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Vaping is increasing at an alarming rate as are the related health concerns. The CDC has received almost 500 reports on severe pulmonary problems being caused by e-cigarette products.  A sixth death suspected to be caused by vaping has now been reported in Kansas.  The Surgeon General has declared e-cigarette use among young people as an epidemic, and advises immediate action.


As September unfolds, and our children settle into the school routine, it may be a good time to ask your school what they are doing to address e-cigarette use.  School policy and education can have an important impact for protecting our young people and preventing the spread of e-cigarette use.


Two good resources for schools have become available.  The Public Health Law Center has developed suggested school policies to address tobacco use and vape products in school.    The policy model includes suggestions for helping students who are found to be using tobacco products on school grounds and progressive responses for students who violate the policies.


The American Lung Association has developed an educational program for schools INDEPTH (Interventions for Nicotine Dependence: Education, Prevention, Tobacco and Health.).  The program provides step by step guides to implement an educational and counseling program in schools.  It requires prior completion of an online training for adults prior to their delivering the curriculum.


If you have children in school, know what your school is doing to address vaping and e-cigarette use. 


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS

Do you remember the song by Sheryl Crow, “a change would do you good”?   If you are here on the EX site, you are likely at least thinking about making a change to quit smoking. 


The thought of quitting can be daunting and it may even seem impossible to do.   What if you decide to stay the same and not change? That too may be hard to imagine as it might mean a shorter life, more health concerns, or less time spent with family and friends.


I would like to suggest trying change “ON” for a short time. Yes, try change ON like you would try ON a new pair of shoes.  Experiment with it, set a date and try quitting. Use the nicotine replacement products, medications, BecomeAnEx and other tools you might need to help you, and just go for it.  How does it feel?  How do your senses respond to the change? Take it all in, and process what is working well, what needs to be different.  Make adjustments as needed, you might need to go back and start over, but that is OK! 


You might find that it is easier than you thought. This change might do you good in more than one way, but you won’t know unless you try!


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS

What happens to people who smoke sometimes “ain’t very pretty.”  That is the point of the new labeling rules for cigarettes that the FDA is considering.  The label changes for cigarettes would include the requirement of having a graphic pictorial image showing 1 of 12 serious complications of smoking or secondhand smoke exposure along with a text warning describing the complication.  Many other countries have had graphic images on cigarettes package labels for many years.  The evidence supporting the effectiveness of these kinds of cigarette labels is quite clear.  When smokers are exposed to graphic images of potential serious and chronic diseases that are caused by smoking they make more quit attempts and they quit smoking more often than people who are not exposed to these labels.


Until now in the United States cigarette package labels have contained a text warning only that is quite small and on the side of the package.  The rotating warnings required under current law contain messages such as cigarettes can cause heart disease or cigarette smoking can cause lung cancer.  For the most part, smokers completely ignore these labels.  The messages about the health risks of smoking on our current cigarette package labels do not really convey the true risks of smoking like pictures.  The saying about pictures being worth 1000 words is really true when it comes to describing the health risks of smoking.  Simply reading the words that smoking can cause fatal lung disease is an abstract concept, but seeing a pair of hands in surgical gloves holding diseased lungs from someone who has died from chronic lung disease makes the potential deadly consequences of smoking very real.


The tobacco companies will fight this new rule just as they fought the previous attempt by the FDA to include graphic labels for cigarette packages in 2010.  Big tobacco convinced an appeals court that requiring these graphic images was infringing on their 1st amendment rights to free speech.  Of course, no one cares to mention that the tobacco companies have taken away from smokers the most important right, which is the right to life.


I believe placing graphic images on tobacco packages is the right thing to do because more smokers will attempt to quit, many people will be successful in quitting and almost all of those who quit will avoid the health consequences portrayed in these pictures.  It is time for cigarette package labeling to ”get real.”


Dr. Hays

The Minnesota Department of Health released an alert this week about severe lung injury in young people related to vaping.   A number of states have now reported similar harm that seems to be caused by e-cigarette inhalation.  


Lungs are vital and very reactive to toxins.  We know very little about the longer term effect of vaping upon these sensitive organs. We know these products are not harmless.  Tragically we seem destined to learn about the extent of the impact of vaping through experimentation by young people, rather than through scientific research. 


One would think that systematic testing for health and safety would be done before a potentially harmful product is marketed and widely distributed.  Unfortunately with e-cigarettes ‘the horse is already out of the barn’.  We should raise our voices to have the FDA issue sensible regulations quickly, and hold the manufacturers responsible for any marketing practices that imply these products are ‘safe’.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

We are just completing another of our Residential tobacco treatment programs. This is a 8 day program in which patients reside at the Mayo Clinic in Rochester for 8 days and participate in education sessions, counseling, and medical visits to stop treat their tobacco dependence.  We provide between 8-10 of these sessions per year.


The program has treated more than 1500 patients since it was first offered in 1994. I have been participating as part of the treatment team for the past 15 years. I would like to share a few brief reflections on this program, as I think it provides some unique perspectives on tobacco addiction and recovery.


First, it is always a privilege that these patients share with us their unique stories of tobacco addiction and their intense desire to be free from it. Sharing their stories with others in the program provides a bond that is an important part of the recovery.  


There are strikingly common themes that we hear in these individual stories.  One is that tobacco use can be an awfully difficult addiction from which to recover.  Another is that the hope patients have to recover provides a foundation to help them succeed.  A third common experience is that group support and a comprehensive plan for managing life without tobacco can transform that hope into a vision of success. 


Through the course of the 8 days we see confidence grow, withdrawal symptoms and cravings decrease, energy increase, and rosy cheeks blossom.   We see recovery begin to happen.


Many of our residential patients join the EX community, so you may hear from them soon.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Many people do not realize just how consequential and extensive the health effects of smoking are.  Unfortunately, many smokers will use a bit of information, like a doctor saying ‘your lung screen is normal’ to justify continuing to smoke.  However, compounds from the combustion process of smoking impact every system/organ of the body including the vascular system, the endocrine system,  even the eyes!!  That’s right – your EYES


In conditions such as AMD (or age-related macular degeneration), the part of the retina known as the macula becomes damaged. This impairs central vision. The blood flow to the macular part of the retina (which enables us to see very fine detail) comprised of the tiniest vessels in the body, can be directly impacted by smoking.  According to the British Medical Journal, those who smoke are at an increased risk developing age-related macular degeneration,  and smokers in general increase their chances of going blind in old age by as much as 4 times.  While smoking can directly impact one’s eye health and vision, quitting smoking decreases your risk of developing AMD by 6.7 percent after  1 year, and by 11.7 percent after 5 years.


Similarly, while you probably already know that diabetes can be complicated by smoking, there is also a condition known as diabetic retinopathy which can again affect those tiny blood vessels of the eye.  Here, those fine vessels can break down, leak or even become blocked – which can lead to blurred vision, or worse yet - blindness. 

Smoking also increases the risk of damage to the optic nerve – the nerve that makes communication from the eye to the brain possible.  The possible consequences here are so central to your vision that damage to the optic nerve can lead to glaucoma, or again, blindness. 


Although  many do not consider it, the detrimental effects of smoking on the eyes is very real, and  quitting smoking is indeed one of the most important things you can do to protect your vision for a lifetime.


Barb Dallavalle, MA, LP

NDC Counselor/CTTS



Eye Health | Tips Prevention | Smokers

Another Clear Eyed Reason to quit Smoking | Your Vision

We have written before about how mindfulness can help reduce cravings.


Indeed, mindfulness cannot only help with cravings, but it can reduce stress, anxiety, depression, insomnia, and reduce high blood pressure.  It also seems to help with asthma, pain, and fibromyalgia.  Personally I found that a mindfulness practice significantly reduced my blood pressure from borderline high to consistently in the healthy range. 


And there are many ways to practice mindfulness.   Trying different methods and sticking with the one that seems right to you is the best way to develop a consistent mindfulness practice.


Ironically, one of the biggest challenges to practicing mindfulness is remembering to do it.  Certainly having a regular time to practice helps.  But, it can be a good habit to practice just about any time, and one can benefit from being mindful for only a few moments.  So why not use challenging situations through the day as a reminder to be mindful. 


If there is a situation that you find annoying, or you notice you are feeling bored, distracted, or experiencing a craving, try to use that as a trigger, a reminder, to be mindful.  Notice how you’re feeling, then choose to instead attend to your place of mindfulness:  notice your breath, be aware of your surroundings, scan your body for tension, relax your shoulder or forehead.   Triggers, like the cues to smoke, need not be a bad thing to be avoided.  A trigger can be an opportunity to develop the good habit of mindfulness.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

The extent of the widespread damage to health caused by cigarette smoke is almost unbelievable.  Smoking kills 60% of people who don’t quit, and cigarette smoke affects almost every organ system in the human body. People are familiar with the most common problems caused by smoking, like cancers, emphysema, and heart disease.  There is less awareness about the impact of smoking on things like vision, diabetes, cholesterol, wound healing, immune diseases, arthritis, to name just a few.


I thought a discussion about some of the less well known health effects from smoking might be of interest.  As there has been some discussion in the community about smoking and the thyroid, we can start there.


The thyroid is a gland that produces hormones which help regulate general metabolism and blood pressure, heart rate, body temperature, and weight. Thyroid hormones are critical for growth, reproduction, development of nerve cells, and regulation of energy. Underproduction of these hormones (hypothyroidism), or overproduction (hyperthyroidism) are relatively common problems which can cause serious health problems.  You can find an overview of the thyroid and associated problems.


Smoking has multiple effects upon the thyroid.  Some of the reported effects on the thyroid are  strongly supported by research, while the research on other effects is somewhat ambiguous.  Reasons for the ambiguity include the fact that there are many different compounds in cigarette smoke, different studies employ different methods to measure cigarette smoking, and studies on the effect of smoking are conducted with different populations such as those with thyroid disease or general populations without disease.  


There is strong and unambiguous evidence that smoking increases a person’s risk for Graves disease (a condition causing goiter and over activity of the thyroid), and will increase the likelihood and severity of thyroid related eye disease (Graves disease can be a cause for bulging eyes that can become severe enough to threaten vision).  In addition, children who have been exposed to cigarette smoke have a significantly higher risk for Graves disease and eye related conditions, as do women who are pregnant.  Stopping smoking seems to reduce the risk and complications from Graves disease, although former smokers do continue to be at higher risk, but more research with consistent measures of ‘former’ smoker are needed.


The association between smoking and enlarged thyroid is strongly supported by evidence, especially among women.  Smoking is also found to have especially damaging effects on the thyroid among people who are iodine deficient.  A number of studies have found that smoking increases the risk of under-active thyroid among people with Hashimoto’s disease (which is the most common cause of hypothyroidism in the United States).  However other studies have not found this association. 


Unrelated to illness, smokers tend to have lower levels of thyroid specific hormones.  Studies are a bit ambiguous on the effects of stopping smoking on hormone levels, but most of the evidence supports a return to normal after smoking cessation, although the time to return to normality is unclear.


Bottom line, is for some people smoking can cause thyroid damage and dysfunction.  Stopping smoking can help.   People who have thyroid symptoms after stopping smoking, should continue not to smoke and talk with their health care provider.


I would be interested in your comments and feedback, including your thoughts on the level of detail in a blog like this.  Ideally we would like to strike a balance between providing information that is generally accessible and describing varied and sometimes complex research findings.  Let us know your thoughts, and here’s to a tobacco free future!


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Dr. Hays wrote a blog a couple of weeks ago aimed to arm parents to talk with their children about ‘vaping’.  Let’s keep the lectures to a minimum. It’s worth a read.   


I want to add to the resources referenced in that blog by my colleague,  with a new one that is right here on  EX. Helping a Child Quit Vaping | BecomeAnEX. Parents who are interested in helping children stop vaping, or who want to be more informed about vaping, can register on EX, sign up for text messages, explore all the information and support on the platform, and participate in the community. If you've already registered but didn't opt in at registration you can do so now, go to your EX Profile, then expand Personal Information, change your reason To help my child quit vaping and Save. I think that the wisdom and experience available in the community can be invaluable to a parent worrying about their teen and nicotine addiction. 


I also think the topic is important for us all, not only parents. The surge in vaping by teens, the continuing development of new vape devices, and the duplicitous and seductive marketing may well be harbingers of a public health crises. As the Surgeon General recently warned, “E-cigarette use is a cause of great concern about which we must take action to protect the health of our nation’s young people.”


As always, I’ll be interested to hear your comments.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


Real Talk

Posted by NDC.Treatment.Team Jun 26, 2019

We live in a world of comparison. Kids and teens are comparing themselves to their favorite social media icon or pop star, all while developing feelings of inadequacy- “why can’t I be like them”?


Are adults much different?


Stay with me on this. Often as humans we seek approval and reassurance in most things we do. It is built into our society and some will say it is all part of the human condition. We seek approval and acceptance in how we perform at our jobs, relationships, exercise, eating well, and etc. Then we compare…. Is what I am doing on target with my counter parts?

What about the ability to stop using tobacco? What do you think?


The reason I bring this up is so often I hear this “Why can’t I quit?” “What is wrong with me?” “My dad threw his pack out the window and never touched his cigarettes again!”


Nothing is wrong with you, everyone’s journey is different! It’s the curse of the human condition that is driving us to assimilate, compare, and judge ourselves when we set definite expectations.


So I encourage you to cut yourself some slack, this is a lifestyle change, one that does not happen overnight!


The path to recovery is not linear.


To learn more visit quit journeys - here you will find other’s unique experiences


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

As a parent, there is plenty to worry about, as we try to raise our children.  We know that as children grow they become more independent from us and can make decisions that can alter their lives.  Smoking cigarettes, which typically begins in high school, is one of those things that parents hope their children never do.  As the rates of cigarette smoking have fallen dramatically among teenagers, most parents have breathed a sigh of relief.  But now we are faced with a new problem, electronic nicotine delivery devices (often called e-cigarettes) that have become very sophisticated in their ability to deliver high levels of nicotine, while at the same time these devices have become very appealing to teenagers who probably would never have smoked a cigarette.


 How should parents arm themselves so that they can counsel their children wisely about the use of these products? 

Here a few things that might help you as you talk to year children about nicotine vaping devices.


Know the facts and ask your child what they know about vaping, and then educate.

Vaping is “safer” than smoking cigarettes but vaping is not “safe.”  The aerosol that is inhaled from these devices contains a number of chemicals similar to cigarette smoke but in lower concentrations.  Some of these chemicals cause cancer and can cause irritation to the lungs and heart.


E-cigarette aerosol contains nicotine which is a highly addictive substance, especially when introduced to the developing brain.  Dependence can happen quickly with repeated exposure, and lead to persistent use and strong cravings.


Studies also suggest that adolescents who vape are at a 25% greater risk of ultimately using regular cigarettes.


Know the “lingo” and know the products

Juul is the most popular e-cigarette vaping product among youth. Juul looks like a USB drive for computer and is easily disguised from teachers and parents.  The nicotine is contained in disposable pods that contain high levels of nicotine- about as much nicotine as contained in up to 3 packs of cigarettes.


 There are many other types of electronic cigarettes use by teenagers.  Some look like pens and others are simply large containers of various shapes and sizes with a mouthpiece on the end.


To learn more about the emerging products called Electronic Nicotine Delivery Systems (ENDs) visit Truth Initiative


“I don’t want to sound like a hypocrite if I smoke”

If you do currently smoke, be honest and talk to your kids about the struggle and difficulty of quitting or health consequences associated with it.


One thing to remember adolescents appreciate honesty and autonomy, when we approach with lectures and scolding they may come back with resistance and then rebel.


Get support

Truth Initiative provides up to date information on vaping and a text support program to help quit geared for young adults and parents of teens of young adults.


Vaping guide for parents

Reach out to teachers and principals at your schools and see what programs or policies they have in place


Talk to other parents  


Talk to your healthcare provider about what you can do to help your children avoid the use of these products, or how to get help for your children who are using.


    Most importantly, keep the lines of communication open and take action to help your children.



Dr. Hays

Tobacco 21 laws have now been approved in several states (including Arkansas, California, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, New Jersey, Oregon, Utah, Vermont, Virginia, and Washington) as well as some large metropolitan areas.  This law is very important for we know that between the ages of 18 and 21 is the crucial period when those using tobacco experimentally become regular smokers.  Therefore, Tobacco 21 will definitely put a dent in the number of those young adults who become regular smokers.   The facts bear this out as we consider that of 80% of adult smokers became daily users before age 21.


And isn’t this exactly what the tobacco companies don’t want? For they realize that getting these young people addicted earlier will replenish their customer supply as their older customers die from tobacco-related disease – which is good for the bottom line! This is borne out by the fact that tobacco companies spend over $9 billion a year (more than $1 million every hour) marketing to young people.


This law could really be a game changer in that the law not only puts the legal availability, and consequently, the choice of tobacco use in a little older population; but indeed recognizes the tremendous addictive potential of nicotine, and its effect on the developing brain in young people.  Limiting access, as the current aim of the Tobacco 21 law, is indeed a very good step.   Similarly, “the Institute of Medicine … strongly concluded that raising the tobacco age to 21 will have a substantial positive impact on public health and save lives.”


Remember that 1 out of 3 of the 350 young people under age 18 who become regular smokers each day, will die as a result of their tobacco use.  If this doesn’t spur us on to support this type of legislation in more states and localities, I am not sure what will!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS


REF: Raising the Tobacco Age to 21 - Campaign for Tobacco-Free Kids |

Connecticut to Join Growing Number of States Raising Tobacco Age to 21 - Campaign for Tobacco-Free Kids 

Cravings to smoke can hijack your brain, and in that moment the desire to smoke can feel stronger than anything else. Cravings, if given the opportunity can sabotage all your hard work you have put into quitting and leave you feeling powerless.

What is a strategy that might help?


One method could be, “Play the tape through to the end’ or ‘think it through to the end” is a craving crusher mental exercise that can help bring to awareness and facilitate the “choice” of what you can do and what the outcome will be. This is a technique that can be done at any time or place!


Here is how it works:

The next time you have a strong craving to smoke,

  • Think about how you would feel after that cigarette, how would your head, stomach, and tongue feel?
  • Think about how you would feel about yourself? How would your friends or family react?
  • Think about what might happen next: you most likely would not be able to just have one, and it would not be long and you would be back buying a pack.
  • Think about more of the short and long term consequences that you may be facing if you were to smoke again.


If your brain is begging you for a quick fix, play that quick fix out to its longer end. It will remind you that immediate gratification has a downside, which doesn’t align with your new long term goal of being tobacco free.


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS

Many people using tobacco hear this advice from family and friends, but sometimes also hear this advice from a healthcare provider.  It seems very odd that a healthcare provider would ever advise a smoker to continue smoking, but in fact it happens more often than you would think.  For example, most people, including healthcare providers, believe that when someone quits smoking their stress levels increase dramatically.  For health conditions where high stress is viewed as contributing to poor outcomes, think of someone who has just had a heart attack, healthcare providers wrongly believe that they should continue to smoke and quit at a time when their serious health condition is under better control.  Many mental health providers believe the same thing about helping someone quit smoking when they are also dealing with a mental health disorder.  I have personally spoken with cancer specialists who have advised patients not to quit smoking shortly after a lung cancer diagnosis because they felt that this would create too much stress for the individual who had just received such bad news.


All of these people and all of this advice is given for the best of reasons, but it is wrong.  Scientific studies consistently show that smokers compared with nonsmokers have greater feelings of stress, anxiety, depression and lower quality of life.  Although the smoking cessation process can be stressful in itself because of withdrawal symptoms and anxiety about how to deal with urges and cravings, after only a few days stress levels subside substantially.  Virtually every scientific study shows that when someone successfully quits smoking they see a substantial decline in feelings of anxiety, depression, and general psychological distress and note an improved quality of life.  The longer someone stays quit the better quality of life and the lower psychological distress they experience. Studies also suggest depression and anxiety decrease to the same extent as if treated with an anti-depressant medication; and blood pressure decreases, breathing improves, healing after surgery improves, your body receives more oxygen, and the list goes on.


So here is the truth… stopping smoking is the best thing you can do for your physical health and for your mental health.  Well-intentioned people, including healthcare providers, may provide different advice, but now you know the truth.  So, don’t stress out about it, make a plan to quit!


Dr. Hays

Doing the right thing!


Does your health care plan cover smoking cessation?  IF not, it should!  Treatment for tobacco addiction should be included in benefit plans as are other addiction and behavioral health treatments.   Because of the extraordinary benefit to people’s health, the Centers for Disease control recommends that smoking cessation treatment be provided to all health plan beneficiaries without cost or co-pay [1}. 


Providing health insurance coverage for smoking cessation is not only the right thing to do, but it is one of the most sensible decisions an employer or health benefit plan can make.  Smoking cessation can provide extraordinary savings to employers and health plans. According to researchers at the University of Ohio, people who don’t smoke save about $6,000 each year in excess health care costs and lost productivity.[2]


Still, many employers and health care plans don’t cover smoking cessation, even though they do cover treatment for other addictions.  Unfortunately, there is a lot of misunderstanding that people should just stop smoking.  However, as the people in the EX community know, stopping smoking can be one of the most difficult addictions from which to recover.


As Maya Angelou said: “The wisest thing I can do, is be on my own side be an advocate for myself and others like me.”  Check your plan.  Does it cover both counseling and medications for smoking cessation?  If not, take a step.  Let your employer or health insurance plan know about the EX Program. Providing the right support to people who smoke, is a win-win: it’s a smart investment, and a good service.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


  1. CDC. Coverage for Tobacco Use Cessation Treatments. Secondary Coverage for Tobacco Use Cessation Treatments 2014. Coverage for Tobacco Use Cessation Treatments | CDC
  2. Berman M, Crane R, Seiber E, Munur M. Estimating the cost of a smoking employee. Tobacco control 2014;23(5):428-33 doi: 10.1136/tobaccocontrol-2012-050888[published Online First: Epub Date]|.

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