I recently worked one of the Mayo Clinic residential treatment programs for tobacco cessation and was reminded of something I’ve heard many times from patients desperate to quit smoking. “I don’t really want to use medications.”
To provide some background, this is an intensive program where patients live on a unit together for 5 days. Programming includes individual and group counseling, educational sessions on many different topics related to tobacco cessation, and medical provider rounds each morning. This is a very intense treatment option, and attendees regularly travel across the country to be a part of it. This is all to say that the people who attend this program are generally highly dependent and have tried many other approaches to quitting, without long-term success.
Patients are told during pre-screening that part of the approach with this program includes use of medications. Yet, when they arrive, it’s common for them to question the rationale for medications and some resist using them. In my experience, these responses mainly come in two forms. One is the desire not to use medication or not to need medication to quit tobacco. An example of this kind of thinking is when you or someone else has a headache but resists using a pain reliever because “it’s not that bad”, even though past similar headaches have required pain meds. The other type of thinking is driven by misinformation that nicotine medications may be harmful and will keep them addicted in the same way that tobacco does. I’ve heard variations of comments like these many times: “Why would I want to use nicotine from medications to get off of nicotine from tobacco? That doesn’t make any sense.”
When patients express these concerns, we listen and validate, offer information regarding the difference between FDA approved nicotine medications and nicotine from tobacco, provide education regarding the difference in nicotine delivery and the resultant impact of nicotine from the different products, and engage them in discussion around what brought them to our program. Finally, we encourage them to consider using the medications.
With this approach, most patients choose to utilize some combination of medications. However, others choose to use a lower dose of the nicotine replacement than is recommended by the supervising medical provider. It’s common to see patients who make this choice struggle with withdrawals and cravings during the first couple of days. Fortunately, most of them eventually choose to increase their nicotine intake, and experience significant relief.
In summary, when quitting tobacco, medications can be your friend. Meet with your medical provider and/or a Tobacco Treatment Specialist to find out what the best medications are for you to use.
Tim Milbrandt, MS, LMFT
Addictions Coordinator /CTTS
credit: Photo by Madison Agardi on Unsplash
