Breaking the Chain of Addiction: Strategies to End Nicotine Dependence

1. Breaking the Chain of Addiction:Strategies to End Nicotine Dependence

2. “Quitting smoking is the easiest thing in the world. I know because I have done it a thousand times.” Mark Twain

3. Discussion Topics for Today • What is Nicotine? • Understanding the Addictive Forces of Nicotine • Nicotine and the Brain • The Nicotine Addiction: Biological, Psychological and the Social Addiction • Breaking Free from the Nicotine Addiction: The Five Roadblocks to Success • Taking the Next Step to Nicotine Independence

4. What is Nicotine

5. Nicotine • Nicotine is the addictive substance found in tobacco. • It is a naturally occurring colorless or yellowish liquid that turns brown when burned and takes on the odor of tobacco when exposed to air. • The amount of nicotine which occurs in tobacco leaves ranges from 2% to 7%. • There are many species of tobacco plants, the tabacum species is the major source of today's tobacco products. • It acts as a stimulant and is mainly responsible for the dependence-forming properties of tobacco smoking. • Nicotine is used in insecticides. • It is considered poisonous and highly addictive drug by the FDA.

6. Did You Know? The cigarette is a highly engineered drug-delivery system. Inhaling cigarette smoke produces a rapid distribution of nicotine to the brain. The drug levels peak within 10 seconds in the brain. Acute affects dissipate within minutes, causing the smoker to continue frequent dosing throughout the day. The average smoker takes 200-300 boluses to the brain per day." ? Sources: Am J of Medicine, 2009; Centers for Disease Control 2010

7. “Let’s face facts: Cigarette smoke is biologically active. Nicotine is a potent pharmacological agent. Every toxicologist, physiologist, medical doctor and most chemists know that. It’s not a secret”. Source: Memo by Phillip Morris, October 1982; Congressional Panel on Tobacco, 1985

8. The Addictive Forces of Nicotine

9. How Does Nicotine Affect the Brain? • Nicotine mimics neurotransmitters: Acetylcholine and Dopamine • Acetylcholine • Heart Rate • Muscle Movement • Cognition • Dopamine • Pleasure • Reward Pathway Biology of Nicotine Addiction, 2009

10. Dopamine Cycle • Dopamine theory: • Addicts become accustomed to the high levels of dopamine • Dopamine plays an important role in regulation of pleasure • Over time, the brain develops a tolerance to nicotine • The body needs more and a continual supply of nicotine to have the release of dopamine • The cycle repeats

11. Trapped by Nicotine

12. Nicotine Habit • Tobacco use can be an habit • Automatic behavior • May not even realize they are smoking or chewing • Habits are usually linked to other habits • Individuals can feel emotionally trapped by nicotine • May feel lonely • Tobacco may be their “best friend” • Reliance

13. Breaking the Chain of Addiction

14. Did You Know… According the Centers for Disease Control and Prevention, seventy percent of smokers wish to stop smoking while 13 million adult smokers (about 40%) have quit for at least a day in the past year. About 50 million adults were successful in efforts to quit and considered themselves former smokers in 2010. Centers for Disease Control and Prevention, 2011

15. 5 R’s: Roadblocks to Living Nicotine Free There are five common reasons often cited by tobacco users for not attempting to break the addiction to nicotine • Fear - withdrawal and relapse • Negative moods • Being around other tobacco users • Triggers and cravings • Time pressures Source: ALA, 2006, CDC, 2008

16. Roadblock Number One: Fear Fear is the most common reason cited by tobacco dependent individuals for not attempting nicotine withdrawal. The two areas most associated with fear are: • Withdrawal symptoms • Failure/Relapse

17. Possible Nicotine Withdrawal Symptoms • Cravings • Physical discomfort • Depression • Insomnia • Irritability, frustration, anger • Anxiety, nervousness • Difficulty concentrating • Increased appetite • Desire to smoke • Cravings for tobacco • Change in bowel habits • Fatigue • Cough, dry throat, nasal drip, clearing throat 17

18. Coping Skills for Withdrawal The Five D's Delay until the urge passes - usually 3 - 5 minutes Distract yourself. Call a friend or go for a walk. Drink water to fight off cravings. Deep breaths - Relax! Close your eyes and take 10 slow, deep breaths Discuss your feelings with someone close to you or with in a social support network. Source: ACS, 2007

19. Dealing with Withdrawal • Nicotine Replacement Therapy (NRT) can help lessen withdrawal symptoms. • The FDA has approved seven NRT's to assist with nicotine dependence. Over-the-counter NRTsPrescribed Medications Nicotine gum Bupropion Nicotine lozenge Varenicline tartrate (Chantix) Nicotine patch Nicotine nasal spray

20. Relapse • Adding psychosocial counseling can be helpful when addressing fears of relapse. • The greatest success rates are seen in a combination of psychosocial counseling and the use of nicotine replacement therapies. • Prepare for the potential “slips” when first attempting to break the nicotine addiction. • Seek our support groups and social networks • Build your personal belief system and visualize yourself free of nicotine.

21. Successful Addiction Quit Rates • Quitting without any form of assistance: 3% • Clinician advice to quit: 5 - 10% • Pharmacological Treatment (NRTs) only: 20 - 25% • Telephone/group counseling only: 20 -30% • Combination of Pharmacological and Counseling: 75 - 90% "The most effective method to break the tobacco dependence cycle is a combination of nicotine replacement therapies (NRTs) and psychosocial counseling." Source: American Journal of Psychology, 2008

22. Roadblock Number Two: Negative Moods • Biological action happening with the elimination of nicotine • Dopamine is not being released; no feeling of pleasure. • Feelings of anxiety, depression or nervousness can occur. Coping with negative moods or thoughts: • Suck on hard candy • Engage in physical activity • Express yourself (journaling, write, talk) • Relax • Think about pleasant, positive things • Ask others for support

23. Roadblock Number Three:Other Tobacco Users Breaking the addiction can be difficult if others around you continue to use tobacco. When you cannot avoid the tobacco, here are some suggestions to help you cope: • Ask a friend or relative to quit with you • Ask others not to smoke around you • Assign nonsmoking areas • Leave the room when others smoke • Keep hands and mouth busy

24. Roadblock Number Four:Triggers and Cravings Remember the Five D's when cravings hit hard • Delay – remind yourself the reasons for quitting • Cravings will lessen within a few weeks • Anticipate “triggers”: coffee breaks, social gatherings, being on the phone, waking up • Change routine—for example, brush your teeth immediately after eating • Distract yourself with pleasant activities: garden, listen to music .

25. Roadblock Number Five:Time Pressures Number one reason a quit attempt fails is due to a stressful event. Two ways to deal with time pressures and stress are: • Change your lifestyle to reduce stress and anxiety • Increase physical activity

26. Are You Ready to Break the Nicotine Addiction?

27. Am I Ready? • Do I want to quit? • Have I tried to quit before? What happened? • Am I committed to trying to quit? • Do I have a support system in place to assist me? • Will I be patient with myself and keep trying if I slip?

28. Preparation Tips Follow the START PLAN S = Set a quit date. T= Tell family, friends, and co-workers A = Anticipate and plan for the challenges R = Remove cigarettes and other tobacco products from home, car, and work. T = Talk to a doctor about getting help to quit.

29. Your "Break Free" Day On Your Quit Day, follow these suggestions: • Do not smoke. This means none at all -- not even one puff! • Keep active -- try walking, exercising, or doing other activities or hobbies. • Drink lots of water and juices. • Begin using nicotine replacement if that is your choice. • Attend stop-smoking class or follow your self-help plan. • Avoid situations where the urge to smoke is strong. • Reduce or avoid alcohol. • Change your routine. Celebrate the Break

30. Staying Quit: Adherence To help avoid Relapse: • Review reasons for quitting - benefits to health, finances, and family. • Remember there is no such thing as just one cigarette -- or even one puff. • Ride out the desire to smoke. • Avoid old habits that are associated with tobacco - alcohol. • If you are worried about gaining weight, put some energy into eating a healthy diet and staying active with exercise.

31. Recovering from a Slip • Slip versus Relapse: • Slip – one mistake; get back on track • Relapse – what caused the relapse back to tobacco; what did I learn from the quit attempt; know that you can always try again • Living free from nicotine is possible

32. Experience. Wellness. Everywhere. Some Helpful Resources • BCBS Lifestyle Management Programs: • Tobacco and Weight Management • Call 1.800.462.3275 to enroll • Centers for Disease Control and Prevention (CDC) • www.cdc.gov • American Lung Association (ALA) • www.lungusa.org • American Heart Association (AHA) • www.americanheart.org • American Cancer Society (ACS) • www.cancer.org • www.mytimetoquit.com • (866) 330-0600 • National Network of Tobacco Cessation Quit lines • (800) 784-8669 or (800) QUITNOW • Quit Net • www.quitnet.com