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Tobacco Dependency

By Daniel Boone, MD

Tobacco dependency occurs in 21% of the population in North America. The vast majority, close to 95%, is by smoking; the rest use smokeless tobacco products. The addicting component of tobacco is nicotine but there are several thousand other chemicals in tobacco smoke or juice that are quite harmful to the body.

When a cigarette is made, a third of the tobacco is cut leaf tobacco. Another third is the processed stalks and other plant parts that are combined and then pressed into sheets that are then sprayed with nicotine and some other chemicals and then cut to resemble leaf tobacco. The final third is leaf tobacco that is impregnated with freon and freeze dried to expand the volume. Tobacco smoke produces anywhere from 600 to 4,000 additional chemicals. What keeps you coming back to tobacco is nicotine.

In the addicted community, which is only 10-15% of the population, 80% of addicts use tobacco. Sadly, relapse rates are higher in smokers versus non smokers and the brain regeneration that occurs in recovery is markedly hampered by tobacco use.

So what do you need to do if you are a smoker? The obvious answer is to JUST STOP! As you know from other addictive processes, however, it is not easy. The success rates for “cold turkey” tobacco cessation are around 3 percent. Fortunately, there are medications that have been designed to help you get off tobacco. The oldest is simple nicotine replacement. The key for replacement therapy is to substitute nicotine mg for tobacco mg. For example, one cigarette contains 1 mg of nicotine. So if you smoke 20 cigarettes per day–one pack–then you need a minimum of 20 mg of nicotine replacement per day. That means a 21 mg patch, or 5 pieces of 4 mg nicotine gum, or 20 sprays with a nicotine inhaler, etc. The idea is to gradually reduce your nicotine use every few weeks until you taper off. The success rates with nicotine replacement are right around 20 percent. You can increase that to close to 30% with a one week pre-treatment course of Zyban or Wellbutrin–a drug that raises dopamine in the brain and is frequently used for depression. To get higher smoking cessation results you would have to take a course of Chantix (varenicline). Chantix is a nicotine receptor blocker, but is also a partial agonist on the nicotine receptors in the brain. It fools your body into thinking you have taken nicotine while blocking the high from the nicotine. It takes a minimum of 7 days to fully block the receptors. Usually by the 8th to 10th day, all the receptors are blocked and cigarettes and tobacco start to taste and smell bad and you gradually reduce and stop your tobacco intake. The major problem with Chantix is the potential side effects. It MUST be taken with a full stomach, but can still cause nausea and headaches. If taken too close to bedtime it can interfere with sleep and cause unpleasant dreams. Chantix can cause mood swings which can lead to worsening depression, psychoses, and suicidal thoughts. This must be considered carefully when you contemplate smoking or tobacco cessation.

So if you want to finally “kick the habit” of tobacco, talk to your doctor about these options. Pick a quit date at least 7 days before you start your smoking cessation efforts. Start focusing on that date, talking about it, dreaming about it. Then, as the commercials say, “Just do it”!