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Behavioral Substitutes

Posted by Dr.Hays Dec 7, 2017

When quitting smoking, often one of the toughest parts is finding a suitable “substitute” for wanting something in your hand.


Suggestions for this include cinnamon sticks, cinnamon gum, or cinnamon candy.  Smokers say that the taste of cinnamon has the same ‘bite’ that a cigarette has.  Keeping a water bottle handy is another good idea – as water can curb cravings or urges also.  Many struggle with weight gain when they quit smoking, as they eat more to keep their hands and mouth busy.  Unfortunately, there is no magic remedy for this other than reaching for more sensible snacking such as vegetable sticks – celery, carrots.


Some people pick up a now hobby or interest when they quit smoking – craft work – wood-working, needlepoint, playing an instrument – such as guitar, will help with keeping one’s hands busy.  Besides this being a good behavioral substitute, it also “signals” to you that you are embarking on a new lifestyle.


There are so many options these days – such as hand-held video games, small magnetic sculptures, stress balls – even modeling clay can often hold one’s interest for some time – and keep your hands busy as well.  Many of these are inexpensive, and can easily get you through a craving – which typically lasts no more than 3-5 minutes.


You might be surprised at how just finding the “right substitute” can really help with that craving!!!


Cravings After Meals

Posted by Dr.Hays Nov 29, 2017

For many people, a particular challenge to becoming tobacco free is managing the desire to use tobacco after finishing a meal. This desire, like all cravings, becomes less intense and less frequent over time; however, the thought can persist for quite a while.  Understanding and planning for these cravings and thoughts can help extinguish the desire for a cigarette after a meal.


Tobacco, like any addictive substance, stimulates the reward system in the brain. In doing that it can become strongly associated with situations, moods, or emotions, that coincide with the tobacco use.  The pairing then reinforces that situation.  For example, having a cigarette after a meal will trigger the desire for a cigarette after the next meal. 


In addition, nicotine has a relatively unique characteristic of being a powerful ‘secondary reinforcement’.  That means that it enhances the enjoyment of the primary pleasure.  In the case of smoking after a meal, the satiety one feels after eating can seem to be more satisfying when accompanied with tobacco. The pairing then strengthens.


Here are a couple of suggestions to rewire that ‘after meal’ pairing.  1.) Remember, the craving for tobacco will go away in a few moments. 2.) Spend a mindful moment after the meal enjoying the feeling of satiety, or contemplating the taste of the good food just eaten. 3.) Distract your mind with a drink, even a sip of cool water. Your mind can’t focus simultaneously on a cigarette, and the taste of the liquid on your tongue.  4.) And most importantly, don’t smoke or dip.  Each time you finish a meal and don’t use tobacco, the association weakens.


I would be interested to hear from other members of the community on ‘beating the craving’ after a meal craving.

While some smokers report short-term benefits to symptoms that can be associated with mental illness studies that have measured symptoms such as anxiety, depression, stress, and quality life before and after smoking cessation find that cigarette use is associated with worsened mental health.  It may be that some of the benefits a person perceives comes from smoking may actually be due to the elimination of nicotine withdrawal symptoms.  Common symptoms of withdrawal include:  irritability, restlessness, insomnia, anxiety, depression, increased appetite, and poor concentration. The table below demonstrates the effect smoking cessation has on symptoms of mental health as well as the increases to psychological quality of life and positive affect.  The positive effect from stopping smoking is measured as similar to the effect experienced from common anti-depressants!


Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:g1151.

Stopping smoking improves mental health
Taylor et. al. (BMJ 2014)

A couple of us at the Nicotine Dependence Center were recently looking at the discussions in the EX community ‘Mental Health Support’ group with great appreciation and admiration.  The perseverance and commitment to becoming tobacco free described by struggling members is moving and awe-inspiring.  And, the experience, strength and hope that members provide in support of their struggling compatriots is wonderful to read.


As you probably know, the reduction in smoking rates that has occurred in the United States over the past 50 years has tragically not happened for people who suffer with mental illness.  Individuals with mental health problems now smoke at 2-4 times the rate, and suffer more illness and early death, than those without mental health diagnosis. 


This tragedy continues, in-part, because of myths such as ‘people with psychiatric disorders are unmotivated to quit, or unable to quit’, or ‘stopping smoking will make mental health problems worse’.  These types of myths have led to tobacco treatment support that is less than sufficient for people with co-occurring mental health problems, and public health campaigns that have not reached out to mental health consumers.


This inequity needs to end.  As the EX discussions show, people with mental illness want to become tobacco free, and can become tobacco free.

It’s that time of the year, the third Thursday of November is known as the Great American Smokeout.  In 1977, the American Cancer Society launched this event to encourage smokers to quit for 24 hours. This event has helped people to learn about the many tools that they can use to help them quit and stay quit.  For some of you this may be your quit date, and for others it may just be a day on the calendar, either way we are glad you stopped by the blog to see what the Ex community has to offer. 


I am curious; it has now been 40 years since they launched the event, what are your thoughts on the Great American Smokeout?


For more information visit the Center for Disease Control: Get Ready...Set...Quit! Great American Smokeout | Features | CDC 

Ever wonder why someone who uses tobacco products are treated with essentially the same drug they are getting from tobacco?

The other components of burning tobacco cause all the harm. Nicotine is the addictive substance which is why we use it for treatment; however, nicotine itself is not causing cancer, heart conditions, or strokes. Without Nicotine, people would not use cigarettes or smokeless tobacco. In order to wean the brain off of the substance with (hopefully) little withdrawal symptoms, we substitute with nicotine replacements (patch, gum, lozenge, nasal spray, and inhaler).

Going back to the addictiveness of Nicotine, when inhaled through a cigarette, it is the fastest delivery of the drug to the brain; 7 to 10 seconds to be exact. Once the Nicotine has reached the brain, it releases an explosion of dopamine (feel good natural chemical), which is why the addiction can be so powerful. When we look at the delivery of Nicotine replacements it is much slower (several minutes) making it rare that individuals abuse or become addicted to these products. The products help to fill the void of nicotine from a cigarette and with the slow and steady release it allows your brain to crave less and less over time.


Here is a graph that demonstrates this:

People who are trying to stop smoking are all too frequently bombarded by confusing information about what works for helping people become tobacco free.  Cream of tartar, quit smoking magic, aromatherapy, essential oils, hypnosis, laser therapy, nicotine replacement, non-nicotine quit smoking medications, and e-cigarettes, are just a few of the myriad of choices that can be found from a web search.


The bottom line is stopping smoking. People can and do stop in a variety of ways.  However, as a health care practitioner my goal is to help our patients in ways that are most likely to be effective.  Fortunately, we have as much evidence for what helps people become tobacco free as we do for other chronic health problems like diabetes and hypertension, and more-so than we do for many other addictive disorders. The scientific evidence supports that a combination of counseling, peer support, FDA approved medications, and strategies to manage cues to smoke and to maintain motivation all work to significantly improve quit rates. 


At the risk of providing too much information, Tobacco Treatment Specialist are professionals who have been trained to provide evidence-based treatment for tobacco dependence.  Currently there are almost 20 schools that have been accredited to provide this type of training, and there is a new national certification just coming on-line.  If this description of Tobacco Treatment Specialists is TMI,  please just ignore. For those who are interested you can find more information about Tobacco Treatment Specialty at ATTUD-Association for the Treatment of Tobacco Use and Dependence 


Truth at Last

Posted by Dr.Hays Oct 20, 2017

Around Thanksgiving you should start seeing television advertisements from the tobacco industry. These are not what you might expect.  Finally, after years of litigation the big three tobacco companies have been ordered to run advertisements to partly correct ‘false and misleading (health) claims’ made by them to promote the sale of cigarettes. 


The courts decided in 2006 that the tobacco companies had deliberately deceived the public about the health effects from smoking. The judge in that case found the tobacco companies had mislead the public on the health effects from smoking, the addictiveness of smoking, impacts from second hand smoke, and low tar and nicotine cigarettes.  Since then the tobacco companies have been appealing.  But, at long last, they are ordered to issue ‘corrective statements’. 


You can find out more about this court ruling at  RICO | Public Health and Tobacco Policy Center 


Fall - A Time for Fresh Starts

Posted by Dr.Hays Oct 11, 2017

As we enter the season of autumn – I always feel a sense of new beginnings, and a ‘fresh start’.


For, this time of year is full of new beginnings:

  • kids going back to school with newly-sharpened pencils and a   fresh box of crayons;
  • the possibility of new friendships;
  • and, young adults beginning their college careers.


Perhaps, I’m thinking about starting a regular exercise regime.

I could begin by:

  •  parking farther from the shopping mall; 
  •  looking into that yoga class I been interested in; 
  •  or, taking a relaxing walk after dinner rather than sitting down in from of the TV.


As humans we are constantly changing as we are shaped by our everyday experiences.

And these changes are processes – often slow and methodical, a little at a time.


So it is with quitting smoking, and as this time of year is full of  ‘fresh starts’, make this fall a fresh start for you – by making small steps towards quitting smoking.


But just what would be some small steps to achieving that goal?

  • write down your reasons for quitting – and how you hope your life will be different as a non-smoker;
  • talking with your friend about quitting smoking with you;
  • or, even making an appointment and talk with a tobacco treatment specialist, or your doctor, about some of the medications out there now to help you quit.


These seem like small steps, yet they are giant leaps in how you will feel about yourself, just knowing you have begun the process.


Just taking small steps toward your goal could make you feel surprisingly productive, and energize you toward achieving the goal in the end – a smoke-free life.

In June 2009 the Food and Drug Administration (FDA) was authorized to regulate cigarettes, roll-your-own tobacco, and smokeless tobacco products.  In June 2016 this authority was extended to all tobacco products.  The rule empowered the FDA to regulate marketing, strengthen warning labels, and take measures to reduce youth smoking.  The FDA was limited in its ability to recommend changes to cigarette design or elimination of harmful compounds in cigarette smoke.


The new FDA commissioner recently announced a new strategy. The agency is delaying a plan to regulate E-cigarettes and vape devices, and embarking upon a plan to reduce the nicotine content in cigarettes.  The idea is that, without nicotine, cigarettes will not be addicting.  While nicotine is not one of the many toxic compounds in cigarettes that causes the myriad of health problems, and hundreds of thousands of deaths each year; however, it is the chemical that causes the addiction to cigarettes.


Reducing nicotine in cigarettes, so that young people do not become addicted and smokers will not maintain their addiction, has been a strategy recommended by some public health researchers and advocates since 1988.  The real life effect has never been demonstrated in actual practice.   Tobacco stocks did drop after the announcement, which may be an indicator of the impact of nicotine reduction.


We would be interested in hearing your thoughts about this new FDA plan.


The Secrets of Addiction

Posted by Dr.Hays Sep 27, 2017

I would like to recommend a very informative article recently published in National Geographic Magazine titled “How Science is Unlocking the Secrets of Addiction”.  If you are interested, you can access the article online.


Our understanding of the complexity of addiction is improving considerably.  Research, using scanning technologies, is identifying more specifically the physical changes that occur in the brain as regular use of drugs gradually hijacks our natural reward mechanisms. 


As addiction develops, habits become hardwired and preoccupations to use a drug can override more rationale decision-making areas in the brain.  And, as recovery happens, healthy habits are relearned, the brain can ‘re-wire’ and a person can regain their ability to make healthy choices free from craving and preoccupation.


The article, illustrations, and video available at the National Geographic link do a wonderful job of summarizing a vast amount of research into addictions.  While the research is on a variety of drugs in addition to tobacco, it is all quite applicable to tobacco addiction.  I hope you find it useful in your recovery!


Let us know what you think in the comments.



Tobacco as a Coping Skill

Posted by Dr.Hays Sep 20, 2017

Using tobacco or any other drug for that matter offers some kind of reward, it may not be the healthiest option but we are inclined to do it.


Think of your brain as the muscle that it is, it gets exercised and formed into the brain it is now.  The beauty of our brain is it has the ability to mold and transform just like the muscles in the rest of your body, this is called neuroplasticity. In addition, the brain is reinforced by chemicals that are released (dopamine) when you interact with your environment or others make you feel good.


Take smoking or chewing for example; since the age you started using tobacco you have been pairing this substance with whatever the thing or situation may be. This in turn gets worked into that muscle memory of your brain and becomes hard wired to the point where maybe you do not even think about it, it’s more of an automatic thing that occurs.  Therefore, you are getting what we like to call a double sided reward. You are allowing the routine (avoiding discomfort of a new routine) and you are getting nicotine, which releases dopamine (a natural feel good chemical). This becomes the norm or habit if you will.


Now, go back to when you were a kid and remember your parents telling you “don’t worry, practice makes perfect.” They were right!  It takes time to rewire the brain circuits to choose the healthier learned behavior over the tobacco, whether it is nicotine replacements or a new found coping skill e.g. deep breathing, sucking on candy, going on a walk, etc. Keep the positive thoughts flowing and reinforcing the replacement behavior, it is hard, and you may slip up, which is okay!

There is an overlying myth that Cigars are less harmful as cigarettes or chewing tobacco. Here are the cold hard facts:

4 Deadly Facts about Cigar smoking

  1. Cigar smoking is harmful. It contains more than 60 cancer causing chemicals such as arsenic, cyanide, polonium 210, chromium IV, aromatic hydrocarbons and benzene.  Cigar smoking causes cancer of the lips, tongue, mouth, throat, voice box, and lungs.
  2. Cigar smoking in addicting. Even if you do not inhale the smoke, high levels of nicotine is still absorbed through the lining of the mouth.  A single cigar can have as much nicotine as an entire pack of cigarettes.
  3. Some people think that cigar smoke is safer because they don’t “inhale”. Even if not purposely inhaled, some gets down to the lungs and tissues.  The lips, mouth, tongue and throat are still exposed to the cancer causing chemicals.
  4. Research shows that smoking cigars may be even more harmful than cigarettes. Cigar smoke is denser, that is, it contains a higher number of cancer-causing substances, more tar and a higher level of toxins. In addition most cigars are bigger than cigarettes, and it can take longer to smoke cigars. This results in more exposure to toxic substances.



Remember that there is no safe tobacco product and no safe level of tobacco smoke exposure.

This past week I had the opportunity to be on a telephone “live chat” with members of the EX Community.  On the call were community members (Giulia, elvan dkr953, Showiestodin and Pops ) who have been tobacco free for many years, and others who were still early in their quitting journey, or trying to figure out how to start the journey again. All of these members, no matter their specific situation, expressed extraordinary commitment to becoming and staying tobacco free.


There is something very special about the strength that can be found in sharing our successes as well as our struggles and setbacks.   It was wonderful to hear during our call the special support that is freely offered to one another in the EX community.  Stopping smoking is vital to health, but it can be very difficult, especially if one feels alone with the struggle.  It is true that shared burdens are suddenly made lighter, and the sharing on the EX Community makes what can seem impossible, become a reality. This is a life saving community to which I am glad to be a contributor.


Dr. Hays

Nicotine withdrawal can be severe.   For many people withdrawal symptoms peak between 3-5 days, but they can last for many weeks.  Recognizing and alleviating withdrawal from nicotine can be extremely helpful in stopping smoking.


The most common withdrawal symptoms are irritability, anxiety, craving difficulty concentrating, depressed mood, insomnia and restlessness.  Symptoms can also include constipation, dizziness, nausea, sore throat, nightmares, tremors, rapid heart-beat, stomach irritation, anhedonia, and fatigue.  These unpleasant physical sensations, emotions, and cognitions can trigger an intense urge to smoke, however smoking in response to these symptoms is very reinforcing and strengthens the cigarette addiction and builds the ‘habitual’ component of smoking.


Nicotine replacement alleviates withdrawal and is a very safe alternative to smoking.  Nicotine medications don’t deliver the rapid and high doses of nicotine like a cigarette, and are not addictive like the cigarette.  More importantly the nicotine medications don’t contain the 1000’s of chemicals that are in cigarette smoke, and which cause the tremendous toll to health.


These days, there is no reason to suffer from nicotine withdrawal.

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