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Not sleeping?

Posted by Dr.Hays Mar 21, 2018

Because there are many different factors, and different ways to measure this, there is not yet a clear answer to the question, ‘how quitting smoking impacts sleep?’


Nicotine is a stimulant, and can lead to insomnia, but insomnia can also be a symptom of withdrawal from nicotine.  Nicotine does appear to suppress dreaming, and this can ‘rebound’ when nicotine leaves the system.  Nicotine has a half-life of 2 hours, so when thinking about your typical night sleep (8 hours or so), it could be marked as periods of withdrawal that may be interfering with the quality of sleep and your sleep wake cycle. 


Impairments in sleep can cause a number of issues some being ability to: make reasonable decisions, think clearly, and be more productive. With chronic sleep deprivation it can impact heart heath, risk of diabetes, and put you at a greater risk for depression.  


So for members of the Ex community, it is important to get enough quality sleep to avoid making snap decisions when you may not be in the right head space. What are some of your favorite practices to make sure you are getting quality sleep?


Stay tuned for next week’s blog on Sleep Hygiene!


Perspective on Nicotine

Posted by Dr.Hays Mar 14, 2018

There is a lot of misunderstanding about Nicotine Replacement Therapy (NRT). What is NRT- It is a medication containing nicotine approved by the Food and Drug Administration and in the United States sold in the forms of patch, gum, lozenge, inhaler, and nasal spray.  A great deal of research, including research conducted here at Mayo Clinic, has found that people using these products are more likely to be successful in stopping smoking than people who don’t use these products. NRT helps to ease withdrawal symptoms by giving you a slow release of nicotine. Yes slow release--- Nicotine in a cigarette releases “feel good” chemicals in your brain in 7-10 seconds (no comparison to nicotine replacements). This makes the cigarette comparatively highly addictive.

Nicotine replacement medications provide a safe amount of nicotine that does not cause heart disease, cancer, strokes, or other serious conditions that are linked to tobacco. However, being that nicotine in a cigarette is the FASTEST delivery, it causes addiction, while delivering other harmful chemicals and carcinogens in the tobacco smoke.

People tend to take their own path while they quit and maybe NRT’s are something you plan to try. If so, be assured that it can be helpful and add to the likelihood of success.

Shame is distressful feeling related to negative thoughts or perceived evaluations of ourselves – a sense that ‘I am bad’.  It is distinguished from guilt, which is a remorse focused upon an action – a sense that I did something wrong.  When it comes to making changes like stopping smoking, that may require multiple tries, and learning from past efforts that were not fully successful, shameful thoughts like ‘what’s wrong with me’, can be an obstacle to success rather than an effective motivation for change.  

Shame about tobacco use has increased over the past 20 years as smokers feel more ‘stigmatized’.   This feeling is understandable.  Rules about smoke free indoor environments, tax increases intended to promote quitting, and public health messages about the tragic health consequences from tobacco can evoke the feeling among smokers of ‘being singled out’.    People can understandably become defensive, defiant, and isolated in response to feeling ‘stigmatized’, and this can decrease the desire and intention to stop smoking.

An additional complication related to shame and smoking has to do with the nature of tobacco addiction.  Tobacco addiction can be seen in part as the hijacking of the unconscious, habitual, automatic part of the brain.  When a person is in a usual smoking situation, like the car, with other smokers, a break between jobs, or a stressful situation, the urge and physical response of reaching for a cigarette can be triggered automatically.   Planning to manage these situations with forethought based upon self-knowledge and past experience of trial and error is much more likely to lead to success, rather than a shame based reaction such as ‘what’s wrong with me’ or ‘why do I keep doing this’.

Stopping smoking can be very difficult.  How we evaluate that challenge, can add or lessen distress and discouragement.   Looking at past attempts as educational, rather than as ‘failures’, and perceiving yourself with self-compassion rather than blame can pave the way for success.


Can Counseling Help?

Posted by Dr.Hays Feb 28, 2018

Counseling can help in many ways. In fact, the more times or number of sessions a person spends in counseling for quitting tobacco, the more likely a tobacco user will become and stay tobacco free.


 A counselor can review past experiences and help discover strengths and new strategies for success from prior attempts to quit. A counselor can encourage a person to elaborate on their reasons for stopping, which can help strengthen confidence to quit.  Counselors can help develop a plan to recognize and manage dangerous situations that could lead to a lapse or relapse. Counseling can help tobacco users to understand why it is so hard to stop. They can help with the proper use of medications, and can refer a smoker to a healthcare provider to prescribe medication. Tobacco dependence impacts many areas in a person’s life; therefore working together with a trained professional can help to cope with what arises and take proper action to reach your goals.


Counseling with a tobacco treatment specialist (TTS) may be available in your area through your State Quit-line or through one of the local hospitals or clinics. If a TTS is not available, you can ask local mental health and substance abuse counselors if they can help to support your efforts to quit


When you decide to quit, use all the tools at your disposal, and don’t forget that counseling could be the key.


What about Chew?

Posted by Dr.Hays Feb 21, 2018

We often talk on this site about the dangers of smoking, but what about smokeless tobacco? Smokeless tobacco is any product that is held in the mouth.  Nicotine, the addicting substance in tobacco, is absorbed through the lining of the mouth. Smokeless tobacco products may be perceived safer than cigarettes because it is not associated with lung cancer, but the truth is these products can cause serious harm. Smokeless tobacco increases a person’s risk for nicotine addiction, as well as oral diseases.  These products are associated with an increased risk for oral cancer, pharyngeal cancer, laryngeal cancer, esophageal cancer, and pancreatic cancer (Ebbert, Elrashidi, & Stead, 2015).


Consider trying to quit if you are chewing tobacco or using other forms of smokeless tobacco.  Create your own quit plan by tracking your triggers and developing support with the EX-community. The nicotine patch, gum, or lozenge are all effective options to help you quit smokeless, as well as smoked tobacco.  In addition, hard candy, sunflower seeds, mints and gum are helpful when having urges to chew.  You can also contact a tobacco treatment specialist if you are struggling to quit.


Ebbert,  J.O., Elrashidi M.Y., & Stead L.F. (2015). Interventions for smokeless tobacco use cessation.  Cochrane       Database System Review Oct.26 (10). doi: 10.1002/14651858. CD004306.pub5

During the 2016 summer Olympic Games this blog was posted, and although the Olympics are in a different part of the world, with different sporting events and athletes, the themes are very similar.


The pinnacle of sports performance in the USA and in many other countries around the world is here, the 2018 Winter Olympic Games. Competing at the Olympics is a lifelong goal for many athletes in hundreds of different sporting events. It is fascinating to see these athletes in action knowing all of the discipline and commitment that they have put into becoming the best athletes in the world.  What makes these events even more interesting is hearing athlete stories – how they persevered and overcame numerous challenges to make it to the top of their game.


The slogan for the games in PyeongChang is “Passion Connected ," and we are seeing each athlete not only living out their passions, but connecting to their passions in a variety of ways during the games. Although most  of us will never participate in the Olympic Games, you may have at one time or another felt passionate about something – whether it be a passion to excel in your career, create beautiful art, or raise healthy, passionate children. Unfortunately, tobacco dependence can interfere with our passions. Without realizing it, our zest for life and the things we enjoy most become second fiddle to addiction.


Many Olympic athletes share that they were able to overcome their challenges because they never lost sight of their passion and goals. There is no doubt that stopping smoking is tough, so what is it that drives you to keep going when the going gets tough? If you were to imagine yourself tobacco-free, what would your life look like? How would you be living out your passions? Sometimes, having a clear vision of our destination can help us plot the course that will guide us there. 


No one makes it to the Olympic Games without the devotion, hard work, and passion to excel in their sport. Additionally, no athlete makes it there without the help and support of others. Remember, there are more EX-smokers today than current smokers. You can achieve your goal to not only live your passion, but become connected to it!


The community and tools at BecomeAnEx are here for you so choose life and get connected to your passion!


2018 Tobacco Scorecard

Posted by Dr.Hays Feb 7, 2018

The American Lung Association just released their 16th annual scorecard on the states and the federal government commitment to implementing proven laws and policies to quell the tobacco epidemic. 


The report cites the good progress made in the United States in reducing tobacco use since 2000; reducing prevalence among adults from 23.5% to 16.5%.  However, about 40 million adults still smoke cigarettes, and tragically the progress made to date has been disproportionate. Interestingly; people who are uninsured, with mental health problems, American Indian, LGBTQIA community, who live in public housing, rural areas, or states with less comprehensive tobacco control laws, continue to smoke at much higher rates than the general population.


We know what will work to provide these people with equal opportunity to stop using tobacco. The American Lung Association reviews five key factors that are proven to work, and that can help address these disparities.


These include:

  1. Funding of tobacco control programs consistently and in the amount suggested by the Center for Disease Control
  2. Comprehensive smoke free air laws
  3. Increasing the cost of tobacco
  4. Providing insurance coverage for proven cessation treatment
  5. Raising the minimum age to purchase tobacco to 21


The report rates each of the states in these areas. I encourage you to look at the report, and check on your state.  How is your state doing?  About 500,000 people in the USA continue to die from smoking caused illnesses each year.  We can bring this tragedy to an end with the right policies and the political will. 


We look forward to any comments from the Community.


Re-learning Rewards

Posted by Dr.Hays Jan 31, 2018

For many people, a particular challenge to becoming and staying tobacco free are the cravings that occur while having coffee, after a meal, or when relaxing. Like all cravings and associations with cigarettes, this fades over time; however, the thought of having a cigarette or ‘dip’ along with these activities can be persistent.   Understanding cravings, and making plans to purposefully enjoy these activities without tobacco, can help the association fade away more quickly.


Tobacco, like any addictive substance, stimulates the reward system in the brain. In doing that it can become strongly associated with other activities, thoughts, or feelings.  This association makes it more likely that a person will ‘want to smoke or dip’ the next time they experience that activity, thought, or feeling.


Nicotine also has some relatively unique characteristics, it is a powerful ‘secondary reinforcer’, meaning It also enhances the experience of other things, like beverages, food, warm social gatherings, or relaxation.  After quitting tobacco, enjoyment of coffee, social connections, or relaxing may not ‘feel-the-same’ for a while. 


The good news is that enjoyment of all these activities, in the absence of tobacco, returns.  Every time you enjoy a cup of coffee, good company, or relaxing without a cigarette; your ability to enjoy that activity becomes stronger.


You can also hasten this recovery by mindfully taking a moment to appreciate, kindle, the taste of coffee, good company, feeling relaxed, or the taste of food.  Enjoying life on life’s own terms has its rewards, and re-learning life’s enjoyments without tobacco is a pleasure in itself

The e-cigarette problem continues to grow! What defines Electronic Nicotine Delivery Systems (ENDS): Vapes, vaporizers, vape pens, hookah pens, electronic cigarettes (e-cigarettes or ecigs), and e-pipes.

The long term effects of these products remain unknown. There has been some research done linking them to pulmonary issues and other health effect to these delivery devices.

According to the Food and Drug Administration (FDA),

  • More than 2 million middle and high school students were current users of e-cigarettes in 2016.1, 2
  • 11% of high school and 4.3% of middle school students were current users of e-cigarettes in 2016.1
  • E-cigarette use rose from 1.5% to 16.0% among high school students and from 0.6% to 5.3% among middle school students from 2011 to 2015.1
  • In 2013-2014, 81% of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use.


Although we have reached an era where less and less children are starting to smoke, the fear is these products have been linked as the “gate way” to smoking combustible cigarettes. The other concern is, since they are so popular among younger populations, are the e-cigarettes “re-normalizing” smoking behavior?



Information has been gathered from the Center on Addiction (, and the FDA (

Pulmonary toxicity of e-cigarettes

Lauren F. Chun, Farzad Moazed, Carolyn S. Calfee, Michael A. Matthay, and Jeffrey E. Gotts

American Journal of Physiology-Lung Cellular and Molecular Physiology 2017 313:2, L193-L206

The US Surgeon General’s Report of 2014 stated that the evidence is sufficient to conclude that advertising and promotional activities by the tobacco companies cause the onset and continuation of smoking among adolescents and young adults. Philip Morris reported in 1999 that “the ability to attract new smokers and develop them into a young adult franchise is key to brand development.”  Smoking is instilled throughout contemporary culture and adversely influences the behavior of adolescents. Half of all movies for children under 13 contain scenes of tobacco use, and images and messages normalize tobacco use in magazines, on the internet, and at retail stores frequented by youth. Many of the video games that were released in the past few years, which were rated appropriate for “teen” audiences, feature characters who smoke. These characters are portrayed as tough and powerful, sending very dangerous messages to young people. Video game content descriptors often fail to mention tobacco use, making it difficult for parents to monitor the games. The depiction of tobacco use in games serves, in effect, as free advertising for tobacco companies, and a recruitment mechanism for the “replacement smokers” they need to make up for the 1,300 people who die each day from a tobacco related disease.


Second and Third Hand Smoke

Posted by Dr.Hays Jan 10, 2018

Exposure to secondhand smoke can cause many of the same diseases as active smoking. It increases the risks of contracting lung cancer by 30% and heart disease by 25%. Heart disease, lower respiratory tract infections, asthma, and lung cancer are the most common causes of deaths related to secondhand smoke. People can be exposed to secondhand smoke in homes, indoor work and public places, cars, outdoor places, and in multi-unit buildings even if nobody smokes in one’s own apartment-but people smoke elsewhere in the building.


Nicotine and other tobacco compounds accumulate on various surfaces (clothes, furniture, walls, and vehicles) and can stay there several months after smoking has stopped, even after the surfaces have been washed. These residues or third hand smoke contain several toxic compounds and have shown harmful effects on human cells and animals in laboratory studies. The nature and magnitude of and health effects are currently being studied. The health effects of exposure to vapor from e-cigarettes are unknown but are being researched as well. The inclusion of e-cigarettes in smoke free regulations is the only way to prevent any potential harm from exposure to e-cigarette vapor.

What is stress? The definition of stress is merely your reaction to an event, not the event itself. Quitting tobacco may place you in a position where you do not have that security/ comfort you once had, possibly leading to distress.


One concept that has been prominent in recovery communities for many years and is gaining more traction in the field of health and wellness is the idea of gratitude and mindfulness:

Gratitude is considered an attitude or expression of thankfulness and appreciation for what one has.  Simply, gratitude is about focusing on the positives in our lives instead of dwelling on the negatives.  Researchers are finding that an attitude of gratitude not only increases happiness and well-being, but can lessen feelings of stress, anger, and depression.

Mindfulness: a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations.


  1. Keep a gratitude journal – Each night try jotting down several things you are grateful for in your life.  They can be as simple as having a good book to read or being able to breathe fresh, clean air.
  2. Help others who are struggling – Being of service to others can help us appreciate what we have in our lives and can provide us with a different perspective on our own challenges.
  3. Keep an attitude of gratitude– Compare these two statements: “I can’t smoke today.” & “I don’t have to smoke.”  How we choose to think about a situation can determine how we feel and act.  Think positive!
  4. Develop a mantra - Many people in recovery recite the Serenity Prayer to appreciate what they can control and accept what they cannot.  Consider memorizing a favorite phrase or prayer that brings peace and positivity into your life.
  5. Find symbols that represent gratitude– Whether it’s writing down inspirational quotes, creating a gratitude board on Pinterest, or keeping a picture of your loved ones at work, surround yourself with the things that motivate you.


Explore brief mindfulness exercises by Dr. Sood of Mayo Clinic



A smoke free 2018

Posted by Dr.Hays Dec 27, 2017

The winter solstice is passed and each day brings more daylight then the next.  Similarly, if you’ve stopped smoking, or intend to stop for the New Year, each smoke free day in 2018 will bring more health and wealth than the day before.


Stopping smoking is the absolute best thing you can do for your health.  If you’ve stopped, congratulate yourself and take a moment to appreciate that you’ve done a wonderful thing. Know that your body thanks you.  Think about the money you saved.  Take a moment to imagine all the cigarettes that you did-not smoke. 


If you’re considering stopping, or planning another stop, the New Year is a great time to take that step.  Get prepared.  Use your past experience as a learning resource.  Explore the tools on EX, recruit your support, and step into a smoke free New Year!

Smoking only a cigarette or two each day would seem to be a lot less harmful than smoking a pack per day, but that’s not necessarily the case.  One problem is addiction. For most people who have an addiction to tobacco, reducing to a few will eventually result in relapse and a resumption of the amount to which they’ve become accustomed.   For most smokers, stopping altogether is easiest.


            However, even if permanent reduction to 1 or 2 were sustainable, the health consequences from smoking only a few are quite severe.  A large study published in Circulation found that heart attack risk, and cardiovascular disease risk from smoking even a cigarette or two per day can be as almost the same as for those who smoke 15-20 per day.       There seems to be no risk-free level of cigarette smoking.  


If you do smoke at all, the only healthy solution is to stop completely.  Also, keep in mind, that health benefits begin as soon as you stop.  Carbon monoxide levels become normal within a day or two, wounds, like from surgery, heal better, after 2 days of not smoking, and lung function improves significantly within 3 months. Within one year, your chance of having a heart attack is cut in half, and within 2-3 years it’s the similar to someone who has never smoked at all!.


Pope CA et al. Cardiovascular Mortality and Exposure to Airborne Fine Particulate Matter and Cigarette Smoke. Circulation. 2009;120:941-948.


Inoue-Choi M et al. Association of Long-term, Low-Intensity Smoking With All-Cause and Cause-Specific Mortality in the National Institutes of Health–AARP Diet and Health Study. JAMA Internal Medicine. 2017;177:87-95.


Team Approach to Quitting

Posted by Dr.Hays Dec 13, 2017

We at the Nicotine Dependence Center are thrilled to see all the support that is happening on the EX Community. 

I have heard a couple of concerns regarding how medications can change effects once you have quit as well as other health concerns. This may be possible, quitting tobacco is a big change and it can make for a disjoint in how your body runs on a day to day basis. Having a team approach which would include health care providers can be very helpful.

Quitting can change; blood pressure, sleep habits, effects of caffeine, and etc. depending on the person.  Therefore, medical staff can play an important role by monitoring and adjusting medications and you move about the quit process.

You’re not alone, keep others informed!

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