Smoking Cessation Program

Our smoking cessation program is designed to help our patients make a life-long commitment to smoke-free lives. We believe that smoking is an addictive behavior that involves a multi-disciplinary treatment approach in order to achieve successful results. As a part of our smoking cessation program our healthcare providers focus on addressing both the physiological and psychological dependence on tobacco use in patients while remaining sensitive to parallel issues including social factors, lifestyle modifications and weight gain.

What Our Program Offers:

• Correctly identify and diagnose smoking dependence category (chemical, hormonal, social or psychological)
• Incorporate the integrated use of pharmacological treatments and psychological therapy
• Management of accompanying concerns such as weight gain, depression, or anxiety
• Long-term wellness and preventive medicine planning
• Comprehensive medical evaluations

Smoking and Health

Despite the rise in awareness about the danger of smoking, it remains a serious national health issue in the United States. Smoking is a risk factor to many diseases including cancer, diabetes, stroke, heart disease, and even infertility. Here are some quick statistics about smoking in the the U.S.:

• 20% of all adults smoke
• Smoking is the leading cause of preventable death and accounts for every 1 in 5 deaths in the U.S.
• Smokers die an average of 14 years younger than non-smokers
• Smoking costs our society $193 billion annually
• Each day 3,500 new teens begin smoking habits
• 70% of smokers report a desire to quit

Treating Smoking as an Addiction

The fact that more than nearly 3 out of every 4 of smokers say that they want to quit, yet are unable, illustrates the fact that tobacco use is a very powerful and real addiction.

From a medical perspective, smoking addiction is categorized into four different types of diagnoses. The type of diagnosis made by the healthcare provider will help guide his or her treatment plan.

Chemical Dependence

The chemical dependence comes from nicotine and its metabolites. Nicotine is a highly addictive drug. After years of smoking, your body is chemically addicted to the nicotine. When you try and stop smoking, your body goes through nicotine withdrawal. Nervousness, irritability, stomach disturbances and loss of concentration are typical symptoms. There are two ways to combat the withdrawal:

1. You can take a non-harmful form of nicotine back into your body through a nicotine patch, nicotine inhaler or nicotine gum.
2. Your doctor can prescribe either Clonidine® or Scopolamine® which help minimize the effects of nicotine withdrawal.

• Scopolamine® works by increasing a chemical called acetylcholine in the brain. This chemical is in very high concentration in the brain when you smoke, so taking this medication when you aren't smoking can help minimize the feelings associated with nicotine withdrawal. Scopolamine® can be used by injection or as a patch.
• Clonidine® in a non-addictive medication that is traditionally prescribed to treat high blood pressure. Although the exact mechanism of how Clonidine® eases withdrawal symptoms is unknown, studies have shown that those who use Clonidine® for smoking cessation are twice as likely to quit than those using no medication at all . The medication can be taken up to three times a day for acute, "break through" symptoms of nicotine withdrawal.

Hormonal/Neurotransmitter Dependence

This form of smoking addiction is caused by hormones and neurotransmitters such as serotonin, epinephrine and norepinephrine that are released in your brain while you smoke. When these are released the smoker feels that feeling of a "buzz" or "pick me up" which can then become the source of addiction. When trying to quit, there are medications available that help replace these chemicals in your brain so that you don't miss the "buzz". The most commonly used medication for this purpose is Zyban® (also called Wellbutrin® and Buproprion) which can provide enough of a replacement to prevent smokers from relapsing.

Social Dependence

Social dependence on smoking is a behavioral phenomenon called "association". We associate certain acts, such as smoking, with specific activities such as socializing with friends, driving to work, drinking alcohol, working at the computer, etc. We call the activities that we associate with smoking our "triggers". For someone with a smoking addition due to social dependence the key to cessation success is to clearly identify all of our triggers and develop strategies to combat them. For example:

• Avoiding your usual hangouts and the places that trigger you to smoke
• Find a friend or family member join you in trying to quit
• Switching cars with someone who is not a smoker
• Avoiding other common triggers such as alcohol, coffee, etc.
• Get a new start by rearranging your workplace, redesigning your office, changing the position of your furniture
• Consider investing in new carpet, drapes, sheets etc. to get rid of the smell of cigarette or cigar smoke and help keep you motivated to stay smoke-free

Psychological Dependence

As part of the mammalian species, human beings have a basic instinct of "suckling" while under stress. Also known as an "oral fixation", this stress-reliever is often indulged in young children in he form of a pacifier or thumb. However, as adults we may use food, nail-biting or cigarettes to fulfill this same basic need. In order to address this issue in a smoking cessation program we use what we call "substitution therapy". You have to substitute something in your mouth for the cigarette that is missing. Toothpick, sugar-free candy, celery sticks, sugar-free mints, sugar-free gum or anything else that can be used to keep your mouth busy can be helpful in your efforts to stay smoke free.

Combatting The Smoke-Free Weight Gain

One of the biggest deterrents for many patients to start a quit smoking program is fear of weight gain. Many patients would rather smoke and weigh less than stop smoking and gain a few pounds. Nothing could be more dangerous to your health. Any weight gain from a smoking cessation program can be combated with appropriate weight management therapies. It is much less healthy to smoke and be thin, than to be smoke free and a few extra pounds heavier. If smoking cessation and weight loss are desired, it is best to start the stop smoking program first, then lose weight. That is because the therapies utilized for weight management work best in a nicotine free patient.

Fiore MC, et al. (2000). Clinical Practice Guideline: Treating Tobacco Use and Dependence. Rockville, MD: U.S. Department of Health and Human Services.