Tobacco use is the leading preventable cause of illness and disease. The most common illnesses include coronary artery disease (heart attacks), strokes, mouth and throat cancer, voice box cancer, lung cancer, chronic lung disease including emphysema, esophageal cancer, pancreas cancer, cervical cancer, kidney cancer, stomach cancer, bladder cancer, peripheral vascular disease (resulting in leg amputations), and macular degeneration (permanent loss of reading vision). Chewing tobacco causes similar problems - but the mouth disease, and young people dying of oral cancers (in their teens and 20's) is particularly tragic. Smoking damages the skin (making it look older), slows wound healing, and shortens life expectancy.

434,000 people die prematurely each year from cigarette smoking: more than from alcohol, illegal drugs, homicide, suicide, auto accidents, fires and AIDS combined. Tobacco smoke contains over 400 toxic chemicals - including 43 proven cancer causing agents. These chemicals include the deadly gas carbon monoxide, nicotine and carcinogens that would not be allowed into the water supply. A radioactive chemical in tobacco smoke may contribute to the cancer problem.

Passive smoking (inhaling someone else’s smoke) has now been clearly established as unhealthy and likely dangerous. Children of smoking parents get bronchitis 50% more frequently. Smoking while pregnant damages the fetus, and causes low birth weight babies who are more susceptible to illness and death.

It is becoming a progressively difficult problem to be a smoker. Smokers are subjected to harassment in the workplace and indoor areas they share with nonsmokers. Insurance rates are rising for smokers. Job opportunities are diminishing due to the higher rates of absenteeism and illness found in smokers - it costs employers more to employ smokers. There are no health benefits from tobacco.

Smokers at all ages benefit from quitting. The risk of heart attack is reduced by half after one year - continued cigarette smoking is the single biggest risk for someone after a heart attack or bypass surgery. Many other health risks are reduced once the smoker quits, and most risks eventually return to normal within approximately 10 years.

Nicotine is the addicting chemical in all forms of tobacco. It is a very powerful and dangerous drug - a small child can die from eating just two cigarettes. Nicotine causes the release of brain chemicals, which can give a "high" similar to other addicting drugs. It may be as addicting as heroin. The body goes through a physical "withdrawal" when the nicotine level drops - causing the "nicotine fit."

Nicotine withdrawal can be very unpleasant - many smokers find it difficult to quit due to nicotine addiction. Withdrawal symptoms can include anxiety, irritability, poor concentration, restlessness, craving nicotine, stomach problems, headaches and drowsiness. These symptoms must be addressed for most smokers to successfully become non-smokers.

There are many options for treating nicotine withdrawal - most are available without a prescription. Nicotine gum (Nicorette) is placed between the gum and cheek. When withdrawal symptoms develop, the gum is chewed until the medication is tasted - then the chewing stops. Those with some dental conditions (such as plates or crowns) may not be able to use the gum. Nicotine patches provide a consistent blood level of nicotine - preventing the withdrawal symptoms particularly in heavy smokers who crave the morning cigarette the most. The most common side effects include rashes, diarrhea, heartburn, muscle aches, abnormal dreams, and sleepiness. The nicotine gum and patches cost approximately the same as 1.5 packs of cigarettes per day.

The antidepressant "Zyban" (a.k.a. Wellbutrin), doubles the success rate.  The homeopathic product "Smoke-ease" by Rexall Sundown has helped many of my patients quit without withdrawal or even wanting to smoke.  The prescription high blood pressure medicine Catapres (clonidine) blocks the withdrawal of both cocaine and nicotine. None of these medicines should be used if the patient continues to smoke.

Hypnosis and non-prescription programs work for some people. The overall long term success rate without prescription medication(s) is 20%. The combination of a formal quitting program (such as the American Heart Association, American Cancer Society, etc.) with medications can double the success rate.

Approximately 80% of those unable to quit smoking are suffering from America’s most common illness - depression. If a smoker suffers from chronic fatigue, difficulty staying asleep, change in appetite, or a lack of interest and pleasure in previously enjoyed activities, he/she should be evaluated for depression. If depressed, the depression must be treated before the attempt to quit smoking. Individuals with attention deficit disorder (ADHD) often treat their disorder with nicotine, and will likely need to have their ADHD treated to successfully quit smoking.

An enzyme that breaks down body fat is artificially stimulated by nicotine, resulting in losing a few pounds when one starts to smoke. The body adjusts by making the enzyme less active. When the smoker quits, it takes a few weeks for that enzyme’s activity to return to normal - and a weight gain of 4-10 pounds is likely. Any more weight gain than that is due to issues beyond nicotine effects. The health benefits of quitting a 1 pack per day habit is equivalent to a 75 pound weight loss by an obese individual - a 4-10 pound weight gain is a fair trade. A 2 pack per day habit is equivalent to over a 100 pound weight loss in total health benefits. The smoker’s cough may actually worsen for 3-6 months as the body tries to repair the damage and clear out the "garbage."

Some helpful hints for successfully quitting: most smokers need to modify their lifestyle to reduce the risk of smoking again, especially avoiding locations and activities strongly associated with smoking - such as eating breakfast on the porch instead of the dining table, or going to restaurants where there is no memory of smoking and eating together. Thoroughly cleaning and deodorizing the car, carpets, drapes, bedspreads, furniture, and clothing to remove the tobacco smell is very important. Most stress relieving techniques are helpful such as slow deep breaths - even breathing through a cigarette sized straw filled with cotton works for many people. Learning to be positive and happy can make a difference. Successfully quitting smoking profoundly improves one’s self esteem and self confidence - making a happy, healthy and successful life more likely.

10/22/99