Smoking Cessation Patient Education

Doctors Who Treat the Need for Smoking Cessation

Most individuals will seek help from the healthcare provider that they have a rapport with and who knows them. This would include:

• General Practitioner (family practice) - deals with prevention, discovery, and treatment of illnesses in all age categories
• Internist - focuses on diagnosis, treatment, and prevention of adult illness
• Gynecologist - deals with female health
• Pediatrician - specializes in infant, childhood, and adolescent care
• Gerontologist - deals with senior or elder health
• Nurse Practitioner - focuses on prevention, wellness, and education of patients about health and health choices

For a higher degree of success in smoking cessation, the following specialists listed in this patient education guide are added to the team:

• Psychologist - deals with the emotional stress, anxiety, depression, and fear that led to smoking as a solution and the same emotional problems accompanying withdrawal
• Behavior modification professional - a psychologist, a social worker, or another trained program leader who helps change habits that contributed to smoking desires; may also provide mediation through sensory relaxation methods, physical exercise, and breathing techniques
• Psychiatrist - deals in the diagnosis and treatment of emotional and mental disorders; may prescribe medication to help tolerate the physical effects of withdrawal as well as antidepressants, anti-anxiety agents, and mood elevators
• Nutritionist - deals with how food and nutrition affect health; will formulate a diet plan to achieve health and help identify foods normally associated with a smoking habit, substituting healthier choices
• Alternative care practitioner - specializes in the mind-body connection, natural biological agents like herbs and supplements, and manipulative practices such as acupuncture, hypnotherapy, meditation, yoga, and exercise

There are additional resources that provide information and help; toll free 1-800-QUIT NOW is the national access number to quit line services for each individual state.

 

Written by Barbara Hales, MD

How to Prepare for Your Smoking Cessation Doctor Visit

Having made an appointment with a healthcare provider, there are certain actions listed below in this patient education guide that you need to take in order to maximize the benefit of your doctor visit:

• Identify the reasons and benefits of quitting smoking.
• Identify foods and activities associated with smoking so that these may be avoided (drinking alcohol is significantly linked to relapse).
• Notify household members that they must not smoke in the house or around you.
• Don’t take work breaks with smokers.
• Have healthy desserts on hand for the “after-dinner” cravings.
• Have oral substitutes available like mints, carrots, celery sticks, and gum
• Make a log or journal to jot down when cravings occur and with what foods or activities they are associated with.

The National Cancer Institute recommends the START plan to quit smoking.

• S: Set a quit date.
• T: Tell coworkers, friends, and family of your intent to quit smoking.
• A: Anticipate the difficulties ahead (some problems will be faced for the first time).
• R: Remove all tobacco products from home, car, and, work.
• T: Talk to your physician about getting the help needed to quit smoking.

 

Written by Barbara Hales, M.D.

Questions to Ask Your Doctor about Smoking Cessation

 

Questions About My Diagnosis

• How do you know that I am addicted to smoking and it’s not just a habit?
• How long will it take after I quit smoking for the harmful effects that were diagnosed to revert to normal?
• What symptoms of nicotine withdrawal can I expect?

 

Questions About My Treatment

• How do I quit smoking?
• What medication can I take to help me quit smoking? Are the over-the-counter medications as effective as prescribed drugs? Will I need to take the medication to stop smoking forever?
• How long will it take before my cravings for cigarettes stop? How long will it take to quit?
• How do I avoid the weight gain? Depression or irritability?
• What side effects and/or risks do the medications have?
• Are these medications compatible with the drugs that I am currently on?
• Is there a program nearby?
• What happens if I smoke while under treatment for smoking cessation?
• Does the patch work? Do those artificial cigarettes work?
• Do alternative treatments like acupuncture, hypnotism and herbal therapy work?

 

Questions About My Lifestyle & Family

• Can I substitute chewing tobacco for smoking? Are cigars and pipes as harmful as cigarettes?
• What are the risks to my family from second-hand smoke?
• Are there foods that I should avoid? Is there a special diet?
• Should my family participate in the program with me?
• Is my family more likely to smoke because I did? How do I discourage my family from smoking?
• I smoke only occasionally or socially. Are the risks I face as bad?
• If I quit “cold-turkey,” will it affect my daily activity or work?
• Do I need to be in a counseling program?

 

Written by Barbara Hales, M.D.

Common Tests or Labs to Determine Extent of Damage Caused by Smoking

There are several diagnostic tests to determine if someone is a smoker and the extent to which smoking is done. These are usually requested by insurance companies to determine your health risk and life expectancy.

 

Test	What is it?	What Happens?	What is Measured?
Urine test	For detection of nicotine byproducts	A urine sample is collected for analysis.	Cotinine (nicotine byproduct) is best detected via the urine; can be detected for 2-4 days.
Blood test	For detection of nicotine in the blood	After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe for analysis.	Nicotine can be detected for 72 hours.Nicotine byproducts can be detected for 3 weeks.
Hair follicle test	For the detection of nicotine in the hair follicle	A hair sample is collected and sent for analysis	Nicotine can be detected in the hair follicle for 30-90 days
Saliva test	For the detection of nicotine in the saliva	A saliva sample is collected using a cotton swab and sent for analysis	Nicotine can be detected in saliva for 2-3 days.

 

Written by Barbara Hales, M.D.

Common Medications and Treatments to Aid in Smoking Cessation

Regardless of the treatment protocol that is chosen by the individual and physician with a well-delineated protocol (usually lasting between 6-12 weeks), it is highly recommended that the patient also enroll in a behavioral modification program and enter a support group.

Further, it is recommended that the patient undergo therapy for 2 main reasons:

• While undergoing therapy, depression, anxiety, stress tension, suicidal tendencies and serious mood or psychological problems may manifest.  Should this occur, antidepressants or anti-anxiety agents will be prescribed.

• The individual may have had difficulty coping with stress and may have used smoking as a coping mechanism.  Now the person must face and deal with these life issues.

 

Drug/Treatment	How it works
Varenicline	Blocks the “high” of addiction Decreases withdrawal symptoms
Bupropion	Decreases craving for nicotine Relieves depression
Transdermal patch	Eases cravings by supplementing nicotine, which is decreased over time
Chewing gum (with nicotine)	Decreases urges to smoke
Inhaler	Relieves symptoms of nicotine addiction
Nasal Spray	Nicotine delivery system which decreases cravings; helps with habit of holding an object
Lozenge (with nicotine)	Nicotine delivery system which decreases cravings and the urge to smoke

 

Lifestyle and Diet Changes

Studies show that norepinephrine and beta-endorphin, brain neurotransmitters, are released when nicotine is introduced into the system. This causes a short-lived mood elevator and stress-reliever.

By changing one’s lifestyle to eliminate stress, a smoker is less likely to get the urge to smoke.

In addition, a smoker greatly benefits by joining a support group that helps show better means of problem solving.

Changing your lifestyle to reduce stress not only helps with smoking cessation but also makes you happier and healthier (two great bonuses!)

Actions	How it works
Acupuncture	Insertion of specialized small needles into energy channels just beneath the skin detoxifies the body and hastens healing. Acupuncture helps to eliminate nicotine withdrawal and also decrease the desire for nicotine.
Herbal therapy	Lobeline (the active ingredient in the herb lobelia) increases the brain’s level of dopamine, a neurotransmitter, in a similar way to nicotine. This may eliminate withdrawal and also elevate mood. However, lobelia is potentially toxic and cannot be used without supervision. St John’s Wort, which is commonly used as an antidepressant, may help in smoking cessation and research studies are ongoing. However, it may interfere with medications being taken concurrently, including birth control pills. Studies are ongoing for the use of ginseng to prevent nicotine-induced dopamine release.
Diet and exercise	Because it has been shown that smoking increases with stress, exercising, which reduces stress, will cause a decrease in desire. Additionally, exercise causes release of neurotransmitters, which evoke the sensation of pleasure, which mimics the same sensation as nicotine. Certain foods and beverages are associated with smoking habits for individuals such as lighting up when having a cup of coffee or with dessert after a meal. By eliminating these items from the diet, the brain is tricked into not getting the urge to smoke. Additionally, by starting a diet and exercise program early in the smoking cessation program, it is less likely for a weight gain from a decrease or lack of nicotine, which can be an appetite stimulant.

 

Written by Barbara Hales, M.D.