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Posted by NDC.Treatment.Team Nov 25, 2020

Thanksgiving is likely to be a different experience than usual this year given the dangers from COVID-19.  We hope you are planning to be safe and stay healthy.  You’ve already shown a commitment to a healthier you by deciding to stop smoking.  Make plans to get through the holiday safe, healthy, and smoke free, despite the COVID pandemic. 


Given the spread of COVID, the safest way to spend the holiday is celebrating with those people with whom you live.  But, that doesn’t mean you cannot connect outside your home.  Call your loved ones, reach out to a friend you haven’t spoken with in a while, maybe even connect with others in this EX community.  Being safe does not need to be alone.


If you’ve decided to travel and or gather with others, try to keep safe distance, do your best not to share air with others, and wash hands often. The CDC provides some good guidance that you might find helpful.  


It has been a difficult year; but if you’re on this community, you likely have some things for which to be grateful.  Take a few moments this holiday to think through your ‘gratitude list’.  If you would, share some of those things here, on EX.  Let’s get through this together.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Often I’ve heard patients say, ‘I haven’t been able to stop, so I must not really want to stop.’ But as many of you know, just ‘wanting’ or willpower by itself is not a solid foundation for recovery.   Not to say that it is not a factor that contributes to success, but too often relying only on willpower results in caving into craving when faced with smoking situations.   Successfully negotiating the highly reinforced triggers to smoke, and instead putting in place different habits or ways of thinking when the thought of a cigarette happens, is best done with solid planning rather than just brute force.


Muscle power is a useful analogy for willpower.   Willpower can energize a quit attempt, or help a person to develop or activate strategies to manage smoking situations.  Like a muscle, it can strengthen or become fatigued.  Most people do ‘want’ to stop on some level. But over time the conflict between hoping for a change and the discouragement inherent in ‘not succeeding’ becomes tiring.  Hope for success fades not because of the lack of ‘willpower’ but because the strategies to manage the reinforced impulse to smoke haven’t been fitting or sufficient.


Willingness to learn from experiences and to try new strategies is a much more rewarding approach than expecting brute force to overcome deeply rooted addictive habits.  Thoughts and urges to smoke are going to happen and won’t be willed away.   They will fade over time and can be reduced, avoided, outlasted, and outsmarted.   Doing something different, taking a deep breath, thinking about reasons for stopping, calling a friend, taking a walk, or having a sip of water are all things that can cause that urge to dissipate or collapse.  The intensity of caving can be muffled and withdrawal symptoms eliminated with nicotine replacement or other medications.  Build the willpower muscle by celebrating little successes and taking things a day at a time.  Use willpower to make a plan rather than as a blunt instrument to overcome all.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

The tobacco epidemic takes a toll on all of us.  Inflated health care costs and lost productivity affects both people who smoke, and people who don’t.  The dangers from second-hand smoke, and possibly vape residue, can cause harm to people who don’t use those products.  Another cost we all bear from nicotine addiction is the environmental burden from the devices that deliver nicotine: cigarettes and vaping devices.


Trillions of cigarette butts are tossed into our environment each year.  Not uncommonly people will remark on the unsightliness of a pile of filters, but less recognized are the real harms to our world.  Filters from cigarettes have been the leading cause of plastic pollution around the globe.  They take years to break down, and when they do they become microplastic particles which are an insidious hazard to both land and aquatic ecologies.  The butts are also laden with toxic metals and other harmful chemicals. Studies have found that one cigarette butt in a liter of water can kill half the fish in that liter. 


Vaping devices are a newer, but increasingly significant, environmental problem.  E-cigarettes include a heating element, a battery, a mouthpiece, and a pod or cartridge that holds the e-juice.  The toxins in the e-juice contain various toxins.  These toxins are no doubt growing as an environmental threat as are the plastic, metal, or other compounds from the device components. 


What can we do?  As a start the FDA has issued guidance for the disposal of e-cigarettes.  If you or others are getting rid of these devices, and we hope you are, dispose of them safely.


And as a proposal to save our environment from cigarette butts, how about we ban filters?   There is no evidence that filters have saved one life or prevented one illness.  They are a sham to imply a healthier product;  a sham which is strangling this world we all love and need.  Why should we have them?  No filters might mean that a few more people think about quitting, or others don’t start smoking.  Seems like a win-win to me. 


I would be interested in hearing your thoughts on this.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

COVID-19 is not going away anytime soon, and so it is imperative that we look at how we can mitigate its effects on our health, and those around us, should we, or anyone we know, contract it.


Research is showing that young people – teenagers and young adults who vape are at a sizeable risk for contracting COVID-19. 


A study by the Stanford University School of Medicine, published in the Journal of Adolescent Health – August 1l, 2020, notes that those who vape are at a 5-7 times greater risk of contracting COVID-19 than those who do not use e-cigarettes.  Bonnie Halpern-Felsher, Ph.D., senior author of this study states that “Teens and young adults need to know that if you use e-cigarettes, you are likely at immediate risk of COVID-19 infection because you are damaging your lungs.


Additionally, the lead author of the study, Shivani Mathur Gaiha, Ph.D, states “this study tells us pretty clearly that youth who are using vapes or are dual-using [e-cigarettes and cigarettes] are at elevated risk, and it’s not just a small increase in risk; it’s a big one..”


This is a wake-up call to young people.


Universities are switching course on in-person instruction to a hybrid or even virtual only due to COVID-19 outbreaks at their school, so this should be a serious concern for young people.


Please know that you are not immune from getting the Coronavirus. And again, whether you have symptoms or not, you could be an asymptomatic carrier of the disease – giving it to your roommate, girlfriend or boyfriend, siblings, parents, and grandparents. 


Barb Dallavalle, MA, LP

NDC Counselor/CTTS



Few people would dispute that we are living through a high-stress time, and that can take a toll.  We are built to adapt to change. The body has a ‘stress response system’ by which we manage our energy to respond to demands.   But when demands are too much, the system can become overloaded, which can cause widespread damage to emotional, physical, and social health.


Managing how we respond to demands and taking some simple steps to care for our ‘stress-response’ system can be wonderfully helpful.   Regular exercise, connecting with friends,    setting aside time to recreate, and kindling positive thoughts and emotions, are all proven to be effective in building resilience and preventing ill effects from stress overload.  Another tool that can help is taking time, even a few minutes a day, to practice meditation and or relaxation.


Meditation can bring about  a foundation of calm from which we can better respond to the change and demands we face during stressful times.  It builds our reserves, helps us relax, and improves our ability to cope.  In the long run it improves both mood and health. 


Types of meditation can be practiced just about anywhere and even during busy times.  While there are many ways to meditate, common characteristics of most meditation include a focused attention, relaxed breathing, and an open non-judgmental attitude toward self.  There is no one right way to meditate, but experimenting with different ways of relaxing, and practicing what seems to fit best, is a good start.  Here is a link to more information that can help you get started or inspire you to recommit to practice.


I’m sure there are many meditators out there in the EX Community and I would invite others to comment on their method and experience?


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

What do Walt Disney, Joe DiMaggio, George Harrison, Lucille Ball, Johnny Carson, Patrick Swayze and Eddie Van Halen have in common?  They all died from a smoking caused illness, and their smoking was not mentioned in any of their obituaries.  We tend to turn away from an accurate and direct attribution of the specific harms caused by smoking. 


First the facts.  Smoking is extraordinarily lethal.  It is the only consumer product that is proven to kill at least 60% of the people who use the product as the manufacturer intends.   But smoking persists.  Many smokers will say things like “I know it’s bad, but that’s not enough to make me stop”.  Others minimize the harm, saying things like “Everything causes cancer”, of “I know a person who smoked and lived to be 90”.  What gives?


Behavior, decision making, perception of risk and attribution of blame are complicated processes.  Human beings are not as rational as we would like to believe. 


A clear- eyed weighing of the benefits and the cost is not how we make most decisions.  Decisions usually spring first from a perception and an associated impulsive response: an immediate unconscious inclination to seek reward and satisfy ‘want’ or avoid pain and unpleasantries.  Often our reasons or rationale for decisions and actions are applied afterwards, to justify or ‘make sense’ of what we’ve done.  We certainly have the capacity to delay gratification, and act in our long term best interest, but that takes an application of energy to override unconscious habitual responses.  If the habitual responses are strong, like addictive behaviors, more energy is needed to do something different.  And if the cost is too high, reasons will shift to explain or justify the behavior. 


Similarly, how we assess health risk is not based upon objective data. Instead it varies and will change based upon the personal perception of how susceptible “I” might be, and the effectiveness and cost of taking action to prevent the health risk.  People who smoke will underestimate the health risks of smoking compared with non-smokers, and people who are more addicted to smoking usually underestimate the risks compared with people who are less addicted.   The assessment of risk will change based upon how difficult it is to stop or avoid smoking.  The severity of the addiction overrides our reasoning.


How we attribute blame varies too.  We tend to blame and shame ourselves or other people when there seems to be ‘responsibility’ for causing an illness.   We tend to feel more compassion and understanding when illness happens by chance or circumstance.   Of course we shouldn’t blame or shame as this just adds insult to injury, but that’s a natural tendency. 


Eddie Van Halen thought that his oral cancer might have been caused by the metal guitar pick he would sometimes keep in his mouth.  Maybe, but unlikely.  Cigarettes are probably the culprit.  But in memorial, I would rather understand his reasoning, have a compassionate thought for the sad loss of a great guitar player, and blame the industry that created this addictive and deadly product.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

E-cigarettes use by young people has increased significantly and steadily since 2011.  The US Surgeon General declared e-cigarettes a school age epidemic in 2016.  Despite this alert, e-cigarette use continued to increase from 2017-2019.  But the recently released 2020 National Youth Tobacco Survey provides a glimmer of hope that we may be making progress. 


28 % of high school students and 10.5% of middle school students reported that they had used an e-cigarette in the past 30 days in 2019.   The most recent survey, completed between January 1 and March 15, 2020, found that 20% of high school students and 5% of middle school students reported current e-cigarette, a seemingly small, but very significant drop.   It may be that comprehensive evidence based strategies are beginning to work.


The FDA has measures in place to reduce access and marketing of e-cigarettes to people under 18.  These efforts may be having an effect.  Now is the time to expand enforcement and increase prevention.  Young people are most likely to use pre-filled pods that have fruit flavors or menthol. Most of these devices deliver very high doses of nicotine while attracting middle school students with the flavor – a wolf in sheep’s clothing.  Flavored and mint e-pods that appeal to children are illegal to manufacture.  The FDA needs to beef up enforcement so that the progress in preventing addiction among young people continues.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Next Tuesday, September 29 is International Heart Day.   Everyone in the EX community should know that you are an important participant in this celebration of the heart.  The World Heart Federation encourages everyone to participate in International Heart Day by 1. understanding what it takes, and changing behavior, to have a healthy heart. 2. Be an example and positive influence for others to have a healthy heart, and 3. act to support others who are vulnerable to cardiovascular disease.   Each of these activities are taking place every day on this community.


Heart disease is the leading cause of death in the world, and tobacco use is the biggest single preventable cause of cardiovascular disease.  Tobacco caused heart disease takes almost 2 million lives worldwide each year.  Different compounds in cigarette smoke affect almost every factor in the development of cardiovascular disease.  Compounds in smoke reduce the elasticity of the arteries. Others causes damage inside the artery wall making the arteries more susceptible to blockage. Different compounds in cigarette smoke lower ‘good’ cholesterol, and make plaquing more likely.  Carbon monoxide reduces the oxygenation of red blood cells.  Cigarette smoke is a ‘perfect storm’ for peripheral artery disease, coronary artery disease, heart attack, and sudden death.  And unfortunately smoking only 1 or 2 cigarettes per day, or exposure to second hand smoke, will increase the risk for cardiovascular disease, heart attack, and sudden death from heart attack.


On the other hand, stopping smoking almost immediately begins to provide a benefit to cardiovascular functioning.  Within hours of stopping smoking carbon monoxide leaves the system and no longer reduces oxygen levels in red-blood cells. Within weeks risk of heart attack decreases, and after a relatively short period of time heart attack risk can return to that of someone who never smoked.


I wonder how many hearts EX has helped, how many lives have been saved.  Each of you, by stopping smoking yourself, by being an example, and by supporting others are actively saving lives.  Take a moment to appreciate the awesome impact you are having by being part of this community.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

When choosing the type of NRT you may use, think about which method will best fit your lifestyle and pattern of smoking or using smokeless tobacco. It is not a “one size fits all” when it comes to short-acting NRT and largely is personal preference. For example, are you looking for something to hold in your hand or to have in your mouth? Or do you want something that works rapidly?


There are currently 4 types of short-acting NRT: Nicotine gum, nicotine lozenges, nicotine nasal spray and nicotine inhaler (puffer)

  • Nicotine Gum: Looks similar to regular gum, other than containing nicotine the only real difference is that instead of constantly chewing the gum, nicotine gum is meant to be chewed until “gum like consistency” and the tucked between your gums and cheek, nicotine is then absorbed through the mucous membrane of your mouth. It comes in 2 mg and 4 mg strengths and can be purchased without a prescription.
  • Nicotine Lozenges: There are two sizes of lozenges that both come in the 2 mg and 4mg strengths. The mini lozenges are about the size of a tic-tac and the regular lozenges are about the size of a nickel. Smokers typically prefer the mini lozenges and smokeless tobacco users usually prefer the larger (or regular) size lozenges. The lozenges are not meant to be sucked on like a hard candy, but rather tucked between your gums and cheek, nicotine is then absorbed through the mucous membrane of your mouth. Lozenges can be purchased without a prescription.
  • Nicotine Inhalers (puffer): The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. Unlike other inhalers, which deliver most of the medicine to the lungs, the nicotine inhaler delivers most of the nicotine “vapor” to the mouth (puffing on, instead of inhaling). You can use the inhaler “like” a cigarette, by holding it between your fingers and putting the plastic tube on your lips. This can be very helpful if you are someone that is use to having a cigarette in your hand. Nicotine inhalers are by prescription only and remember the inhaler does not produce smoke or heat and it is not an E-cig.
  • Nicotine Nasal Spray: The fastest acting NRT product. The nicotine nasal spray is a little container with a small tip that is placed at the base of nostrils and you self-administer a small spray of nicotine. The nasal spray delivers nicotine to the bloodstream quickly because it’s absorbed through the nose. It relieves withdrawal symptoms very quickly and lets you control your nicotine cravings. Nicotine nasal spray is only available by prescription.


Here are a few things to consider when you are decided on NRT

  • Nicotine gums and lozenges are simple, discreet and fairly inexpensive.
  • Nicotine gum and lozenges are available over-the-counter.
  • Nicotine gums and lozenges are generally sugar-free.
  • Nicotine nasal spray works very quickly when you need it.
  • Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler.
  • Both inhalers and nasal sprays require a doctor’s prescription.
  • If insurance does not cover the nicotine nasal spray or the inhaler, they both can be expensive.
  • Nicotine gum may stick to dentures or dental work making it hard to chew.

Laura McConahey

NDC Counselor/CTTS

The leading cause of cancer death among both men and women continues to be lung cancer.  Lung cancer mortality is so high because it is usually not discovered early enough for treatment to be effective.  Screening and early identification saves lives.  It has become a recommended preventive practice and covered service for people at risk for lung cancer.


Most lung cancer is caused by smoking cigarettes.  Tobacco smoke contains more than 70 carcinogens, and lungs are particularly sensitive to toxins.  There is a ‘dose-response’ to smoking and cancer, so that the risk for cancer increases the more a person has smoked.  Conversely, quitting smoking is the single best way to reduce cancer risk, and the sooner the better.


Who should get screened for lung cancer?  People who are between the ages of 55 and 80, currently smoke or have quit within the past 15 years, and have a ’30-pack year’ history; for example smoking 1 pack per day for 30 years, or 15 cigarettes per day for 45 years.   Most health insurance plans, including Medicare, cover the screening for those at risk. 


The scan is done using a ‘low-density computerized tomography’ (LDCT).   The large majority of screens are negative, or have ‘incidental’ findings which are clinically insignificant.  Annual screens are usually recommended for five years in order to confirm and obtain the full benefit from screening.  For more information check out the Lung Cancer Screening and Smoking page.


Any community members care to share their experience with screening? 


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS



Posted by NDC.Treatment.Team Sep 2, 2020

In previous blogs we’ve discussed the importance of sleep for health and the complex relationship between smoking, nicotine withdrawal and sleep. Sleep is a key factor in quality of life and can be an important part of recovery from tobacco addiction.


Insomnia can mean difficulty falling asleep, inability to stay asleep, or waking too early and not being able to get back to sleep.  In any case it can be pernicious, with an increasing negative affect on energy, mood, health and performance. And too frequently the frustrations related to insomnia adds to the problem. 


At times, many adults experience some short-term insomnia which lasts for days or weeks. The culprit is frequently stress, a situational change, or a change in sleep habits.  Simple changes such as increasing physical activity during the day, reducing or managing stress, adhering to a bedtime schedule, and turning off the ‘screens’ at night can help one return to restful sleep. 


If sleep problems become chronic, a visit to your healthcare provide can help.  A sleep habit review of overnight sleep study might be indicated to define the problem.  Treatments such as Cognitive Behavioral Therapy, light therapy, and medications can work wonders in resolving chronic sleep problems.


Sleep is important.  Most people need 7-9 hours of sleep per night to be at their best.  If you are having problems getting a restful sleep, or the sleep you need, take steps to address it.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Many smokers learn, “If I smoke, my mood gets better.”  While smoking in the short-term improves mood, it produces a decline in mood, long-term.  How do you take care of your mood while trying to quit smoking?  Have you heard the phrase, “Fake it till you make it?”  It is important when quitting smoking to develop a new plan for self-care to help boost your mood. One way to do this is through Behavioral Activation (BA).  The premise of BA is to increase your contact with “feel good” rewarding activities that are aligned with a goal, such as quitting smoking.  So while you may not feel like doing the distracting activity in your quit plan because of low mood, “fake it” and do it anyway.  If you force yourself, for example, to go for a walk when a craving hits, your thoughts will brighten and your mood will lift, preventing increased depression and keeping you on track with quitting.  The next time, you are feeling blue, force yourself to do an activity that you know in the end will bring you joy and help keep you on track with your goals.


 Steps for behavioral activation:

  1. Choose specific, positive actions you can take each day to improve your mood
  2. Notice when you feel resistance to engaging in a behavior you know will help you (e.g., "I don't feel like going for a walk," etc.)
  3. Acknowledge that the resistance may be due to existing stress or depression.
  4. Decide to do it anyway (fake it till you make it!)
  5. Notice how it improved your thoughts and feelings

Heather Kraling-Coons, MA

NDC Counselor/NCTTP


Feeling Stressed?

Posted by NDC.Treatment.Team Aug 19, 2020

Feeling Stressed? Well who isn’t these days!  COVID has the whole world turned upside down. With its seemingly never-ending levels of confusion, uncertainly and worry. Yet, somehow you are still standing. You have somehow managed to find a way to be resilient enough to navigate these trying times and if you can make it through COVID you can work towards a tobacco free life.


Stress affects your health in ways that you may not even be aware of, from headaches, to insomnia, to decreased productivity. Stress may impact your mood, your behavior, your relationships, and your work. In short, stress can affect every aspect of your life.


Smokers often feel that smoking helps reduce stress while in fact it does the opposite. As Dr. Hays stated “Regular use of cigarettes shortly leads to brain changes that actually make it harder to experience stress relief. Within a short time virtually every smoker experiences increased stress and psychological distress with increased anxiety and feelings of depression as a direct result of continued smoking and dependence on nicotine”.

Check out this page on EX for some tips on managing stress.   If stress persists talking with a professional can also help. 


Laura McConahey

NDC Counselor/CTTS

As a respiratory disease, the severity of the novel coronavirus (COVID-19), may be greater for those in whom pulmonary function may already be compromised – such as those who smoke. However, the risk of initially contracting the disease may also be higher for those who use tobacco – chewers as well as smokers, due to the behavioral routines associated with their tobacco use.               


We know that many diseases can easily be spread through inadequate hand hygiene.  Any contamination on your hands can then be spread through the very act of touching other people (such as shaking hands), or touching objects or surfaces (such as doorknobs, your cell phone, a desk top, etc.)  And so it is in the current pandemic that health experts ask that we try to mitigate the touching of the nose, mouth, and face (which of course, is especially second nature to those who smoke); as it introduces another link in the chain of possibly contracting the virus.


Similarly, while COVID-19 can be found in the tiny droplet secretions from the mouth or nose (such as when coughing, sneezing, or simply exhaling), the spitting behavior so characteristic of those who use chewing tobacco can prove to be part of a very viable pathway for the spread of the disease as well.  After the chewer has spat, the virus can live on a surface for a few hours to several days. Others then, after touching such surfaces and then touching their face (nose, eyes or mouth), could become infected as well.  In fact, in previous epidemics (such as that of influenza a century ago), in more densely populated countries such as India, the spitting associated with using chew was banned to mitigate the spread of the disease.  And today, the largest state in India, Uttar Pradesh, has now banned all production, warehousing, and sale of smokeless tobacco in response to the COVID-19 pandemic. 


The behavioral actions so familiar with the use of tobacco - from either smoking or chewing - combined with the current health concerns from the possible contraction of COVID-19 make tobacco use a very high risk practice both for the individual and society as a whole. And in this very uncertain moment, the stakes could not be higher.


Barb Dallavalle, MA, LP

NDC Counselor/CTTS




Still a problem

Posted by NDC.Treatment.Team Aug 5, 2020

Prior to the COVID 19 outbreak, youth vaping and nicotine addiction were widely recognized a public health crisis.  The problem was pervasive.  The ‘Monitoring the Future’ survey found in 2019 that 25% of High School Seniors and almost 10% of 8th graders had used an e-cigarette containing nicotine in the past month. 


While youth vaping may have disappeared from the headlines, it has not disappeared as a real public health threat.  If you have teens in your  life check it out yourself;  ask them about vaping in their school or among their friends.  You are likely to hear something like this quote from a high school senior recently interviewed by Colorado Public Radio “Everybody I know or hang out with vapes”.


This is cause for concern.  Vaping can cause addiction and a number of different health problems.  It may also increase the risk for COVID-19 spread.  Keep informed and aware. Good information is available from the Truth Initiative.  As decisions are made about schools opening safely let’s not forget about the dangers from vaping.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

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