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I have recently spoken with two patients, and a few other folks, who had heard or read that smoking was ‘good’ for COVID.  Not true!  Maybe you’ve heard similar misinformation?  I thought I would share with you an update on what we know about the association and talk some about the genesis of the misinformation.


As of today, SARS COVID 19 has infected almost 5 million people.[1] The majority of people who contract the virus recover without the need for hospitalization or intensive interventions.[2]  However, people who smoke are more likely to die or need critical care interventions than people who don’t, and may be more likely to contract the COVID virus. [3],[4]


There has been confusion that has been popularized in media that smoking may be preventative for COVID.[5]  As headlines tend to do, these headlines have taken more complex information out of context and unfortunately have caused some people to ‘leap to’ wrong conclusions.  (A patient I spoke with yesterday actually relapsed to tobacco use after reading such a headline and suffered from a subsequent heart attack.)


The headlines have been extrapolated from two types of studies. One type looked at the number of people with COVID who reported that they smoke and compared that percentage of patients to the percentage of people in that country who smoke based upon survey research.  There are a number of potential problems to this type of analysis and more recent studies are finding that the correlation does not hold and there is likely under-reporting of smoking by those with severe COVID complications. 


The other type of study is from cell biology and in particular studies that show a complex interaction between compounds in cigarette smoke and receptors by which the COVID virus attaches to human cells.  Some studies have described a ‘down-regulation’ of COVID receptors and others an up-regulation that may be associated with nicotine.  The most recent study4 seems to show most definitively that cigarette smoke increases the susceptibility to COVID at a cellular level. It also shows that  quitting has an immediate and positive effect on reducing that risk. 


One must keep in mind that it is a long leap from ‘cell reaction’ to human susceptibility, and that the relationship is complex.  For example different compounds in cigarette smoke have different effects in cell biology.  All in all though, the evidence is clear. Stopping smoking is the most beneficial thing a person can do for themselves.  Not smoking decreases the severity of COVID symptoms and is likely to reduce the risk for infection.  If you have stopped, stay tobacco free. If you are smoking, stopping can only help.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


[1] (accessed May 20, 2020 7 AM)

[2] (Wu, Z., and McGoogan J.. JAMA. 2020;323(13):1239–1242. doi:10.1001/jama.2020.2648)

[3] (Patanavanich, R., and Glantz, S.A. (2020).[3] Smoking is Associated with COVID-19 Progression: A Meta-Analysis. MedR;


Zhao, Q., Meng, M., Kumar, R., Wu, Y., Huang, J., Lian, N., Deng, Y., and Lin, S. (2020a). The impact of COPD and smoking history on the severity of Covid-19: A systemic review and metaanalysis. J. Med. Virol).

[4] Joan C. Smith,Erin L. Sausville,Vishruth Girish,Monet Lou Yuan,Anand Vasudevan,Kristen M. John,Jason M. Sheltzer Cigarette smoke exposure and inflammatory signaling..Developmental Cell Available online 16 May 2020

[5]   Accessed May 20, 2020

“Practice makes perfect.” This powerful, three word phrase has been shared countless times to inspire commitment, dedication, and hard work for achieving personal goals. Such goals can be as diverse as increasing a step each day, creating a space to practice self-care daily, or like all of you at BecomeAnEX to quit smoking, vaping, dipping or chewing tobacco. This simple three word phrase provides the encouragement for you to focus your effort, to take steps toward a positive outcome. So how does this apply to quitting?


One of the biggest things that will help after deciding to quit is replacing old habits with new ones. Research has shown that we do not get rid of our old ways of thinking very quickly. We have old neural pathways or habits that will remain ready to be reactivated if we do not provide our brain with an alternative. To quit, it is beneficial to experiment with new routines and discover alternatives for coping with emotions without smoking, vaping, dipping or chewing. Each time you respond differently (such as drinking an iced tea instead of having coffee with a cigarette, or listening to music instead of vaping) to a familiar situation, a new neural pathway is created and it replaces the old one. The more you practice your alternative behaviors, the stronger the new pathways get, and the weaker the old ones become. The more you practice a new behavior, the more natural it will become, until you find a new perfect (and tobacco-free) version of you!


Heather Kraling-Coons, MA

NDC Counselor/CTTS

During this time of uncertainty, our anxiety levels can be up one day, down the next, depending on multiple factors. When will life return to normal? When will I go back to work? Will I still have a job? When will this pandemic end? We can put ourselves into chaos by all of the thoughts that can race through our heads in a day.Many people might think that this is the worst time to quit smoking, vaping, dipping or chewing. If you have already quit, you may be concerned that the anxiety of the unknown might push you to relapse. But does tobacco really relieve our anxiety? It does not.


There are several factors to consider when looking at anxiety and tobacco. It may seem that nicotine calms our nerves when we are stressed or anxious, but in actuality, it is just relieving our withdrawal symptoms. The half-life of nicotine is usually less than 2 hours. It leaves the system very quickly, and that withdrawal from nicotine feel like anxiety. So, when anxiety or stress presents itself, the memory of how nicotine calmed that anxiety creates an urge to smoke, vape, dip or chew.


Evidence suggests that by stopping tobacco, real anxiety and depression lessen. In fact, smoking is linked to developing anxiety. Retraining your brain to develop skills for managing anxiety and stress can be an important part of recovery. Unfortunately, our brains will always remember what gave us instant gratification and a “quick fix.”


I like to think of recovery from tobacco use like driving a manual/stick shift car. When we are starting out, we have to think of a lot of different things in order for the car to go. But, as we are on the highway cruising along, driving becomes much easier. BUT, we still have to pay attention to the road or we will end up in the ditch!So today, pay attention to the roadblocks that may heighten anxiety, and have confidence in your ability to maneuver through those obstacles without tobacco.


Molly Leis

NDC Counselor/CTTS

It may seem like ‘duh,’ but it is true that people who smoke cigarettes are much more likely to cough compared with people who don’t. Coughing is a reflex that expels irritants from lungs. It functions along with cilia, microscopic hair-like structures, and mucous, a liquid that lines the airways, to protect the lungs from particles and chemicals. Cigarette smoke contains thousands of particles which both irritate lungs and damage the mechanisms which are designed to protect the lungs. Coughing increases in response to the smoke particles being inhaled.

Studies find that for most people, cough improves within a few hours of the last cigarette, and continues to improve for up to a year after stopping. Some people, however, report that their cough increases after stopping. There may be a couple of reasons for this.

When you stop smoking, the cilia become active again. As the cilia recover and the mucous is cleared, coughing might increase for a week or two.

Another reason may be that a person is more likely to stop smoking when they feel ill or are experiencing respiratory symptoms. These symptoms might be caused by an underlying condition such as a common cold. An increase in cough after quitting may be due to that underlying condition but be attributed to having stopped smoking.

In any case, stopping smoking is the best thing you can do to lessen cough and improve your lungs’ protective mechanisms. You can speed the process of healing by staying well-hydrated, resting when needed, and being active when appropriate. If coughing is persistent after stopping smoking, please consult your health care provider.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Smoking and vaping are being actively studied as possible risk factors for COVID-19.  A recent review of five studies from China found that smokers are more likely to be admitted to intensive care and to need mechanical ventilation compared with non-smokers.   Other studies propose that the higher death rate from COVID-19 among men compared with women may be due to the higher rates of smoking among men.  Vaping is less studied, but early indications are that a number of compounds in vaping, including nicotine, may increase the likelihood for lung problems.


While these studies are not definitive, the likelihood of increased risk for COVID-19 among smokers makes sense.  Smoking can lower immunity for other illnesses and make it harder to fight infections; for example, smokers have twice the risk of getting the flu than non-smokers.  Smoking has been found to increase risks related to SARS, which is another coronavirus. Smoking affects the lungs’ natural defenses by partially immobilizing cilia, the hair-like structures on cells which function to clear the lungs from irritants.  Also, smoking is a well-known cause for major lung problems like emphysema and lung cancer.


Stopping smoking is the best single thing that you can do for your health.  Now, it may be more important than ever. If you are still smoking, now is a good time to stop.  If you have stopped, take the steps you need to avoid relapse. 


For more information on Smoking and COVID 19 Scientific American has published a very good article which you can find at the following link. Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection - Scientific American 


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

The COVID-19 crisis has caused disruption and worry for us all.  Life can seem ‘out-of-control’. You might feel more stressed than usual, out of your routine, or missing the things or people you rely on to hang on to your quit.  However, one thing in which everyone on the EX community can take solace is the focus on being or making efforts to be tobacco-free.  To quote a recent tweet from Jon Bon Jovi, “If you can’t do what you do, do what you can”.  And, being here in the EX community is an important thing that you are doing right now to act in your own best interest.


Stopping tobacco use, and staying stopped, is a tangible, and positive action that you can take each day. It’s also something that may directly lower your risk of COVID-19 or complications (not to mention other infections and illnesses, too).  Take comfort in the fact that you are doing something good for yourself today, right now.  No matter where you are in the journey, the fact that you are here in the  EX Community is a testimony to your intention for doing your best for yourself today.  


Take a breath and celebrate your accomplishment in being here right now. Maybe that celebrating looks different than usual: savor a refreshing cold drink; admire a spring view out the window; connect with a friend by text message or call; watch a favorite program; post right here in the EX Community. Congratulate yourself and congratulate others here for having the courage to ‘change the things we can’.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


Smoking and Stress

Posted by Dr.Hays Mar 11, 2020

Stress in its many forms and the desire to relieve stress are common reasons for people to smoke.  Early on most smokers experience relief of stress and anxiety but regular use of cigarettes shortly leads to brain changes that actually make it harder to experience relief of stress.  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.  A recent study of healthy young adult smokers showed that they actually experienced more perceived stress and had less well developed coping skills compared with other healthy adult nonsmokers approximately the same age.


The message from this study and many others is very clear:  If you want to reduce the levels of stress you feel and improve your overall mood, the best way to do that is to quit smoking.  For sure, there will be moments early on in the quitting process where stress levels feel increased, but getting support to help through this early time will result in a better, lower-stress you in the end.


Want to de-stress, cope better and develop a more positive take on life? Then get help and support to quit smoking, and keep trying until you are successful.


Dr. Hays

The news cycle happens very fast in this country. What is hot news one day can be back page news or completely out of sight the next.  This has happened with a condition known as EVALI, or “E cigarette or vaping associated lung injury.”  In some ways it is good news that this problem has become less newsworthy in the last few months because this means the epidemic of vaping associated lung problems is declining.  What we now know is that the lung problems appear to be mainly associated with vaping liquids that contained THC (the chemical in marijuana that causes the “high” feeling) and a chemical known as vitamin E acetate that was being used to thicken (very thin liquids are harder to vape) and dilute the THC.  Although the exact cause of the lung problems has not been determined, chemical changes of the vitamin-E acetate caused by the heating in electronic cigarettes seems a likely cause for the lung problems that occurred.  The epidemic appears to have peaked in around September of 2019 and now is declining.  This is probably because of all of the press this problem received and the public education that was quickly provided.  People across the country got the message and stopped using vaping devices and liquids that came from “casual” sources.


So where does this leave us with regard to the safety of electronic cigarettes in general?  Unfortunately, we are left still very uncertain about the safety of e-cigarettes and how useful they might be in helping people quit smoking tobacco cigarettes.  I still advise people who smoke and want to quit smoking to use the proven safe and effective methods of behavioral therapy and approved medications. 


Another reason that we are in a tight spot is because the groups who own the technology and best science in support of electronic nicotine delivery devices are the big tobacco companies.  The epidemic of EVALI probably set back the opportunity to develop safe electronic cigarettes and market them to help adult smokers quit by years.  My hope is that in time we will be able to see truly safe electronic nicotine delivery devices in the market place and move to a future where no one smokes tobacco and no one suffers from the long-term health effects of chronic tobacco smoking.  There seems little doubt that we in the public health and medical care communities will eventually have to make an uneasy peace with the tobacco companies who are working on developing safe electronic nicotine delivery devices.


If we can get to a point where we have a proven safe electronic cigarette (no matter who makes it), then we might achieve a future where no one smokes.  Wouldn’t that the great to see tobacco cigarettes go “poof” in a cloud of vape!


Dr. Hays

Recovery from addiction can be difficult.  Relapse and struggle are frequently part of the process.  People who are more addicted can have a very challenging time becoming tobacco free despite a strong desire to stop and a great deal of effort expended trying to stop.  We try to encourage those folks to stop being hard on themselves and stop unfairly comparing self to others.  Instead of blaming yourself, use every tool available to help you stop smoking. 


One phrase or tool you might find useful is to ‘don’t say anything to yourself that you would not say to a good friend’.  Positive and supportive ‘self-talk’ conserves the energy wasted through self-blame, and can provide a strong and gentle foundation to manage the difficult challenges in ‘re-learning’ life without tobacco. Quitting can be difficult.  Provide yourself with understanding and do the planning needed to make this important change happen.


One of the things I really love about the EX Community is the empathic way in which people are accepted and encouraged.   Good positive support helps to build success.  Understanding and care provide a net to bounce back from any relapse or set-back.  


If you are struggling, don’t blame yourself.  Be kind.  If you’re struggling alone, take a risk.  Share your struggles.   A load shared is half a load.  Give and get the support, care and encouragement that you deserve.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

The Surgeon General has newly released a report on smoking cessation.  Since the first report released in 1964, the Surgeon General has published more than 25 reports on the health effects from tobacco, second hand smoke, e-cigarettes, and addiction, but this is only the second report, and the first in 30 years, on a topic of personal interest to the members of the EX community: smoking cessation. 

The major conclusions in the report include 1.) Despite important and dramatic reductions since 1964 in the percentage of people who smoke, tobacco is still the leading cause of preventable death in the United States. 2.) Smoking cessation at any age improves health and enhances quality of life. 3. Most people who smoke attempt to quit each year but the large majority of them do not use methods (like EX) that are proven to improve success.  4.) FDA approved smoking cessation medications and counseling or other behavioral support effectively increases success in quitting.  5.) Coverage for smoking cessation that is barrier free and widely promoted leads to higher rates of successful quitting.



What the report has to say about web based support may be of particular interest to members of the EX Community.  For any of the Reports, the Surgeon General team review thousands of studies and then determine if the scientific evidence is sufficient to show cause, or infer the effectiveness of an intervention.  This new report finds for the first time, that the evidence is sufficient to determine that web and internet interventions increase success for people trying to quit, especially if the site is interactive. 



But, I suspect you already knew that.  You see the wonderful success that stems from EX every day. You hear from one another about how the struggle to quit becomes easier over time, how the health benefits happen for people of any age, and how quality of life can improve each day.  You encourage those who are struggling, congratulate those who are succeeding, and welcome those who are unsure. The interactive support you provide for one another is wonderful, and it works!  Thanks and keep up this good work!


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

You probably are aware that ‘Tobacco 21’ was signed into federal law in December, and went into effect as of January 1, 2020.  This is a good thing.  The National Academy of Medicine in a report issued in 2015 estimated that this law would reduce smoking initiation among people ages 15-17 by 25% and among those age 18-21 by 15%; eventually resulting in more than 200,000 saved lives for people born since the year 2000.


The purchasing restrictions include all types of tobacco including cigarettes, cigars, pipe tobacco, chewing tobacco, snus and dissolvable nicotine products.  It also restricts sales for anyone under 21 of all types of vapes and e-cigarettes, including e-liquids and components intended for use in an electronic smoking device such as mechanical heating elements, batteries or tanks.


A question was raised about how this might affect people between ages of 18 and 21 who might be tobacco addicted and suffer from craving and withdrawal symptoms.  The new regulation does not include medications, like nicotine replacement, Chantix, or Zyban, that can alleviate craving and withdrawal and help people to stop smoking or vaping.  Again, good news from our perspective.


Would be interested in hearing any thoughts or experiences people in the community might be having with the new Tobacco 21 regulation.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

We often hear from people that they are better off not making a tobacco quit attempt because they are depressed, anxious, or too stressed and they fear that these problems will worsen if they stop using tobacco.  These challenges can certainly make it difficult to consider stopping, and often the reinforcement from nicotine is paired with natural and effective coping skills like taking a breath, stepping away from a situation, or taking time to think things through.  The good news is that for many people, stopping tobacco will usually result in improved mood, and lower levels of depression, anxiety and stress.  


A number of studies have now found that within 2 weeks of stopping tobacco stress, anxiety, and depression all improve.   And, the total effect from stopping smoking is comparable to the effect shown in studies of people who begin antidepressant treatment for mood and anxiety disorders.  Contrary to what many people believe, stopping smoking may help improve their mental health in addition to being the single best thing they can do to improve their physical health.


There is an important caveat.  Depression and anxiety are relatively common nicotine withdrawal symptoms.  So, withdrawal can mask the improvements in mood that happen after stopping tobacco. This is one reason that a nicotine replacement therapy (nrt) can help people quit, it effectively reduces the withdrawal symptoms like irritation, anxiety, depression and stress. 


  I would be interested to hear your thoughts and experiences with quitting, anxiety, depression, and stress?


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


Resolution Time

Posted by NDC.Treatment.Team Jan 8, 2020


It’s resolution time of the year,...again.  Making a resolution is an admirable New Year tradition but, resolution season can be a time of demoralization and great pressure from self and others.   As a person wanting to make any important change, are you sometimes worried burdened with judgement and expectation from others, or yourself, that your resolution should be completely and perfectly accomplished?  


Quitting smoking or staying tobacco free is a great resolution, as it can be a singular path to achieving three of the most touted New Year’s resolutions:  health (saving your body from smoking related illnesses), wealth (saving your income from smoking related costs) and peace of mind (saving yourself from anguish about engaging in the harmful habit).  However, one can get discouraged by challenges or the fear of failure in light of the expectations by the second week of January. So, how do we resolve to achieve this goal without caving under its weight?   I have suggestion, just a suggestion: approach quitting tobacco or other resolutions in a gentle, uplifting and “bit by bit” way.

Resolve to:

  1. Go beyond verbalizing a resolution and create a plan for managing stress, cravings and triggers.
  2. Resist the tendency to try to conquer the beast on your own. Let others know your goals and challenges.
  3. Resist the urge to “rush” the process.
  4. Resist the tendency to romanticize the relationship with cigarette or old behaviors.
    • For example, beware of thoughts like “It has or had been the only thing that has been there for me through the highs and lows for 30 years.”
  5. Don’t wait to celebrate your accomplishments along the way to the long-term goal.
  6. Resist all or nothing thinking.


  1. Identify a plan that can work for you to make the process easier.
  2. Reach out to your trusted family and friends or participate in the EX community.
  3. Take each day at a time, or one moment at a time if need be.
  4. Recognize and draw from your strengths in overcoming great challenges in the past. And remind yourself why you choose to be healthier.
  5. Honor your efforts daily.
  6. Never, ever give up believing in, going after and yes, even fighting for the best healthy lifestyle for you.


Any additional thoughts from EX community members?


Jennifer Burden, PhD

NDC Counselor/CTTS


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


The holidays can be a challenge for people who are trying to stop smoking or vaping.  Being busy with family commitments, shopping lists, party preparations, and the chaos of the holidays can be quite stressful.  And while on one hand, being busy can take one’s mind off of smoking, there is also a drain that occurs to the ‘willpower’ muscle, so that a quick impulse and opportunity to smoke results in lighting up or puffing.  However, thinking through and deciding on what you’ll do if the opportunity to use arises, is a path to success. 


When the urge to smoke or vape happens, the cognitive energy to develop an alternative is somewhat compromised.  Having pre-formed plans of what you will do in a smoking situation makes it much easier to do something different.  It doesn’t have to be much.  Sipping a glass of water, taking a deep breath, thinking of those you love, are all alternatives that will allow the thought of smoking to fade, and assure that you will get onto a smoke/vape free season.


Remember also that smoking will not solve worries and it is not an effective way to manage stress.  Find real ways to build your body’s stress immunity: laugh, do something you enjoy, talk with a friend, get active.  There are many ways to build your resilience.  Check out the website and click the picture at ‘New Tobacco-Free Ways to Relieve Stress’ to see how you might really reduce stress and build your relaxation response.   


The holidays can be a good time to help the people you know and love be most supportive. Let those who can be helpful know that you are doing something important.  If you can, limit your time as much as possible with people who smoke and if you cannot, make a plan for slipping away into a smoke-free room or outside environment for those times and places where you know relatives and loved ones will be smoking. 


Put some fun time and effort into being good to your-self during the holiday. Happiness relieves stress. Look for recreation throughout your day. Enjoy!  As the song says, ‘Don’t worry. Be happy.’   And may we add – ‘Be healthy!’


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Next week, here in the northern hemisphere, is winter solstice, the shortest day, the darkest day, of the year.  The solstice however is the beginning of a change. Each day afterwards, the amount of daylight increases.  Each day is brighter and longer through spring and into summer.  I like to think of the solstice as a time of renewal, a time when we can begin to kindle a sure hope of spring.


This time of year also reminds me of the struggle, challenge, and eventual achievement people face in becoming tobacco free.  As you all know, the process of stopping smoking can be long and difficult.  It is not uncommon to struggle through feelings of discouragement and hopelessness.  But at some point, maybe at many points in a lifetime, hope that one can succeed  begins to dawn and builds into an intention, a plan, success and increasing confidence in a tobacco free life.


I wish all of you a warm, hopeful and tobacco-free holiday season.  If you have been tobacco free for a while, spend a moment to remember how far you’ve come.  If you’re still struggling to quit, take heart and kindle that hope.  Spring is sure to come.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

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