smoker is at greater risk of developing cancer (especially in the lung, mouth, larynx, esophagus, bladder, kidney, pancreas, and cervix); heart attacks and strokes; and chronic lung disease. Using tobacco during pregnancy increases the risk of miscarriage, intrauterine growth retardation (resulting in the birth of an infant small for gestational age), and the infant's risk for sudden infant death syndrome.
The specific health risks of tobacco use include: nicotine addiction, lung disease, lung cancer, emphysema, chronic bronchitis, coronary artery disease and angina, heart attack, atherosclerotic and peripheral vascular disease, aneurysms, hypertension, blood clots, strokes, oral/tooth/gum diseases including oral cancer, and cancer in the kidney, bladder, and pancreas. Nicotine is also associated with decreased senses of taste and smell. During pregnancy, nicotine may cause increased fetal death, premature labor, low birth weight infants, and sudden infant death syndrome.
Nonsmokers who are regularly exposed to second hand smoke also may experience specific health risks including:
The specific health risks for smokeless tobacco users include many of the diseases of smokers, as well as a 50-fold greater risk for oral cancer with long-term or regular use.
In diabetics taking medication for high blood pressure, it has been reported that smoking may increase the risk of kidney disease and/or kidney failure.
Long lead times for elective procedures like joint operations offer a good opportunity for doctors to encourage their patients to quit smoking, but only the smoker has the power to stop smoking. Before a smoker decides to quit, he should make sure he wants to quit smoking for himself, and not for other people. The following are some questions as well as some suggestions the smoker may want to consider:
Smokers who are trying to quit should remind themselves that they are doing the smartest thing they have ever done. Because of the preparation for smoking cessation, the smoker won't be surprised or fearful about quitting. The quitter will be willing to do what's necessary, even though it won't be easy. Remember, this will likely add years to the lifespan. The quitting smoker should be prepared to spend more time with nonsmoking friends, if other smokers don't support the attempt to quit.
Since hospitals are smoke-free environments, if a smoking patient is in the hospital for elective surgery , it may be a good opportunity to quit smoking. It might be best to set the quit date around the time of the surgery and let the attending doctor know. As the smoker takes the first step, professional hospital staff will be there to give the support and help needed. Medical staff can start the patient on nicotine replacement therapy to help control the cravings and increase the chances of quitting permanently.
Cold turkey, or an abrupt cessation of nicotine, is one way to stop smoking. Cold turkey can provide cost savings because paraphernalia and smoking cessation aids are not required; however, not everyone can stop this way as tremendous willpower is needed.
Laser therapy is an entirely safe and pain-free form of acupuncture that has been in use since the 1980s. Using a painless soft laser beam instead of needles the laser beam is applied to specific energy points on the body, stimulating production of endorphins. These natural body chemicals produce a calming, relaxing effect. It is the sudden drop in endorphin levels that leads to withdrawal symptoms and physical cravings when a person stops smoking. Laser treatment not only helps relieve these cravings, but helps with stress reduction and lung detoxification. Some studies indicate that laser therapy is the most effective method of smoking cessation, with an extraordinarily high success rate.
Acupuncture—small needles or springs are inserted into the skin—is another aid in smoking cessation. The needles or springs are sometimes left in the ears and touched lightly by the patient between visits.
Some smokers find hypnosis particularly useful, especially if there is any kind of mental conflict, such as phobias, panic attacks, or weight control. As a smoker struggles to stop smoking, the conscious mind, deciding to quit, battles the inner mind, which is governed by habit and body chemistry. Hypnosis, by talking directly to the inner mind, can help to resolve that inner battle.
Aversion techniques attempt to make smoking seem unpleasant. This technique reminds the person of the distasteful aspects of smoking, such as the smell, dirty ashtrays, coughing, the high cost, and health issues. The most common technique prescribed by psychologists for "thought stopping"—stopping unwanted thoughts—is to wear a rubber band around the wrist. Every time there is an unwanted thought (a craving to smoke) the band is supposed to be pulled so that it hurts. The thought then becomes associated with pain and gradually neutralized.
Rapid smoking is a technique in which smoking times are strictly scheduled once a day for the first three days after quitting. Phrases are repeated such as "smoking irritates my throat" or "smoking burns my lips and tongue." This causes over-smoking in a way that makes the taste and sensations very unpleasant.
There are special mouthwashes available, which, when used before smoking, alter the taste, making cigarettes taste awful. The aim is for smoking to eventually become associated with this very unpleasant taste.
Smoking cessation aids wean a person off nicotine slowly, and the nicotine can be delivered where it does the least bodily harm. Unlike cigarettes, they do not introduce other harmful poisons to the body. They can be used for a short period of time. However, it should be noted that nicotine from any source (smoking, nicotine gum, or the nicotine patch) can make some health problems worse. These include heart or circulation problems, irregular heartbeat, chest pain, high blood pressure, overactive thyroid, stomach ulcers, or diabetes.
The four main brands of the patch are Nicotrol, Nicoderm, Prostep, and Habitrol. All four transmit low doses of nicotine to the body throughout the day. The patch comes in varying strengths ranging from 7 mg to 21 mg. The patch must be prescribed and used under a physician's care. Package instructions must be followed carefully. Other smoking cessation programs or materials should be used while using the patch.
Nicorette gum allows the nicotine to be absorbed through the membrane of the mouth between the cheek and gums. Past smoking habits determine the right strength to choose. The gum should be chewed slowly.
The nicotine nasal spray reduces cravings and withdrawal symptoms, allowing smokers to cut back slowly. The nasal spray acts quickly to stop the cravings, as it is rapidly absorbed through the nasal membranes. One of the drawbacks is a risk of addiction to the spray.
The nicotine inhaler uses a plastic mouthpiece with a nicotine plug, delivering nicotine to the mucous membranes of the mouth. It provides nicotine at about one-third the nicotine level of cigarettes.
Zyban is an oral medication that is making an impact in the fight to help smokers quit. It is a treatment for nicotine dependence.
The nicotine lozenge is another smoking cessation aid recently added to the growing list of tools to combat nicotine withdrawal.
Generally, the longer one has smoked and the greater the number of cigarettes (and nicotine) consumed, the more likely it is that withdrawal symptoms will occur and the more severe they are likely to be. When a smoker switches from regular to low-nicotine cigarettes or significantly cuts back smoking, a milder form of nicotine withdrawal involving some or all of these symptoms can occur.
These are some of the withdrawal symptoms that most ex-smokers experience in the beginning of their new smoke-free life:
These side effects are all temporary conditions that will probably subside in a short time for most people. These symptoms can last from one to three weeks and are strongest during the first week after quitting. Drinking plenty of water during the first week can help detoxify the body and shorten the duration of the withdrawal symptoms. A positive attitude, drive, commitment, and a willingness to get help from health care professionals and support groups will help a smoker kick the habit.
Researchers from the University of California San Diego strongly suggest that any of the above cessation aids should be used in combination with other types of smoking cessation help, such as behavioral counseling and/or support programs. These products are not designed to help with the behavioral aspects of smoking, but only the cravings associated with them. Counseling and support groups can offer tips on coping with difficult situations that can trigger the urge to smoke.
Why do some people who have heart transplants continue to smoke? In a three-year study at the University of Pittsburgh of 202 heart transplant recipients, 71% of the recipients were smokers before surgery. The overall rate of post-transplant smoking was 27%. All but one of the smokers resumed the smoking habit they had before the transplant. The biggest reason for resuming smoking was addiction to nicotine. Smoking is a complex behavior, involving social interactions, visual cues, and other factors. Those who smoked until less than six months before the transplant were much more likely to resume smoking early and to smoke more. One of the major causes of early relapse was because of depression and anxiety within two months after the transplant. Another strong predictor of relapse was having a caretaker who smoked. The knowledge of these risk factors could help develop strategies for identifying those in greatest need of early intervention. According to European studies, the five-year survival rate for post-transplant smokers is 37%, compared to 80% for nonsmoking recipients. Smokers can develop inoperable lung cancers within five years after a transplant, thus resulting in a shorter survival rate. There is an alarming incidence of head and neck cancers in transplant recipients who resume smoking.
Overall, there is a 90% relapse rate in the general population but, the more times a smoker tries to quit, the greater the chance of success with each new try.
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Crystal H. Kaczkowski, M.Sc.