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Tobacco
to the blood cells. Performing these activities could have a calming effect as well.
If you know someone else who would like to quit using tobacco products, it may be
a good idea to quit together. This way you could encourage each other throughout
the process. You can set goals for quitting and celebrate your accomplishments
together. This may even result in being able to break an addiction to nicotine
sooner than doing it alone.
The severity of nicotine cravings will likely depend on the amount of time you have
used tobacco and the frequency of its use. You may notice that nicotine withdrawal
symptoms become less intense as time goes on. With a persistent effort, you may
enjoy the health benefits and financial savings associated with being tobacco-free.
229
Nicotine Dependence
Tolerance to nicotine develops rapidly with 2 in 3 smokers demonstrating nicotine
dependence i.e. emergence of withdrawal symptoms when they attempt to stop
smoking.
Nicotine dependence can be assessed by asking two questions:
■ how many cigarettes do you smoke a day?
■ how long after you wake up do you have your first cigarette?
Those who smoke more than 15–20 a day and have their first cigarette within 30
minutes of waking are likely to be nicotine dependent and are also more likely to
benefit from pharmacotherapy to help manage nicotine withdrawal.
Nicotine Addiction
Nicotine addiction is a physical reaction of the body to repeated doses of nicotine.
It can also be seen as an emotional reaction that builds up over time in relation
to using the products that contain nicotine. A person with a nicotine addiction
may have a nearly uncontrollable urge to use products that contain nicotine, and
that need can come from both emotional and physiological processes. Nicotine
addiction is comparable to many other serious addictions when it comes to severity
and difficulty in quitting.
The mechanism behind physical addiction to nicotine is based on chemicals
released in the brain. When someone uses a nicotine product, like a cigarette, for
example, it causes a person’s body to release many brain chemicals, including one
called dopamine. This chemical can create feelings of euphoria in heavy doses.
Many other drugs cause a release of dopamine, including cocaine. The brain can
become dependent on dopamine, and eventually, there is a mental association
made between dopamine and the nicotine product, which often eventually leads
to a physical addiction.
230
When people suffer from this kind of addiction, their brains start producing a smaller
level of dopamine on a regular basis, so when they don’t have the nicotine product,
they will often feel bad. They may feel angry or depressed or nervous, and they
may even lash out at people around them. When they take the nicotine product,
their dopamine levels are generally raised, but only enough to reach a normal
level. This basically means that over time, nicotine addiction makes someone feel
chronically negative, and the only way to reach normality is with the nicotine. This
level of addiction happens gradually enough so that the smoker may not even be
aware of the effect.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://images.wisegeek.com/man-holds-cigarette.jpg
There is also a purely psychological level to nicotine addiction. People don’t only
become addicted on a chemical level. They also become dependent on the act
of taking the nicotine. For example, smokers often associate smoking with many
normal daily behaviors, like watching television or reading. When they quit, they
may feel like all their activities are missing something, and they may have difficulty
enjoying things for a while.
There are many approaches to dealing with nicotine addiction. Some people simply
stop using nicotine products and try to deal with the withdrawal. This can be quite
difficult, and some people can’t handle it. There are also drugs designed to lessen
nicotine cravings, and there are products such as patches that make it easier to
wean the body off from nicotine.
Nicotine Withdrawal Effects
Withdrawal effects start within several hours of the last cigarette, peak in the first
24–72 hours and resolve in 2–4 weeks.
Withdrawal symptoms include:
■ craving
■ irritability, restlessness, mood swings
Tobacco
■ increased appetite and hunger
■ sleep disturbances with resulting insomnia and fatigue
■ dizziness
■ anxiety and depression
■ difficulty concentrating
While withdrawal is relatively short lived, many smokers relapse in the first three days
and over half relapse in the first three months. A range of effective pharmacotherapies
are available to help smokers overcome nicotine withdrawal.
231
Psychological effects
Most psychological complications of smoking are a result of withdrawal from nicotine.
Symptoms of Nicotine Withdrawal
Symptoms arising from nicotine withdrawal can be physical and psychological.
In general, most people see a decrease in physical nicotine withdrawal symptoms
about 72 hours after last use of nicotine. Psychological symptoms can continue
for many months afterwards, which can often account for people beginning to use
nicotine again.
The physical symptoms of nicotine withdrawal in the first three days include cravings.
These cravings tend to last from three to five minutes, so it is possible to ride out a
craving. Distracting one’s self from the craving by engaging in some kind of activity
for a few minutes usually helps people get through a craving.
Those in nicotine withdrawal are frequently irritable, may have an exceptionally
“short fuse,” and may find handling ordinary stressors quite difficult. People in
nicotine withdrawal may also note difficulty concentrating and extreme fatigue. In
fact, when possible, fatigue can be a friend rather than enemy. Taking naps is a great
way to take a break from cravings. If possible, try to schedule smoking cessation
when one has a few days of uninterrupted rest, as on a weekend.
Nicotine withdrawal can cause a number of cold or flu-like symptoms. Some people
refer to these as smoker’s flu. This can include dry or sore throat, nasal congestion,
coughing, and tightness in the chest. Some people have headaches, and some may
suffer gastrointestinal symptoms like constipation, gas, or nausea during nicotine
withdrawal. Others may note soreness of the tongue and/or gums.
While some undergoing nicotine withdrawal may experience fatigue and find
sleeping quite easy, others may find it extremely difficult to sleep. Insomnia may be
aided by a few days of low dose sleep medication. Getting sleep during nicotine
withdrawal is important, since lack of sleep tends to dull one’s ability to resist
cravings and may worsen mood. Once through the physical symptoms of nicotine
withdrawal, people may still experience psychological symptoms of withdrawal.
These include still wanting a cigarette, or other tobacco products one has used in
232
the past, feeling lost without one’s habitual smoking apparatus, and simply deeply
missing smoking or chewing tobacco. Usually, wanting a cigarette after the body
has completed nicotine withdrawal is not as urgent as the cravings one experiences
during the first few days.
It helps to replace old smoking or chewing habits with new ones. Some people
find comfort in chewing gum, munching on cigarette-sized carrots, or doing work
with their hands, like crocheting, knitting, or woodworking. The former smoker
who doesn’t replace old habits with new ones runs more of a risk of returning to
smoking. He or she feels like something is “missing” from their lives, creating anxiety.
Persistence of depression, irritability, inability to control mood swings, sleeplessness
or fatigue warrants a doctor’s visit. People often use nicotine to control their
behavior, and nicotine can mask symptoms of mild psychiatric disorders like anxiety
or depression. Many people find benefit in a short course of anti-depressants or
anti-anxiety medications while overcoming the psychological symptoms of nicotine
withdrawal.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Irritability and anxiety
You might feel irritable or anxious. These feelings can be made worse by caffeine.
Smoking reduces the effect of caffeine and when you quit you become more sensitive
to the effects of caffeine. Try to halve your usual caffeine intake by drinking half
as much coffee, tea, energy drinks and cola. Relaxing activities, such as taking a
short break from work or going for a walk, can also help.
Difficulty concentrating
The changes that are happening in your body and cravings for cigarettes may make
it more difficult to concentrate. This can start to improve after a few days as your
brain adjusts to getting more oxygen. It might help to do tasks in small ‘bite-size’
chunks. Take regular breaks and do something active to clear your mind. Your
concentration levels ill improve over time.
Restlessness and insomnia
Some people feel as though they cannot sit still and need to move about or do
something with their hands. You can use this in a positive way by doing some
physical activity that you enjoy. Some people also find it harder to sleep when
they are quitting (insomnia). Restlessness and insomnia are made worse by caffeine.
Halving caffeine intake helps.
Cravings
Cravings are a normal part of quitting. They last usually no more than a few minutes.
Some people experience a series of cravings and this can be very challenging. As
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time passes, your cravings will usually be less strong, be shorter and happen less
often. Some people keep a diary to record how they feel, including how often and
strong their cravings are. This can help to show that things are improving. Talking
to Quitline (13 7848) can help you with deas on how to manage your cravings.
233
Dizziness
Smoking raises your blood pressure over time. When you stop smoking, your blood
pressure can drop quite quickly in the first few days of a quit attempt, so that if
you stand up too quickly, you may feel dizzy for a short time. This usually passes
in a few days.
Social Complications
Highlighting the rising cost of cigarettes can be an effective strategy to reduce smoking.
The high cost contributes to financial hardship and the poverty cycle, especially
in socially disadvantaged groups. Smoking is also responsible for considerable
absenteeism and loss of productivity through its contribution to both acute and
chronic illnesses.
Social Impairment
Social impairment is a distinct dissociation from and lack of involvement in relations
with other people. It occurs with various mental and developmental problems
such as autism, schizophrenia and severe anxiety disorders. It can also be a result
of medical issues that cause disfigurement, such as acne or the loss of a limb or
problems with teeth. There are a number of effective treatments for social impairment,
including medication and various forms of therapy.
Autism spectrum disorders can mean that the person’s focus is more on things
than people, resulting in some social impairment. Children with autism exhibit a
marked withdrawal from interactions with family members or caretakers. Asperger’s
syndrome is a mild form of autism characterized by a lack of normal social
functioning, although intelligence is usually average or above. It is often seen as
social awkwardness, little or no eye contact, obsessive interests and a tendency to
miss social cues.
234
Ciattion: http://images.wisegeek.com/crying-child-on-floor-near-woman-sitting-on-couch.jpg
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Social anxiety and phobias can cause very severe avoidance behaviors. Generally
people with social phobias recognize that their fear is unreasonable, but they are
hard-pressed to change it, so they avoid situations that may trigger a panic attack. In
the case of disorders like agoraphobia, they may never go out at all. Post-traumatic
stress disorder (PSTD) can cause social impairment in adults who cannot maintain
normal interactions due to persistent anxiety, flashbacks, and a sense of detachment
from others who did not experience the same trauma.
People with a disfiguring medical condition may become victims of social impairment
due to their intense desire to avoid situations such as teasing, bullying and staring
related to their conditions. Adolescents with severe acne are often very prone to
this. A lack of confidence stemming from the condition can negatively affect all
aspects of life, from interpersonal relationships to employment. Depression and
suicidal thoughts are not uncommon.
Tranquilizers, antidepressants and a number of other drugs may be used to treat
social anxiety disorder and phobias. Patients often benefit from role playing and
experiencing gradually progressive exposure to frightening social situations. Cognitive
behavioral therapy (CBT) for those with anxiety disorders, PSTD and phobias works
to change thinking patterns and desensitize sufferers to anxiety triggers. A groupcentered CBT approach has been shown to improve social impairment in those
with schizophrenia and schizo-affective disorders.
Tobacco
Citation: https://www.healthncure.org/wp-content/uploads/2016/02/Why-do-People-Start-
Smoking.png
For individuals with Asperger’s syndrome and other cognitive behavioral disorders,
specialized interactive training on responses to social situations can help. They can
essentially learn to refocus their attention on others and gain interpersonal skills
they may not have picked up the way others do. Those with disfiguring conditions
can investigate alternative therapies that ease symptoms or correct problems, such
as obtaining dentures and prosthetics or medical interventions for acne. This can
often bring about a significant increase in confidence, possibly improving the desire
for social interaction.
235
SMOKING CESSATION STRATEGIES
It is useful to highlight the benefits of quitting to patients who often only see the
unpleasant effects e.g. nicotine withdrawal, worsening cough. Quitting is beneficial,
even after many years of smoking as it contributes to both improved quality of life
and slows progression of many smoking-related diseases.
Smoking cessation strategies should be geared to the target group’s level of motivation
to quit, and degree of tobacco addiction. Motivational interventions (e.g. media
campaigns) aim to encourage more people to try to stop smoking. Treatment
interventions (e.g. nicotine replacement) aim to increase the chances of a quit attempt
being successful. In populations which have already been saturated by motivational
interventions, the overall effect of adding further motivational interventions may be
rather small, and possibly non-existent in heavy smokers. As a population’s smoking
prevalence declines, so the balance of interventions should shift from motivational
to treatment approaches. Nicotine replacement is an effective smoking cessation aid
and should form the basis for treating moderate to heavy smokers. There may be a
case for the development of more specialist clinics to treat motivated but addicted
smokers and train health professionals how to apply effective smoking cessation
methods as part of their routine work.
236
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://i.imgur.com/OnTin33.jpg
Quitting
As more people learn about the dangers of cigarettes to everyone, city, state, and
national governments are passing laws against smoking. Smokers are finding fewer
places outside their own homes and cars where they can smoke. Smoking is no
longer socially acceptable. Less than ten years ago, people could smoke almost
anywhere and feel comfortable. One result of these new laws and increased public
information about cigarettes is that more and more smokers are quitting. More than
3 million Americans quit smoking each year.
Today, the U.S. government is talking about stopping smoking in all workplaces.
Smoking is no longer allowed in any military workplace, whether in an office,
airplane, helicopter, or tank. The U.S. Postal Service has gone smoke free.
In 1992, 42 states had laws restricting smoking in government buildings, and 21
have them in private work sites. 39 states did not allow smoking on buses and trains.
Local and state governments are even passing laws that say that no one can smoke
in restaurants and/or bars. In 1992, 505 cities in the U.S. had passed ordinances
(local laws) restricting or not allowing smoking in restaurants. As of April 1995, all
restaurants in New York City, California, Maryland, and Washington are smoke-free.
The Benefits of Quitting
The benefits of quitting smoking start immediately with noticeable effects in the
first 72 hours (improved sense of smell and blood flow to hands and feet). Benefits
continue to accumulate, even in those who have smoked for 20–30 years. Table
1 lists the benefits to be expected after quitting. A range of policy and legislative
changes have contributed significantly to the decline in smoking prevalence.
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These include:
■ increasing the price of cigarettes
■ regulating access
■ making a number of public areas and facilities smoke-free
■ banning the advertising of tobacco
■ penetrating media campaigns depicting the damage done by each cigarette
Health care providers (especially GPs) can also make a significant difference due to:
■ Opportunity — over 80% of the population visit a doctor at least once a
year and most smokers have several visits
■ Credibility/expectation/acceptability — many smokers (up to 50%) are
interested in quitting and see doctors as having a key and supportive role
in smoking cessation
■ Feasibility — brief, clear non-judgmental advice can take less than a minute
■ Effectiveness and efficiency — brief interventions incorporating advice,
follow-up and possibly pharmacotherapies are effective and achievable.
Research has shown that, with such intervention, one of every 5–6 patients
will be a long-term quitter
237
Table 1: Benefits of quitting smoking
238
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Why People Smoke
Most people start smoking when they are in their teens and are addicted by the
time they reach adulthood. Some have tried to quit but have returned to cigarettes
because smoking is such a strong addiction. It is a habit that is very difficult to
break. There are many different reasons why people smoke.
Citation: http://media.pennlive.com/opinion/photo/people-smoking-art-a5608c6973c633ac.
jpg
Three of the main reasons that young people smoke are to look mature, to be
like their friends, and to experiment. Since teens see older people all around
them smoking, especially their parents and relatives, they smoke to act older. If
their friends or peers smoke, they may feel pressured into doing the same to be