Great American Smokeout 2013

Cindy* walked into my clinic desperate to kick her three pack-a-day habit. The smoking was clearly affecting her health and finances. During our counseling session, I asked her for a list of five things she could do to combat cigarette cravings.  Cravings only last a few seconds to a few minutes, and we needed an easy “go to” list of activities to occupy Cindy’s hands and mind until the cravings subsided.   She came up with a couple of great ideas.  First, she was going to repaint her apartment, something she has always wanted to do for many years. Not only would that help stop her smoking, it would help freshen up her home and signal a new smoke-free beginning.  She also pledged to clean out her junk closet.  But the real breakthrough came when she bought a handheld video game system.  Instead of spending work breaks with coworkers who would smoke together, she played video games. It engaged both her mind and hands, so she forgot about smoking. Within 12 weeks, she had fully quit.

Today is the Great American Smokeout, a day promoted by the American Cancer Society to encourage smokers to make a plan to quit. The organization estimates about 1 in 5 adults smoke cigarettes.  That is more than 43 million Americans.  Another 15 million smoke cigars or pipes. Many are specifically addicted to nicotine, a main chemical ingredient in cigarettes.

In my experience, very few patients are able to quit cold turkey. Many need assistance from nicotine replacement products like patches, gum, or lozenges. Like many other products sold in pharmacies, the options can be overwhelming. In addition to receiving support from your family and friends to stop smoking, your pharmacist can be an invaluable resource to find the right kind of assistance that works for you. Furthermore, most patients who are able to successfully quit need a strong motivator driving their attempt to quit. Motivators commonly include strong desire for better quality of life, fear of developing cancer or cancer recurring, or financial difficulties.  I frequently inquire about a patient’s motivation for their quit attempt during the first five minutes of the counseling session. 

Since becoming involved with smoking cessation over the last four years, I have noticed a higher success rate with the patch. When a patient buys a box of gum or lozenges, there is a strong temptation to use too many in a 24-hour period when cravings strike. The temptation is often too much for my patients to control.  By design, the patch releases a dose of nicotine evenly throughout the day. Gum and lozenges are like short bursts of nicotine, so there are more highs and lows. No matter which product smokers choose, it doesn’t fully take away the cravings, and the first six weeks are the hardest. The cravings will usually subside significantly thereafter. 

I always think nicotine dependence is not simply a physical addiction. Depending on the patient, there can be a strong emotional and/or mental addiction to nicotine. I tell patients that the nicotine replacement products are not a cure. During our counseling sessions, we talk about triggers and why the patient started smoking in the first place. Thanks to some relatively new rules in Missouri, I’m able to prescribe the correct nicotine formulation to give the patient a better chance of quitting for good.

In the past few months, I’ve had several patients talk to me about e-cigarettes. They are battery-powered devices which look like cigarettes. Users inhale a vaporized mixture to simulate smoking. I’m not a fan for two reasons: it does not break the hand-mouth habit and activates all sorts of triggers; secondly, there are a lot of ingredients in e-cigarettes that we don’t know about. They could be just as bad as what is in paper cigarettes. Without stronger regulations, there are too many unknown risks with the use of e-cigarettes. 

My advice on how to stop smoking for good:

  1. Get help and support for this big step you’re taking in your life.
  2. Talk to a health care provider about nicotine replacement. All pharmacists, whether in clinics or community pharmacies, are equipped to help patients find and use the right products for you.
  3. Thoroughly clean your house and car on your quit day.  It will help mark a new start, remove some of the smoke smell, and also keep you busy so you’re less likely to give in to cravings.
  4. Break the hand to mouth cycle.  Think about buying a bag of sugar-free lollipops, flavored toothpicks, or sugar-free gum.

It’s never too late to quit. You will benefit from quitting no matter your age!  

*Name changed

About the author: Shin-Yu Lee, Pharm.D., assistant professor of pharmacy practice is also an ambulatory care pharmacist at an outpatient clinic in St. Louis.

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