Many environmental factors help determine the risk level each individual has to become addicted to smoking. Smokers are often influenced by family members and friends who smoke, making smoking seem like a normal part of life.

However, research has shown that genetic factors are also important in determining a individual’s likelihood of developing different types of addiction, including addictions to drugs, alcohol and tobacco. A recent study led by Dr. Jacqueline M. Vink and Professor Dorret L. Boomsma has further investigated this connection between genes and addiction, specifically addiction to smoking.

The study, published in The American Journal of Human Genetics, made a significant breakthrough by identifying the specific groups of genes active in smoking behavior and addiction vulnerability. The effort was initiated by the Department of Biological Psychology at Vrje Universiteit in Amsterdam and was collaborated by several international research groups.

The researchers used a genome-wide association study to investigate the DNA of smokers and non-smokers for more than 500,000 genetic variants. The variants were tested to see whether certain variants occurred in smokers at a higher or lower level.

The researchers discovered that several groups of genes held variants of interest. In one group of genes, a common variant was found related to glutamate. Glutamate is a neurotransmitter that has a specific role in normal brain processes, but is also associated with addiction vulnerability.

A second group was identified that may also play a significant role with addiction. The NTRK2 gene is located in a chromosomal region that affects addiction vulnerability and the GRB14 gene which may restrict the genes that regulate nicotine receptors and may alter the reward response that a person has after smoking a cigarette.

Some of the genes identified in the study have been identified as playing a role in several types of psychiatric disorders, including schizophrenia, attention deficit hyperactive disorder, autism, and multiple types of addiction. Each of these psychiatric disorders has also been connected with smoking.

Dr. Vink cautions that an identified predisposition for smoking does not imply that a person’s offspring will develop an addiction to nicotine. Though they may have more difficulty with cessation, each smoker should understand that a genetic predisoposition is never an excuse to continue an unhealthy behavior.

As research continues to understand the genetic influence over different types of addiction, there may be connections found between many types of behaviors. It may soon be possible to target individuals tested for “addiction genes’ for additional education and prevention efforts.
 

Tobacco smoking is the leading cause of preventable death in the United States. But the fact is that people with mental health problems are among those with the highest smoking prevalence. According to the most recent estimates, 75 percent of people with mental health problems or addictions smoke cigarettes, compared to 23 percent of the general population.

Americans with mental health problems represent an estimated 44.3 percent of the U.S. tobacco market. And half of all deaths from smoking occur among patients with mental illnesses or substance use disorders.

Clearly, smoking cessation programs could benefit people with mental health problems. In fact, these individuals express a desire to quit smoking just as much as smokers in the general population. Let’s look a bit closer into this area.

Alarming Statistics

Consider the following statistics, which should be alarming to anyone:

• At least 1 in 5 people has a diagnosable behavioral health disorder during the course of any given year
• Individuals with behavioral health disorders die up to 25 years earlier than those in the general population
• People with mental health problems and addictions are nicotine-dependent at a rate 2 to 3 times higher than the general population, represent over 44 percent of the U.S. tobacco market, and consume over 34 percent of all cigarettes smoked in the U. S.

Tobacco Use by Diagnosis

Researchers have determined the following tobacco use by diagnosis:

• Schizophrenia – 62 to 90 percent
• Bipolar Disorder – 51 to 70 percent
• Major Depression – 36 to 80 percent
• Anxiety Disorders – 32 to 60 percent
• Post-Traumatic Stress Disorder (PTSD) – 45 to 60 percent
• Attention Deficit Hyperactivity Disorder (ADHD) – 38 to 42 percent
• Alcohol Abuse – 34 to 80 percent
• Other Addictions – 49 to 98 percent

Barriers to Smoking Cessation

Significant barriers to smoking cessation exist among people with mental health problems, just as they exist for smokers in the general population. While the barriers may be the same, for persons with mental health problems, some of these barriers are particularly vexing. Included are:

• Nicotine addiction
• Socially-reinforced habits
• Expectation of failure
• Lack of motivation
• Lack of adequate support to quit
• Lack of hope that quitting will be successful
• Fear of gaining weight
• Fear of the side effects of withdrawal
• Difficulty in coping with anticipated increase in anxiety and tension
• Loss of pleasure
• Loss of the social reinforcements for smoking

Suspected Targeting by Tobacco Industry Revealed

A 2007 study by Prochaska, Hall, and Bero analyzed previously secret documents from the tobacco industry. They found that the tobacco industry monitored or directly funded research supporting the idea that people with schizophrenia were less susceptible to the harmful effects of tobacco or needed tobacco as a means of self-medication.

The study further found that the tobacco industry promoted smoking in psychiatric settings by providing cigarettes to patients and by supporting efforts to block hospital smoking bans.

Smoking Cessation Concurrent with Mental Health or Addiction Treatment

Results of several studies from 2005 to 2008 show that smoking cessation has no negative impact on psychiatric symptoms. Rather, quitting smoking may lead to better mental health and overall functioning.

Numerous studies (from 1993 through 2004) show that participation in smoking cessation efforts while engaged in other substance abuse treatment has been associated with a 25 percent greater likelihood of long-term abstinence from alcohol and other drugs. In other words, treating the primary addiction concurrent with tobacco addiction, patients actually may do better.
Responding to the clinical needs of patients requires programs that hit both the physical and the behavioral side of interventions. On the physical side, addictions and biology mean treatment that involves medications and medical procedures, monitoring, follow-up. The behavioral side involves a person’s habits and environment and treatment that include a program to change behavior.

Smoking Cessation Programs Work

The facts are indisputable. Some 70 percent of smokers say that they want to quit, while about 40 percent attempt to quit. But it’s not a simple matter to just say you want to quit or attempt to quit. Quitting smoking is a difficult process, but it is feasible – if the individual has help to quit.

Consider these statistics:

• Willpower alone accounts for quit rates of about 4 percent
• Nicotine replacement therapy (NRT) alone accounts for quit rates of 22 percent
• Quit line counseling in conjunction with NRT accounts for quit rates of 36 percent
• Medication (Varenicline) accounts for quit rates of 44 percent

Interestingly, smokers who have insurance coverage are more than twice as likely to quit.

Results of smoking cessation programs among people with mental health problems show that most combine medications and psychoeducation and/or cognitive behavioral therapy (CBT). Eight studies of patients with schizophrenia who were smokers attempting to quit showed quit rates of 35 to 56 percent post-treatment, and 12 percent at 6 months. Another eight studies of patients with depression who smoked and tried to quit showed quit rates of 31 to 72 percent post-treatment, and 12 to 46 percent at 12 months.

Advice Helps Reinforce Quitting

People with mental health problems who want to quit smoking have a better chance of successfully doing so if they receive advice as part of their smoking cessation program. Compared to people who smoke who do not get help from a clinician, those who do receive help are 1.7 to 2.2 times as likely to successfully quit smoking for 5 months or more.

Wellness Resources and Tools

There are a number of wellness resources and tools available to help people with mental health problems in their quest to quit smoking. These include:

• Medications and medical interventions
• Cognitive behavioral therapy (CBT)
• Motivational enhancement therapy (MET)
• Individual counseling
• Group meetings
• Individualized treatments based on diagnoses
• Family-based strategies
• Peer-to-peer support
• Referrals – such as a quitline

FDA-Approved Smoking Cessation Products

With smoking so prevalent in the U.S., it’s not at all unusual to see the progression of medications and products approved by the Food and Drug Administration (FDA) over the years. The first tobacco cessation product approved by the FDA was prescription nicotine gum in 1984. A prescription transdermal nicotine patch got the go-ahead in 1991. In 1996, a trio of products was approved: an over-the-counter (OTC) nicotine gum and patch, and a prescription nicotine nasal spray.

In 1997, a prescription nicotine inhaler was approved, along with the prescription medication, bupropion SR. A nicotine lozenge reached the marketplace in 2002 and in 2006, the prescription drug, varenicline. Drugs currently in development include rimonabant and a nicotine vaccine known as NicVAX (currently in a second FDA Phase III clinical study).

Smoking Cessation Program – NYC

The New York City Department of Health and Mental Hygiene instituted a campaign for mental health providers to assist their patients to stop smoking. The program began in 2003 and was modeled after the pharmaceutical sales approach. This approach sells the benefits of good health and promotes public health interventions. It consists of brief, one-on-one interactions with health care providers and staff.

The goals of the detailing program are to promote preventive health interventions to mental health providers in the primary care practice setting, to promote use of clinical systems so that opportunities for care are not overlooked, and to develop relationships and serve as a resource to the staff of the mental health practice.

After visits to 400 mental health sites in January and February 2009 and follow-up visits in July and August 2009, the following key recommendations were made for mental health providers:

• Assess smoking status and readiness to quit at intake and at least every 3 months thereafter
• Provide smoking cessation medications and treatments to assist people in becoming free of tobacco
• Provide education and raise awareness about how to become and remain tobacco-free

Smoking Cessation Action Kits were provided to mental health providers which included clinical tools, provider resources, patient education, medications, health bulletins, and incentives (such as post-it pads and pens). Provider resources included peer-reviewed articles and clinical guidelines on evidence-based care, vital statistics, and information on smoking interventions.
Materials available to patients through the NYC smoking cessation program include Still Smoking. The brochure, targeted to all literacy levels and available in multiple languages, provides key patient messages and prompts discussion with a health care provider.

Sites involved in the initial and follow-up visits received copies of “Smoke Alarm: the truth about smoking and mental illness,” for consumer use in waiting rooms.

What were the lessons learned? By every measure, the campaign proved to be a success. Programs assessing smoking status at every treatment review increased from 21.2 percent to 58 percent. Programs providing smoking cessation education, medication, and counseling, increased from 34.9 percent to 49.5 percent. Willingness to use clinical tools and/or adopt key recommendations increased from 5 to 52 percent. Sites are also requesting additional support and assistance from the NYC
Department of Health and Mental Hygiene.

Successful Strategies

Among other lessons learned are those involving successful strategies. These include:

• Holding regular group sessions
• Addressing smoking at intake and regular reassessments
• Including smoking cessation in treatment planning
• Educating and counseling clients on health benefits and the expense of smoking
• Providing medication
• Providing one-on-one counseling
• Shifting the focus from quitting to reducing amount smoked
• Educating the staff
• Providing a smoke-free facility

Peer-to-Peer Support for Smoking Cessation

One organization has had considerable success in peer-to-peer support for smoking cessation. This group is CHOICES, or Consumers Helping Others Improve their Condition by Ending Smoking. CHOICES employs mental health peer educators and consumer tobacco cessation advocates to deliver two messages to smokers with mental illnesses:

• Addressing tobacco use is important and can improve their quality of life in numerous ways
• Seeking tobacco treatment will increase their chances of successfully quitting

In essence, what CHOICES personnel do is to provide information and support and motivate individuals who smoke to seek treatment. They do not attempt to “force” the individual to quit, nor is this a formal stop-smoking treatment. Each CHOICES member receives 30 hours of tobacco education prior to going out into the field to work with smokers. They also are involved with advocacy, organizing events with agencies, and have ongoing supervision.

This approach, peer-to-peer support, has several advantages. First, it involves shared experiences. Second, there’s increased trust. Third, the interaction is relaxed and non-structured. Fourth, there is no element of judgment. Fifth, consumers find such peer-to-peer support empowering. And, finally, consumers rate the approach as highly satisfactory.

Why do mental health consumers say they want to quit? The answers may or may not be surprising, dovetailing quite a bit with answers from the general population. These consumers want to quit smoking for reasons of health, cost, smell, children, and relationship to other addictive behavior.

The barriers these consumers list to their ability to stop smoking also mirror that of consumers in the general population. The barriers include:

• Stress
• Weight gain
• What else is there?
• What if everyone around me smokes?
• What if I don’t have the willpower?
• Where can I get free treatment?

What Else Is Required to Stop Smoking?

Smoking cessation, in order to be effective, also requires accurate information, support, self-discipline, motivation, and a determination to live a healthier lifestyle. Whether a person has a mental health illness and/or substance abuse, the desire to quit smoking is similar to that voiced by smokers in the general population. The barriers to quitting are similar, and the tools and resources available are also similar in nature.

The fact that there are smoking cessation programs that are tailored to individuals with mental health problems is encouraging. The fact that mental health providers are getting on board is even more encouraging.

Resources

The following resources may prove helpful in understanding smoking cessation programs for people with mental health problems.

• CHOICES, available at http://www.njchoices.org
• Bringing Everyone Along, available at http://www.tcln.org/bea/
• Rx for Change: Clinician-assisted Tobacco Cessation, available at http://rxforchange.ucsf.edu/curricula/
• Smoking Cessation for Persons with Mental Health Illnesses: A Toolkit for Mental Health Providers, available at http://smokingcessationleadership.ucsf.edu/Downloads/MH/Toolkit/Quit_MHToolkit.pdf
• Tobacco-Free Living in Psychiatric Settings, available at http://www.nasmhpd.org/general_files/publications/NASMHPD.toolkitfinalupdated90707.pdf

It’s no surprise to anyone who smokes cigarettes today that the additives in the tobacco are stronger than they were a decade or so ago. That some people can smoke a cigarette now and then without becoming a pack or more smokers a day is actually a rarity. The reality is that it’s far more likely that even casual smoker will become addicted to nicotine – and faster than they think. For some, it’s a built-in vulnerability or predisposition, a genetic component that researchers are only now beginning to unravel. Although much more research still needs to be done, scientists say there is a strong link between genetics, nicotine and dependence.

What do we know now about nicotine, genetics and dependence? The issue is complicated, of course, but the body of knowledge is expanding in this field of study.

Facts about Nicotine

Cigarette smoking is the leading cause of preventable death worldwide, according to data from various sources, including the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and the American Cancer Society. Smoking causes about 5.4 million deaths worldwide each year. By 2030, according to a report from WHO, tobacco use will kill more than 8 million people worldwide each year if current trends continue. According to the National Institute on Drug Abuse (NIDA), in the U.S. alone, one of every 5 deaths can be linked to smoking, making tobacco more lethal than all other addictive drugs – combined.

Nicotine is an addictive substance, and is the primary component in tobacco. In addition to nicotine, however, there are numerous other dangerous chemicals in cigarette smoke. These include tar, acetaldehyde, carbon monoxide, nitrosamines, and more. When a smoker inhales the tar in cigarette smoke, he or she increases the risk of bronchial disorders, emphysema, and lung cancers. Carbon monoxide also increases the risk of cardiovascular disease. It is also well known that second-hand smoke increases the risk of lung cancer in adults. But the great risk from second-hand smoke is to our children, who are at greater risk of developing respiratory diseases. Data from WHO shows that more than 600,000 people worldwide die from second-hand tobacco smoke each year.

Smoking Risk Factors

Smoking harms almost every organ in the human body.

• Cigarette smoking has been linked to almost 90 percent of all lung cancer cases, and is the leading cause of cancer death in men and women, accounting for about one-third of all cancer deaths, according to some reports. Overall, the death rate from cancer is twice as high among smokers as non-smokers. Among heavy smokers, the rate is 4 times greater.

• Other diseases associated with smoking include cancer of the mouth, pharynx, larynx, esophagus, cervix, kidney, urethra, bladder, stomach, and pancreas.

• Lung diseases, such as chronic bronchitis and emphysema, are linked to smoking. Smoking exacerbates asthma symptoms in adults and children. A frightening statistic is that more than 90 percent of all deaths due chronic obstructive pulmonary diseases are attributable to smoking.

• Smoking substantially increases the risk of heart disease – including aneurysms, heart attack, stroke, and vascular disease. Smoking is said to account for an estimated 21 percent of deaths from coronary heart disease each year.

• Second-hand smoke increases the risk for many diseases. It is estimated that second-hand smoke causes approximately 3,000 lung cancer deaths per year among non-smokers and contributes to more than 35,000 cardiovascular-related deaths.

• Smoking in the home contributes to the initiation of smoking among other family members. It also increases severity of childhood asthma and has also been associated with sudden infant death syndrome (SIDS).

Nicotine Addiction

In the classic sense, addiction to nicotine is like addiction to any other drug. It is characterized by compulsive behavior – the seeking and continued use of a particular stimulus – despite negative health consequences. Anyone who smokes knows that it is harmful to their health. Many smokers say they want to or have tried to quit – repeatedly. The statistics on smoking cessation among those who say they want to quit isn’t good. Only about 6 percent of those who try to quit last for more than a month before resuming smoking.

Why such a dismal record? Why can’t people just toss their cigarettes and be rid of them? Scientists have discovered there’s more to it than just the pleasant feeling that smokers experience – and don’t want to give up. Besides, whenever they do try to quit, they have to go through withdrawal symptoms: headaches, irritability, anxiety, cravings, insomnia, fatigue, cough, dry mouth, sore throat, constipation, inability to concentrate, and tightness in the chest. Some can quit with the help of smoking cessation aids, such as nicotine replacement therapies (nicotine gum and transdermal nicotine patch), non-nicotine medications (such as bupropion and varenicline), or counseling (cognitive behavioral therapy). Some who want to quit, however, find it almost impossible to do so. Why? It may be genetic.

The Genetic Connection

Much research has been devoted to identifying genes that are associated with initiation of smoking, addiction, and smoking cessation. Simply put, one or more genetic variants have been found that, among smokers, are associated with more smoking and higher rates of nicotine dependence – which makes it harder for them to quit.

It is important to note that the addictive properties of nicotine affect all smokers, whether or not they have a genetic variant that makes addiction more likely. In addition, there are individual differences in smoking behavior, dependence on nicotine, and the success of smoking cessation methods.

The National Institute on Drug Abuse (NIDA) (http://www.nida.nih.gov/researchreports/nicotine/newFrontiers.html) reports that studies of twins indicates that approximately 40 to 70 percent of an individual’s risk of becoming addicted to nicotine depends on his or her genes. Genetic variants associated with nicotine metabolism have been shown to influence how people smoke. One recent NIDA-funded study identified a variant in the gene for a nicotinic receptor subunit that doubled the risk of nicotine addiction among smokers. Later, another study found the same gene variant also increased susceptibility to severe health consequences of smoking, including peripheral arterial disease and lung cancer.

Interesting research centers on three genetic regions associated with the number of cigarettes smoked each day. In one study, which analyzed the phenotypes of more than 74,000 people, one region was associated with smoking initiation, while one was associated with smoking cessation. Genetic variants located on chromosome 15 that were associated with heavy smoking lie within a region that contains nicotine receptor genes, which other scientists have previously associated with lung cancer and nicotine dependence. Helena Furburg, study co-author and a research assistant professor at the University of North Carolina, cautioned that getting yourself tested for these variants won’t tell you anything meaningful about your smoking risk or ability to quit smoking. In the future, however, it might be possible for researchers to use these genetic variants to predict how different smoking cessation techniques may work.

In a second recently-reported study, a research team led by Clyde Francks from Oxford University tested the human genome for genes associated with cigarette smoking. Based on their analysis of more than 40,000 people, the team found that a group of genes located on chromosome 15q25 is associated with the number of cigarettes that people smoke each day. These three genes (CHRNA5, CHRNA3, and CHRNB4) encode neuronal nicotinic acetylcholine receptor subunits. The study was reported in the April 25 online issue of Nature Genetics and is available through PubMed (http://www.ncbi.nlm.nih.gov/pubmed/20418889).
In a third study, researchers in Iceland, using data from more than 70,000 smokers, confirmed that genes on chromosome 15 were linked to tobacco use. The researchers found two other genes involved in nicotine metabolism (CYP2A6 and CYP2B6), and two more (CHRNB3 and CHRNA6) that play a role in how the body processes nicotine. Researchers also pointed out that some of these gene regions are also associated with a predisposition to lung cancer. The abstract is available at PubMed (http://www.ncbi.nlm.nih.gov/pubmed/20418888).

A fourth study using mice finds that altering one letter (or nucleotide) in a genetic code significantly impacts how an individual responds to nicotine. In the study, mice engineered to differ at a single nucleotide in a gene called CHRNA4 don’t find nicotine to be rewarding and are less inclined to self-administer it orally. The researchers report that the change of this single nucleotide also alters how an area of the brain that is critical for nicotine dependence responds to nicotine. This is the first study to demonstrate that a single nucleotide change is enough to alter behaviors and change brain function relative to nicotine dependence. The study abstract, “CHRNA4 A529 knock-in mice exhibit altered nicotine sensitivity” is available through PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez).

Outlook for the Future

Efforts to help curb smoking such as “Quit Smoking Day” and other media campaigns, bans on cigarette smoking in public places, and educational efforts aimed at youth are important elements in an overall coordinated plan to reduce smoking in this country, as they are worldwide. Some developing countries, where smoking initiation continues to rise, especially among women, are going even further by issuing a ban on tobacco advertising and sponsorships. While that’s not likely to happen in the U.S. anytime in the near future, keeping media and educational efforts going may begin to show results.
As with other addictive substances, the earlier an individual begins smoking tobacco, the quicker they are likely to become addicted. The more often they smoke, the greater their risk for developing serious illness and disease. Add in genetic and familial components – family history of tobacco use, genetic disposition to becoming addicted to nicotine – and the issue of tobacco use among young people becomes even more significant.

The good news is that smokers can improve their health by stopping. The U.S. Surgeon General has said that, “Smoking cessation represents the single most important step that smokers can take to enhance the length and quality of their lives.” Based on data from the 1990s, the CDC estimates that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years because of smoking. The American Cancer Society says, “No matter how old you are or how long you smoked, quitting can help you live longer and healthier.” People who quit smoking before the age of 50 cut their risk of dying within the next 15 years in half, compared to people who continue to smoke.

Here’s what happens in the human body after you quit smoking (data from the American Cancer Society):

• 20 minutes after quitting: Heart rate and blood pressure drops.
• 12 hours after quitting: Carbon monoxide level in blood drops to normal.
• 2 weeks to 3 months after quitting: Circulation improves and lung function increases.
• 1 to 9 months after quitting: coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
• 1 year after quitting: Excess risk of coronary heart disease is half that of a smoker’s.
• 5 years after quitting: Stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting.
• 10 years after quitting: Lung cancer death rate is about half that of a person who continues to smoke. Risk of other cancers decrease as well, including cancers of the mouth, throat, esophagus, bladder cervix, and pancreas.
• 15 years after quitting: Risk of coronary heart disease is the same as a non-smoker’s.

How to Quit Smoking

Experts recommend a coordinated and comprehensive approach to smoking cessation. For those who do not have a genetic predisposition that increases their risk of addiction to nicotine, nicotine replacement therapy, or NRT, (gums, patches, and lozenges) can make it easier to quit. But NRT only handles the physical symptoms of nicotine withdrawal. Pairing NRT with a program that helps to change the smoker’s behavior will likely yield greater success. Such a combined approach doubles the smoker’s chance of successfully quitting.

Hard-core, chronic smokers who also have a genetic and familial component to their smoking habit can also benefit from the combined approach to quitting, although it may necessitate additional measures. There is some evidence that high-dose NRT may help heavy smokers. Research suggests that patients’ withdrawal symptoms go away and their cravings improve without harmful effects on the heart and circulation. Still, the patient must not attempt this on his or her own. They must be carefully monitored and supervised by their physician.

Medications may also be prescribed for certain smokers trying to quit. Bupropion (Zyban), a prescription anti-depressant in an extended-release form, reduces symptoms of nicotine withdrawal. Doctors may recommend combination therapy (bupropion and nicotine patch, for example) for heavily-addicted smokers – along with counseling or behavior therapy.

Varenicline (Chantix), another prescription medication, is a newer drug developed to help people quit smoking. It interferes with the nicotine receptors in the brain to lessen the pleasurable effects of smoking and to reduce nicotine withdrawal symptoms.
Other older drugs used for smoking cessation include clonidine and nortriptyline.

A smoking vaccine, NicVax, may soon be available. As of April 2010, studies are already being conducted. NicVax stimulates the immune system to create antibodies that bind nicotine molecules so they can’t pass into the brain. In essence, the smoking vaccine reduces the rate of nicotine delivery to the brain.

Other aids to help an individual quit smoking include hypnosis, acupuncture, and low-level cold laser therapy. Some communities have Nicotine Anonymous groups, which operate according to 12-step programs such as Alcoholics Anonymous. Support from family and friends are also critical in any attempt to stop smoking. Quit smoking classes are also available through the American Cancer Society, the American Lung Association, or local health departments.

For more information on how to quit smoking, see the American Cancer Society’s “Guide to Quitting Smoking” (http://www.cancer.org/docroot/PED/content/PED_10_13X_Guide_for_Quitting_Smoking.asp). The American Cancer Society can help smokers find other resources that may be available for quitting. Call them at 1-800-227-2345.

Bottom line: You’re not losing your mind if you find that it seems almost impossible to quit smoking. If you’ve determined that you want to quit, utilize every resource available to you to put together a comprehensive program that will provide you the support and encouragement you need to follow through with your decision. Keep at it. If you relapse, get back into the program and keep going. Look at it this way. Your life – and the lives of those you love – may depend on it.

You would be hard-pressed to find a pregnant woman under a doctor’s care in the United States who does not know that smoking during pregnancy can have long-term effects on the physical health of the child.

Now, according to new research featured in a Science Daily release, prenatal smoking can also lead to psychiatric problems and increases the need for psychotropic medications in childhood and young adulthood.

Researchers in Finland found that adolescents who have been exposed to prenatal smoking were at an increased risk for use of all psychiatric drugs, especially those that are used to treat depression, ADHD and addiction when compared with those who were not exposed.

“Recent studies show that maternal smoking during pregnancy may interfere with brain development of the growing fetus," said Mikael Ekblad in the Science Daily.

Ekblad is lead author of the study and a pediatric researcher at Turku University Hospital in Finland. "By avoiding smoking during pregnancy, all the later psychiatric problems caused by smoking exposure could be prevented," he added.

In gathering information from the Finnish Medical Birth Register on maternal smoking, researchers analyzed data to find that 12.3 percent of young adults had used psychiatric drugs. Of those individuals, 19.2 percent had been exposed to prenatal smoking.

Researchers found that the rate of psychotropic medication use was highest in young adults whose mothers smoked more than 10 cigarettes a day while also pregnant at 16.9 percent. In a close second were youths whose mothers smoked fewer than 10 cigarettes a day at 14.7 percent and unexposed youths at 11.7 percent.

Smoking appeared to increase the risk for use of all psychotropic drugs, especially stimulants used to treat ADHD and drugs for addiction. An increased risk for use of drugs to treat depression was also seen.
 

Smokers try various methods to aid their determination to eliminate nicotine addiction. Some try gum, others try the patch, while still others undergo hypnosis to try to quit smoking. Now smokers may be trying another method—electronic cigarettes.

Electronic cigarettes are also called the e-cigarette, which is sold as a refillable nicotine dispenser with a heater that simulates the effects of smoking a cigarette. The heater is used to vaporize the nicotine into the user’s mouth. While electronic cigarette companies market the safety of their product, there is some question as to its effectiveness in smoking cessation.

A recent study evaluated the impact of the e-cigarette on the smoking habits of smokers who wanted to stop smoking (Eissenberg, 2010). The study compared the nicotine and craving levels of regular cigarettes and two brands of e-cigarettes when used by smokers.

The study employed 16 participants who were aged 18-55 and smoked more than 15 cigarettes per day for the last year. The participants had no prior knowledge of the e-cigarette, were not trying to quit smoking, and agreed to not smoke for the 12 hours preceding each session.

The participants went to one session each for four products: preferred cigarette brand, a sham cigarette (where participants “smoked” an unlit preferred cigarette), an e-cigarette with an 18mg nicotine cartridge, and an e-cigarette with a 16mg cartridge.

The researchers measured the blood plasma nicotine levels of the participants. The participants were also evaluated using the Tiffany-Drobes Questionnaire of Smoking Urges Brief and a visual analog scale that included measures of the Hughes-Hatsukami Smoking Withdrawal Scale (Hughes & Hatsukami, 1986).

The researchers evaluated the participants 5 minutes before each puff, and then at 5, 15, 30, and 45 minutes after the first puff. After one hour, the product was used again and the evaluation process was repeated.

The results of the study show that the preferred lit cigarette increased plasma nicotine levels and decreased cravings, while the two e-cigarettes did not produced a significantly elevated level of plasma nicotine and did not reduce cravings, except in one scenario: the 18mg nicotine e-cigarette did reduce cravings at the 5 minute timepoint during the second round.

The sham cigarette did not reduce craving levels or increase plasma nicotine levels.

There are limitations to the results of the study. The sample size is small and the results may not be generalizable to other populations. In addition, nicotine delivery and effects may differ depending on chronic use and intensity of inhalation of nicotine.

The results of the study indicate that e-cigarettes may not be accurately marketed as a smoking cessation assistance tool. Further research is needed to determine whether the results found here translate to a larger population and can support or disprove the ability of e-cigarettes in easing smokers in quitting.
 

Accidental poisoning is a common occurrence among those using medications for recreational purposes. Now, a new dissolving nicotine pellet could lead to accidental poisoning in children, simply because the pellet too closely resembles candy.

According to a recent Science Daily release, the Harvard School of Public Health (HSPH), the Northern Ohio Poison Control Center, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), found the candy-like products could appeal to young people and even lead to nicotine addiction.

R. J. Reynolds Tobacco Company launched a dissolving nicotine product in 2009 known as Camel Orbs. Company literature promotes this product as containing 1 mg of nicotine per pellet and flavored with cinnamon or mint. Camel Strips and Sticks were also introduced and all products were intended as a temporary form of nicotine for smokers in settings where smoking is banned.

Professor Gregory Connolly, lead author of the study and director of the Tobacco Control Research Program at HSPH, believes the actual impact and potential public health effect could be disastrous.

"This product is called a ‘tobacco’ product, but in the eyes of a 4-year-old, the pellets look more like candy than a regular cigarette. Nicotine is a highly addictive drug and to make it look like a piece of candy is recklessly playing with the health of children," said Connolly.

Throughout the nation, ingestion of tobacco products by infants and children is a major reason for calls to poison control centers. In fact, in 2007, 6,724 tobacco-related poisoning cases were reporting among children five and under.

Researchers determined that a one-year old infant could suffer mild to moderate symptoms of nicotine poisoning by ingesting 8 to 14 Orbs, 14 Strips or 3 Sticks. Severe toxicity or death could result from ingesting 10 to 17 Orbs, 17 Strips or 3 to 4 Sticks. A four-year old could suffer moderate symptoms from 13 to 21 Orbs, 14 Strips or 4 Sticks. Severe toxicity or death could result by consuming 16 to 27 Orbs, 27 Strips or 5 Sticks.

Smokers are inundated with enticements to stop smoking. Commercials and posters warn about the risk of cancer, nicotine gum advertisements tempt smokers with images of healthy people living fresh, outdoorsy lives, and even their own packs of cigarettes warn them that it might be wise to quit.

But quitting is hard. Relapse is common (Shaffer et al., 2004), and smokers often avoid quitting to avoid the frustration of the relapse. A recent study examined whether reactivity exhibited prior to quitting to smoking-related images and words might indicate an increased risk of relapse (Janes et al., 2010).

The study was based on the assumption that if markers for high risk of relapse could be identified, then smokers might be targeted for additional opportunities to intervene before relapse has taken place.

The researchers identified 21 women who met criteria for nicotine dependence and smoked a minimum of 10 cigarettes per day over the last six months, produced more than 10 ppmv air CO, and were part of an 8-week smoking cessation clinical trial.

The participants were asked to complete written questionnaires and to engage in two reactivity tasks. The first task was a Stroop task, in which participants were asked to indicate a word color for smoking-related and neutral words and their accuracy and time were recorded.

In the second task, participants were measured using fMRI scans while they responded to smoking-related, neutral or animal images. The participants were measured each week for smoking levels using expired CO measurement and self-report.

The results of the study showed that the participants who relapsed back into smoking behaviors showed more fMRI reactivity to smoking cues in multiple brain areas.

The small number of participants in the study presents a limitation to the generalizability of the study’s results. The enrollment of the participants in the smoking cessation trial also limits the generalization of the results, because the circumstance might indicate that the participants are help-seekers and different from the general population of smokers.

The findings of this study are important because establishing markers for smoking relapse could be critical in helping to identify individuals who are about to relapse. A type of early detection and warning system could be established with more research to allow smokers to quit with the reassurance that their relapse could be identified and prevented.

The identification of markers using fMRI may offer some comfort to smokers who are being encouraged to quit at every turn. Their relapse risk could be measured as an enticement to cessation success, giving them a temptation to quit that could hardly be refused.

You’ve decided to quit smoking. Now comes the hard part. It is tough to quit smoking. There’s no getting around that. But with preparation, careful planning and determination, you can get through it. Here are some strategies for how to quit smoking.

Know the Smoking Risks

First, it’s important to keep in mind that there are many risks to continued smoking. It’s wise to take a look at them to help you solidify your intention to quit smoking.

Short-term health risks include increased coughing, the start of worsening asthma symptoms, and shortness of breath. Long-term health risks include emphysema, heart attack and stroke, lung disease and cancer. There are also risks to others. These include family members getting lung cancer or heart attack, children starting to smoke because you do or getting frequent ear infections or asthma, and infants succumbing to sudden infant death syndrome (SIDS).

The American Lung Association says that more than 392,000 people in the U.S. die every year from tobacco-caused disease, making it the leading cause of preventable death. In addition, 50,000 people die each year from second-hand smoke. Thousands of young people pick up a cigarette and begin smoking every day. Thus, the cycle of addiction, disease and death continues – all due to a completely preventable condition.

Make a Plan to Quit

Second, you have to have a plan. When you decide to stop smoking, recognize that it won’t happen by itself. You have to make it happen. That entails making a plan. Identify potential problems along with barriers you will face.

• Set goals – Break your plan into a series of smaller goals. Such goals should answer questions such as by when, how long, or what. For example, you may write, “I will make daily entries into my quit smoking journal for one week. I will start tomorrow.”

• Set a start date – You can’t stop smoking if you don’t begin your program. Get yourself motivated by putting down a specific start date – and then stick to it. Experts advise avoiding high-stress days such as holidays, birthdays or vacations.

• Plan your rewards – Put down ways to reward yourself when you reach certain milestones: the first day you don’t smoke, after the first week, a month, two months, six months, and a year. Write the ways you will reward yourself. This may be a gift you give yourself, going away for a weekend with your spouse or significant other, buying new clothes, going out for a special event in celebration.

• Pace yourself – You just may need longer to accomplish your goal to quit smoking. Understand that some of the obstacles you encounter will still cause you to be tempted for many months after you quit smoking. This may be the smell of cigarette smoke as you pass by other smokers, the sound or sight of someone lighting up on TV or in the movies, being around certain friends or family members who smoke.

• Be realistic – When you set down your goals, it’s important to be realistic about them. Make sure they’re doable for you. For example, make a goal to start by cutting back to 10 cigarettes a day instead of your current 20. You can step down from that, incrementally.

• Make small (but important changes) – Ditch all your cigarettes – from your house, car, and garage, office, stashed away in hiding places. Toss out your cigarette lighters (even those with sentimental attachment, costly ones, etc.), ashtrays, pipes, cigars, and snuff containers – anything associated with smoking.

• Clean house – Literally and figuratively, you need to freshen things up in your surroundings. This includes cleaning the house to get out the smoke residue in curtains, walls, upholstery.

• Don’t allow smoking in the home – Make sure everyone abides by this rule. Smoke traces will only contribute to your urge to pick up a cigarette.

Make a Conscious Choice to Quit Smoking

All anti-smoking plans involve making a choice not to smoke, but it’s very important to make this a conscious choice. And you don’t just say you’re going to quit smoking, start the plan and forget about your choice. No, you need to remind yourself daily that you are not a smoker and you choose a life free of smoking. This conscious choice is an affirmation of the way you want to live. Repeating it daily, and whenever you encounter temptations, feel the pull of triggers, or experience withdrawal symptoms, will help you in your overall goal to quit smoking.

The toughest time will be the first 24 hours. Once you get through this critical time, it will get progressively easier to stick to your quit smoking plan – if you utilize your strategies.

About Urges

Regarding urges, you can’t stop them completely, but you can deal with them – one at a time. Give yourself time for the urges to pass. Experts say that urges will generally last no more than 6 minutes. You can time it to see how long yours last. Plan in advance what you’ll do when these urges occur. Don’t think you can “just smoke one” cigarette to get rid of the urge. It will only increase the frequency and intensity of the urges and quitting will be all the more difficult.

Exercise is a good way to combat urges. Strenuous exercise (it can be anything from walking around the block to playing sports) helps relieve tension and prevents weight gain in addition to distracting you while the urges pass.

Deep breathing exercises also help. Every time you have the urge to smoke, engage in five minutes of deep breathing. Repeat this at regular intervals throughout the day. Deep breathing not only helps curb urges, it also is one of the best relaxation techniques there is. It’s also easy, convenient, and it doesn’t cost you anything except a few minutes.

It also helps to control your blood sugar by eating small meals more frequently. Eating foods rich in unrefined carbohydrates gives your body a steady source of glucose. And glucose helps you combat nicotine-created “highs” and “lows.”

Know – and Deal With – Triggers

Triggers may be people, events, places, or certain times. Learn to identify your triggers for smoking and plan for how to deal with them before you begin your stop smoking program. Some common triggers include:

• Alcohol, stress, and being around other heavy (or light) smokers.

• Routine – smoking after a meal, when you get up in the morning, just before you go to bed, after or before exercise.

• Places – a bar or restaurant, family get-togethers (times of high stress), outside of work.

• Times – Happy Hour on Friday nights, certain times of the day or night), holidays.

• Events – Anniversaries, birthdays, before making a speech, a job interview.

How you deal with your triggers will vary. For some people, acknowledging a trigger and focusing on coping strategies works. Distraction, counseling, having telephone support, exercise or medication works for others. Some people use a combination of all of these. The important point is to have a strategy in place to deal with your triggers – and then use it.

Combat Weight Gain

Many people, especially women, are afraid of gaining weight if they stop smoking. Some even begin smoking as a means of losing weight. Here are some suggestions to help you combat potential weight gain during your stop smoking campaign:

• Increase your daily intake of fresh fruits and vegetables. Avoid high-fat foods. Add more whole grain products into your diet.

• Get out there and exercise. Being active helps you feel better and keep off the pounds. Aim for at least 20 minutes of strenuous physical exercise – walking, hiking, and working out, etc. – at least four times a week.

• Need to chew? Use a substitute. Instead of food, try chewing gum. Nicotine replacement gum is a good choice for many since it satisfies the urge to chew, helps reduce cravings, and doesn’t add weight. Other chew substitutes include a straw, coffee stirrer or Popsicle stick. Don’t laugh. They work.

• Anti-smoking medications – Besides helping you to stop smoking by reducing cravings, anti-smoking medications may help you keep weight off.

About Taking Medication

Quitting smoking is stressful. You have cravings, powerful urges to smoke. There are withdrawal symptoms such as irritability, sleeplessness, lethargy and headaches. These symptoms may last for 2-3 weeks as your body is trying to heal from the addiction of smoking.

A common reason people relapse into smoking again is that they can’t deal with the cravings and withdrawal symptoms. Medication may help. And research studies show that taking anti-smoking medication may double your chance of success at quitting smoking.

Are you afraid of replacing one addiction with another? Non-smoking aids are not addictive and, when used as directed, have few side effects for most people. And you won’t need to take the medicine forever – just as long as you need to stop smoking.

Your employer or health plan may pay for a stop smoking program and/or help to pay for the cost of medication. Another plus is that medication to stop smoking costs far less than the smoking products themselves. Once you’ve quit, you’re done with the medication and the cigarettes.

There are two types of medications you can take in your stop smoking program: nicotine replacement products and prescription medicines.

• Nicotine replacement products include nicotine gum, patches, lozenges and inhalers. This is a first choice and recommended by doctors – for individuals who wish to stop smoking. Nicotine replacement products can be purchased over-the-counter (OTC) and do not require a prescription.

• Prescription medicines to help individuals quit smoking include bupropion (Zyban, Wellbutrin), varenicline (Chantix), nortriptyline (Aventyl, Pamelor), and clonidine (Catapres). These are non-nicotine prescription medicines that can be taken alone or in combination with nicotine replacement products. Bupropion and varenicline are taken before you quit smoking (1-2 weeks for bupropion, one week for varenicline), and continued for 7-12 weeks (bupropion) or 12-24 weeks (varenicline) after you quit smoking. Bupropion can be taken for 6 months to a year. Varenicline helps reduce withdrawal symptoms, cravings to smoke, and the pleasure you feel with smoking.

Medication Risks

Any decision to take anti-smoking medication should be made in conjunction with your doctor’s recommendation. There are risks for prescription medications, potential side effects that some – but not all – users may experience.

Itching and redness may appear at the site of nicotine replacement patches.

Common side effects of varenicline include constipation, increase in dreaming, and nausea. Most people who use varenicline and a nicotine patch will experience dizziness, headaches and nausea. Caution: varenicline may make symptoms of mental illness worse, or it may bring back symptoms in people that have had a mental illness such as bipolar disorder or depression.

Bupropion’s common side effects include dry mouth and trouble sleeping. There is a small risk of seizure in some people taking bupropion. This risk increases if you have had seizures in the past (before taking bupropion).

Be sure to inform your doctor about any other medications (prescription and OTC) you are taking, along with any vitamins and supplements. Using anti-smoking medication may change the way those medications work.

Note that the Federal Drug Administration (FDA) warns that people taking varenicline or bupropion that experience serious or unusual mood or behavior changes or who feel like hurting themselves or others should stop taking the medication and immediately contact their doctor. If friends or family members notice such changes in mood or behavior in someone taking the anti-smoking medications, they should encourage the person to stop taking the medication and contact their doctor right away.

How to Decide About Anti-Smoking Medication

Experts recommend the following when making a decision about whether to take anti-smoking medication to quit smoking.

• Reasons to take – If you smoke more than 10 cigarettes per day, tried to quit in the past without medication and it didn’t work, you have withdrawal symptoms when you try to quit (grouchiness, inability to focus or concentrate on what you’re doing, hunger), you may wish to take anti-smoking medication.

• Reasons not to take – Persons under 18, women who are breast-feeding or pregnant, and those who smoke fewer than 10 cigarettes a day should not take anti-smoking medication.

Where to Find Support

Counseling and support are critical to a successful stop smoking program. Research shows that people who use group, one-on-one counseling or telephone support systems are much more likely to stop smoking. It’s not hard to find such support, either. Make use of any and all outlets to get the support you need, including:

• Friends and family – Your loved ones and close friends, even coworkers, can offer encouragement, a shoulder to lean on when you’re having trouble, recognition and reinforcement of your commitment to quit, a distraction when you need it, and understanding when you’re in the midst of withdrawal symptoms.

• Counseling services can help provide practical ideas and tips on how to avoid common mistakes when you begin your stop smoking program.

• Consult with your physician, a nurse or a therapist.

• Check with your local hospital or county health department about programs to quit smoking.

• Call the National Tobacco Quit Line at 1-800-QUIT-NOW (1-800-784-8669).

• Stop smoking plans – Check out the American Lung Association’s Freedom from Smoking program available through www.lungusa.com or QuitNet (www.quitnet.com). Anti-smoking programs can benefit you by offering help deciding which medicine may be right for you, daily email reminder messages, email, live chat or online support from counselors and others who have quit smoking.

What If You Relapse?

It’s not the end of the world if you fall back into your habit of smoking. Recognize this and prepare yourself ahead of time for what you’ll do if this happens – and, it may not. Experts say that many people try unsuccessfully to quit smoking before they finally get it out of their system for good. All it means when you relapse is that your strategies didn’t work quite as well as you’d hoped. It doesn’t mean you’re a failure or a bad person. You just need to rededicate yourself to your effort, take a look at what did work and incorporate more of that into your new plan, and examine what didn’t work so that you can eliminate that or avoid it in the future.

If you didn’t use medication the first time around, maybe you should consider it this time. Or, if you used medication but didn’t get counseling, try adding that to the mix. Experts say that the best success in anti-smoking efforts occurs when people use medication and counseling together.

Above all, don’t give up. The process of quitting smoking – especially for long-time smokers – is tough and it takes time. Not everyone succeeds the first time out. Keep reminding yourself of why you want to quit smoking, the benefits or goals you have in your action plan. Post these where you can see them every day – on your dresser or bathroom mirror, on a 3×5 card you keep in your purse, at your desk, in a small photo frame or elsewhere. This serves as reinforcement and a positive reminder that you are striving for something truly worthwhile.

You can do it. You really can quit smoking. Make your plan and start today.

While parents may believe their influence over their children diminishes over time, in reality, they can still play a significant role in teen choices. A recent study found this to be especially true in terms of tobacco use.

Science Daily recently posted a release covering a study done by the University of Washington’s Social Development Research Group. In this study, researchers found new evidence supporting the theory that parents do play a key role in whether or not teens who experiment with tobacco go on to become daily smokers before they graduate from high school.

“If parents really don’t want their children to smoke they need to communicate that by establishing clear guidelines in their families about not smoking and discuss them with their school-age children.” said Min Jung Kim, a research scientist with the University of Washington’s Social Development Research Group and lead author of the study.

This is great news for parents, of course, but they can have the opposite impact at the same time. In fact, parents can increase their children’s chances of smoking by their own use of tobacco.

“If parents smoke, teens have more access to cigarettes than teens that have non-smoking parents. A second preventive measure for smoking parents is to quit smoking themselves,” said Kim.

In addition to parental influence, other factors that contributed to the likelihood of a teen smoking include having friends who smoke and their involvement in other problem behaviors, such as skipping school, fighting and vandalism.

According to Kim, most smoking prevention programs do not directly address the role of parental smoking or the link between anti-social behavior and smoking, which commonly occur together.