Skip navigation
All Places > Mayo Clinic Blog > Blog
1 2 3 Previous Next

Mayo Clinic Blog

420 posts

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]|.

One of the most poignant “Becoming an Ex” stories I ever heard from a patient was about leaving a loved one out in the rain!


I worked with a 40-year old gentleman, who had smoked all of his adult life, 2 packs a day, for 25 years!  He had a large heart attack, and was reminiscing about what might have “put him in this state of health”, as he described his situation.


Just a few weeks earlier, the patient told me that he was on his way to pick up his 5-year old daughter, from kindergarten.  It was a very stormy day and the rain was coming down heavily. When he was just a short distance from her school, he saw his little girl standing in the rain, with no umbrella and soaking wet.  His heart went out to her!


 At that very same moment, he also realized that he had used his last cigarette just 20 minutes earlier, and he was totally out!  Without missing a beat, the gentleman drove right past his crying daughter, two blocks further to the nearest drug store, and bought, not a pack, but a carton of cigarettes! 


As he got back in his car in the pouring rain, now almost hailing; he headed back to pick up his daughter.  “All of a sudden”, he said “it was like I was hit, alongside of the head with a brick!  What had I just done??   My tobacco addiction, yes addiction, had sent me right past my little girl, on to the nearest drug store, to feed my habit!  At that moment in time, I realized that my priorities needed to change and fast!  I was addicted to tobacco, no matter how I wanted to deny it!


Many times, we make major life changes when our health suffers, when we lose someone close to us, or something important gets our attention!


You are now on the path to “tobacco-free living”! Don’t leave those you love, “out in the rain”!  The BEST thing you can do for anyone you care about is to take care of yourself first, so you are around for them!  You ARE doing that with the support of “Become an Ex”!   Please reach around and pat yourself on the back, each minute/hour/day you are tobacco-free!  It is one of the most important things you will ever do for yourself and those you care about.


Kathy Zarling, MS, APRN


Sometimes the seemingly easy things are actually the hardest to do.  I was talking with a patient today about triggers for smoking, and how the average cravings last 5-7 minutes.  He responded something along the lines of “Well it should be easy to put something in there for THAT amount of time (i.e., rather than smoking).”  “But in reality”, he added,” it is very difficult to do.” 


And YES, it is.  There is NO doubt about that. 


So when you think about making behavioral changes for something like quitting smoking – where do you start?  How do you find something to put in place in your life?


Some find that substituting some form of physical activity– a quick walk around the block, or jumping on a treadmill, is helpful.  Others find that they just need to keep their hands busy with something – a game on their phone, or some craft work. 


Often, what is really helpful is finding something you REALLY LIKE to do, VALUE   doing, and that TIES IN with the reason you wanted to quit smoking in the first place.


Lifestyle changes are nothing short of that – a LIFESTYLE change.  It is not something that happens overnight, or when you simply get that “mindset” to do something.  The motivation will “wax and wane”, but once you have a few reasons or values that are truly meaningful to you, it gets easier – ESPECIALLY when the motivation is not what it could be.  A lifestyle change means that your values are different now.  You are placing THIS over your smoking in what you value in life.


A patient of mine had always wanted to volunteer at the local elementary school; but knew she couldn’t do that and still be smoking.  She was concerned about smelling like smoke around the kids, and she knew that leaving the school to smoke was simply not an option.  So when she did quit, that was the first thing she put in place, and so she now is able to enjoy volunteering at her local school library.


So how can you bring out your values in your behavioral changes when quitting smoking?  Well, how do you like to spend your time?  Maybe making something for a child or grandchild when you get those cravings will help remind you why you are doing this?  Or, perhaps completing that local 5K Run/Walk is a key goal for you, or just completing a walk around the block with a loved one is motivation enough. 


Whatever you find meaning in or priority in your life, make that your reason to quit smoking, and start living the reality you truly value.


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

Wellness-- is a trendy term and, in fact,  has grown on me.  According to Webster, wellness is defined as “the quality or state of being in good health especially as an actively sought goal”.  


What do you think of when you hear this term?

In my experience, many people hear the term wellness and immediately think of exercise or going to the gym routinely, but what we are really talking about is wellness as a whole, which may  mean many different things to each of us! Some of these thoughts and ideas may include:

  • Exercise
  • Meditation
  • Yoga
  • Spending time outdoors
  • Making time for the ones you love
  • Fueling your body with wholesome foods


Overcoming tobacco use may require one to be creative to  find peace elsewhere or determine other ways to get that dopamine fix that is missing.


Research shows physical activity provides a release of dopamine, has been shown to improve mental health, and can be helpful for those overcoming addictions. There is even talk that physical activity should be prescribed just like other medications as it is  crucial for well-being. It has been found, with exercise, one gains confidence through practice and mastery- which in turn can be measurable goals and something to focus on versus using.


Meditation and yoga provide great practice to focus on being in the present moment and being aware/in tune with one’s body. Specifically with addiction, practicing mindfulness (by being aware) one will recognize their signs and symptoms to use and transition them to acceptance and a reduction of impulsivity.


Make the space for those who are important to you. Using tobacco can sometimes place a wedge in close relationships, leaving individuals feeling alone and isolated. Humans are social beings! A quote stumbled upon at Mayo Clinic from William Mayo himself says, “No MAN is BIG enough to be INDEPENDENT of others.


Spending time in nature and fueling your body with wholesome food can be seen as practices of self-care or as a practice of spirituality. Making these positive choices can increase energy levels, allow space for choosing other healthier options for food or activity, and increase overall mood.


The moral of the story is…. When you feel good you can do ANYTHING you set your mind to!


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

Shortly after electronic cigarettes came on the market in 2011 people became interested to know if these devices might help smokers to quit smoking tobacco.  There were a number of early studies and observations that made people believe electronic cigarettes might ultimately be a very helpful product and might be the solution to help people quit long-term tobacco use.  Scientific publications from a number of highly regarded government and non-governmental organizations declared that electronic cigarettes were as much as “95% safer” than standard cigarettes.  Studies also confirmed the vapor from electronic cigarettes contained concentrations of harmful chemicals that were many times lower than the concentrations found in cigarette smoke.  In the early days of electronic cigarettes it was also true that nicotine delivery was unreliable and quite a bit lower than a person could get from a standard cigarette.  All of this information made most people feel electronic cigarettes were safe and unlikely to the cause the kind of addiction we had been used to seeing with standard cigarettes. 


Then, it seemed, everything changed…..


In fact, things did not change suddenly in the electronic cigarette world but they did change dramatically over the course of a few short years.  Electronic cigarettes were changing and the way people use them was also changing.  The newer devices were able to deliver higher and more reliable doses of nicotine and the number of devices and the number of electronic cigarette solutions available to purchase grew into the thousands.  And while this was happening, teenagers were taking up electronic cigarette use in larger and larger numbers, so that between 2011 and 2015 the percent of high school student in the United States using electronic cigarettes had quadrupled.  We were briefly reassured that this was not going to continue when the number of high school students using electronic cigarettes or other tobacco products stabilized and fell slightly in 2017; but then in 2018 there was a dramatic rise again in tobacco product use among high school students.  Most of this rise was due to the increasing use of electronic cigarettes, particularly the ”Juul” device.  Juul raised the stakes a lot by providing a device that was very appealing to teenagers (it looks like a flash drive for a computer, and is easily hidden from naïve adults) and used disposable pods containing flavored nicotine solutions (fruit flavors and candy flavors appealing to kids).  The solution in these pods also contains highly concentrated nicotine and the Juul device delivers high concentrations of nicotine in the vapor which is absorbed quickly into the blood stream when inhaled.  Sounds a lot like a cigarette doesn’t it?


Nicotine addiction from use of electronic cigarettes is now becoming more common both in children and young adults.  In our clinic, where we treat nicotine dependence we are now starting to see more and more people who are addicted to electronic cigarettes after they made the switch to these devices thinking it would help him stop smoking tobacco.  Most adults continue to use tobacco while using electronic cigarettes but many teenagers are using electronic cigarettes exclusively and become heavily addicted.


Our approach to treatment for addiction to nicotine due to electronic cigarettes is very much the same as for the standard cigarette.  Through counseling, we move people toward positive health behavior change and commitment to a plan to quit.  We use medications such as nicotine replacement to reduce withdrawal and craving for electronic cigarettes so that they can have early success and reduced risk of relapse as they put their quit plan in place.  We expect to see more patients like this as electronic cigarettes become better and better at delivering nicotine (“better” meaning more addictive).  As we and others learn more about how to treat people who now are addicted to electronic cigarettes, we are certain we will get better at it. Our mission continues to help people become free of addiction to tobacco as well as electronic cigarettes.


Dr. Hays


Take back control

Posted by NDC.Treatment.Team Apr 3, 2019

Does one have control over smoking? I often hear- smoking is the only thing in their control, it is their right, their freedom, their choice….. But is it?


It sounds mundane, but really thinking about how smoking plays a role in your life and the reasons you want to stop smoking. To some they will say smoking is “the one thing they have,” “their vice,”  “their choice,” “their life,” etc. Then once stopping smoking is brought up, there tends to be this layer of resistance built like someone is taking away their freedom. This became prevalent to me while working with individuals attending our 8-day residential program, that the more one believes the thought “cigarettes are the only saving grace,” the more resistance and struggle one felt.


On the contrary, when these individuals worked to acknowledge and re-frame these thoughts to “I choose to quit” it seemed to lessen the internal battle. Like they were choosing the control knowing they technically could smoke they just are choosing not.  What are your thoughts on this?


I will often encourage people to think about the reasons THEY want to quit. Not why others want them to quit.


What thoughts or motivations tipped the scale for you, to allow you to choose instead of the cigarettes choosing for you?


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

So, we are several months in to the New Year and you find you may be feeling a lag in your drive to stay smoke-free.  In contrast to the excitement you felt on New Year’s day about quitting smoking to have a “fresh new and healthy start in life”, the new “shine” you felt as a new smoker may be giving way to be tarnish from the wear and tear of life and you may sense a dull ache for a cigarette. So, you need a boost to revive your commitment or recharge your motivation to stay quit.  How about using the onset of a new season to add fresh “pep in your step” and recharge the “spring in your vigor” about being smoke-free? If you practice mindfulness about the “new-life” that the spring season brings, you will find ample free things in your environment to motivate you to keep living a healthy, smoke-free life.


Being Spring-filled mindful simply involves opening your senses and plugging into your consciousness the season-specific things you see hear, smell, feel and, yes even taste.  Breathe in a large whiff of fresh spring air

  1. Embrace the newness of animal life (bunnies, lambs, chicks)
  2. Soak up the radiant feel of sun on your skin
  3. Notice the vibrant green of the grass and flower buds
  4. Stretch out in the grass and look up at the clear blue skies
  5. Listen to the serenade of the birds


Now ask yourself, “Do I really want to mess this natural setting and fresh feeling up with cigarette smoke?” Remind yourself, “I don’t need to smoke in order to escape the stress of everyday life.  If I really soak in and stay in-tune with the characteristics of nature, the peaceful calm and sensory stimulation it provides are enough to replace the relaxation and or stimulation I think I am getting from smoking cigarettes.  The characteristics of Spring are reviving, whereas cigarettes are toxic.”


So, remember, a simple, easy, free and natural way to stay on track with smoke-free living is to be mindful of the newness and freshness of nature that “springs” forth and blossoms with the Spring season.


Jennifer Burden, PhD

NDC Counselor/CTTS

If this title resonates with you and you feel that you have tried countless times to quit and/or countless methods to quit and still haven’t found the right approach, don’t worry there may be other options. Also, if this title speaks to you then you are someone that doesn’t give up and you keep on making efforts to quit! Most people are not successful the first time they attempt to quit (actually the last research article I read said 30 or more times before being successful) So keeping that in mind- Don’t give up! Perhaps the next time will be the ONE that WORKS!!

Have you considered the following:

  1. Individual counseling with a TTS (tobacco treatment specialist) – They are all over the country
  2. Combination medications- meaning using at least 1 long acting medication (nicotine_patch, chantix or bupropion ) & using at least 1 short acting medication (nicotine_gum, nicotine_lozenge, nasal_spray or “puffer”) together- I have had patients that use all 7 meds at the same time (most people uses 2, 3 or 4, but whatever it takes to remain tobacco free)
  3. Doing both #1 & #2 simultaneously
  4. Becoming more involved here on the EX Community (having support is key)
  5. Join NicA (Nicotine Anonymous)- Contact your local meeting to see their beliefs on using nicotine products some believe in abstinence some are open to all.
  6. An In-patient treatment program that solely focuses on quitting smoking

If you have ever thought- I just need to be “locked up” to be able to quit, then #6 might be a great option for you. Our in-patient treatment program does not actually lock you up; instead you spend a week in a hotel like setting with other individuals (6-10) that are trying to become tobacco free. Mayo Clinic offers an excellent program in Rochester, MN that I invite you to look into if you have tried EVERYTHING and still struggle with remaining tobacco free.


Laura McConahey

NDC Counselor/CTTS


Lung Cancer Screening

Posted by Dr.Hays Mar 13, 2019

Early in the 20th century lung cancer was described as one of the rarest forms of cancer, but what could not be predicted in the early 1900’s was the impact cigarette smoking would have in the United States. Since 1986 lung cancer is the leading cause of cancer death for both men and women.  The dramatic increase in lung cancer caused death, estimated to reach over 150,000 deaths in 2018, can be directly attributed to the manufacture, sale and consumption of the modern cigarette.


For people who smoke, stopping smoking and staying stopped is the single best thing you can do to extend your life and to reduce your risk for many health problems, including lung cancer.  If you have a significant smoking history, another important step you can take is to talk with your health care provider about receiving a Low Dose Computed Tomography (LDCT) screening x-ray for lung cancer.


Previously lung cancer was usually diagnosed only after it was advanced enough to cause symptoms, like chronic coughing, coughing up blood, chest pain or weight loss. However, in the past 5-10 years research studies have shown that annual LDCT screens for people at risk can save lives by identifying lung cancer before symptoms arise and early enough for more effective treatment.  Those who can benefit from screening are people between the ages of 55 and 80, have smoked a pack per day for 30 years or the equivalent (smoking one package per day for 1 year would be “1 pack-year”, so smoking 1 pack per day on average for 30 years or 2 packs per day for 15 years would both be equal to “30 pack-years”), and are currently smoking or quit within the past 15 years. 


Annual lung cancer LDCT screening is now covered by most major health plans including Medicare.  If you are at risk, we recommend that you talk with your health care provider to decide if it is right for you. And while you are thinking about the decision to have LDCT lung cancer screening, give some thought to the benefits of quitting cigarette smoking. That will be the most important decision you make for your health. 


Dr. Hays

As the number of children using e-cigarettes remains at epidemic levels, the FDA has announced new actions that are currently being taken focusing on both retailers and manufacturers, as part of our commitment to combat youth access to e-cigarettes.


 On March 4th, 2019 a letter was sent to Walgreens corporate management requesting a meeting to discuss whether there is a corporate-wide issue related to their stores’ track record of violating the law by illegally selling tobacco products to kids. Last month alone, the company’s stores have racked up almost 1,800 violations across the country. Walgreens is currently the top violator among pharmacies that sell tobacco products, with 22 percent of the more than 6,350 stores inspected having illegally sold tobacco products to minors.  As the leaders of the FDA note, this is disturbing, particularly since the company positions itself as a health-and-wellness-minded business.


Walgreens is not the only corporate owned chain and franchise stores with very high rates of violations for illegal sales of tobacco products to minors.


The FDA plans to hold these companies accountable as well!  Ignoring the law and then paying associated fines and penalties can no longer be the cost of ‘doing business.’


 The stakes are too high for our young people and our country’s decades-long fight to reduce the morbidity and mortality that accompanies tobacco product use.


What are your thoughts about this?




Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS


Lately, I have been encountering many individuals that are “closet smokers.”  This made me wonder how many of you on the EX Community were hiding your smoking from loved ones?  What types of lies did you tell yourself? How big of a canyon did you create in your relationships with the people you love?


When people smoke in secret it creates loneliness, pain, and isolation for the smoker.   It often times makes the person feel ashamed, guilty, and trapped. In addition, most have gone to great lengths to cover up their addiction to avoid being discovered.  Using mints, air fresheners, perfume, changing clothes, reasons to get up and leave, not go somewhere, and hiding in unusual places are all methods and excuses for the closet smoker to hide their addiction.  I once had a patient tell me that she hid under a school bus to smoke.


If this is you, how do you go about quitting? The first step is being honest with yourself and others to help end your relationship with cigarettes. Many times, covert smokers quit in secret, which eliminates support when it is needed the most. Your loved ones may already know of your addiction, but have chosen to avoid confrontation.  Being honest opens up a bigger circle of support bringing you out of isolation. Set your stop date and plan your quit approach whether it be reducing to quit, “cold turkey,” or nicotine replacement medications.  Even if your road to quitting tobacco has a few detours, STAY OUT of the CLOSET and keep reaching out for support.


Heather Kraling-Coons

NDC Counselor/CTTS

There is SO much information/MISinformation out there about how nicotine replacements are harmful for our hearts!  But, is it?  Literature has been plentiful, since the 90’s on how nicotine replacement therapy (NRT) is much safer for our heart health and blood vessels, than smoking!


Yes, nicotine can cause constriction of blood vessels. Although when smokers use NRT, this doesn’t seem to happen, probably because they are used to using the high doses delivered from cigarettes. Not to mention, nicotine alone does not have 7000 chemicals released when burned, like tobacco, which include cancer-causing agents, heart disease, and stroke-causing agents. Therefore, when looking at harm reduction, nicotine replacement therapy is a viable option. 


What about heart attacks?  Individuals, with heart disease who are able to stop all tobacco use, can have a rapid drop in the recurrence of acute heart events and slowed or stopped “hardening of their arteries”.   Nicotine patches have shown to be of benefit in aiding smoking cessation and is a prominent feature of Clinical Practice Guidelines for smoking cessation by major healthcare institutions and organizations.


Does it affect blood pressure? We know that nicotine has effects on blood vessels that can lead to increase in heart rate and blood pressure and cause constriction of the blood vessels.  But at the same time, wearing a nicotine patch can lead to lower nicotine levels in the blood than cigarette smoking and will lead to many fewer bad effects on the heart, than smoking.   Tobacco and its components cause blood vessel constriction; they cause a roughness in the vessels where normal cholesterol needed for body building and body repair collects, as it flows through the body; and, we know that tobacco products “latch” on to the oxygen in our blood stream, leaving carbon monoxide (a waste product from the blood), for our heart and blood vessels to work on, rather than rich oxygen.


Not everyone will choose to use nicotine replacement therapy but get to know the facts and talk with your doctor  to make the choice that will lead to a healthier you! There are SO many misconceptions regarding tobacco cessation aids, for more information ask your healthcare team and visit!  Good luck, YOU are well on your way!


Kathy Zarling, MS, APRN


Recently when working with a group of patients quitting tobacco, we were talking about coping skills for urges and cravings.   While we have traditionally looked at the 4 D’s (Delay, Distract, Deep breathing, and Drink water), this group added 2 more to the list: Discuss, and a surprise fun one - Dance!!


So, consider trying these cognitive strategies for your cravings or urges to smoke:

Delay:  Delaying acting on your urges - say 5 minutes  - and most likely the urge will lessen or even completely go away.

Distract:  Find something to occupy yourself with for a few minutes while the urge or cravings dissipate.

Deep breathing:  Breathe in through the nose, and out through the mouth.  This can be very calming and relaxing.

Drink water:  That’s right!  Drinking water does help with cravings; and while most of us don’t drink enough of this life giving fluid anyway, it is a good reason to drink up!


And finally, the 2 new ones:

Discuss:  Ask for help from, and utilize, the support people in your life to help you work through cravings and urges.

Dance:  Quitting smoking is hard work – make sure you celebrate your efforts !!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

I wanted to express my gratitude to all of the members of the EX community for our partnership.  Mayo Clinic’s blogs on the EX Community started more than 10 years ago! Through the years we have appreciated being part of your community.  We have learned immensely from the real life experience and expertise shared on the site by community members. It is wonderful to read how each and everyone one of you have generously shared your vulnerability, determination, and courage in support of each other. I appreciate being able to confidently refer my clients/patients to BecomeAnEX.


The mission of the Nicotine Dependence Center is to inspire hope and empower change for healthier living and a future free from tobacco. This mission continues to grow in the partnership of Truth Initiative and the members of the EX Community.


A warm thank you from yours truly,

Dr. Hays

Mindfulness is a term one hears frequently these days.  It is associated with an almost unbelievably wide array of self-improvement and relaxation strategies, as one look in the ‘self-help’ section of a bookstore, or a web search can confirm.   While I can’t vouch for the many claimed good effects of mindfulness, it does seem to help to reduce both the intensity and frequency of tobacco cravings.  So what is it, and why would it work?


Mindfulness is the process of directing your awareness to the present moment with an attitude of curiosity, openness, and acceptance.  The mind has a tendency to almost constantly jump around from sensations, to past experiences, to future plans, to emotions, to hurts or joys or thoughts, or imaginings.  Mindfulness is taking a step back to observe the constant bouncing of one’s attention, rather than being unconsciously bounced from thought to thought.


Craving can be understood as a strong desire, usually to consume a specific food or drug that intrudes into awareness.  Cravings develop when rewards from food or a drug are associated to cues, either internal or external.  The craving serves to induce an action/behavior to obtain the associated reward.


There are a number of theories as to why and how cravings are affected by mindfulness.  One that I favor is that being mindful of the present moment inhibits the automatic associations between the cue and the action by occupying working memory.  We really can’t focus upon more than one thing at a time.  The present moment awareness stops the mind’s conditioned leap from cue to action.  By stepping back from the jump from cue to action, one can then choose to attend to other things, like a deep breath, or a happy thought.  This new association begins to diminish the strength of the past reinforced habit.


I would be interested to hear from others about their use of mindfulness to help with craving?


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Filter Blog

By date: By tag: