Local area professionals aim to put the light out on smoking

In 1970, a pack of cigarettes cost $1.70. Today, the price is nearly $5 a pack. To date, 24 states have passed laws prohibiting smoking in public places. And as tobacco and its effects on the body receive more study, research shows nicotine’s toxins impact many of the body’s interrelated biological systems beyond the lungs and heart.

The growing financial cost, public and workplace restrictions and overwhelming medical research on the dangers of smoking are driving the number of smokers down in all categories – from 43 percent of the population in 1965 to 19.8 percent in 2007 (about 26 million men and 20 million women smoke today). Among the nation’s teenagers, the Centers for Disease Control estimates that smoking is down from 28.3 percent in 1991 to 19.8 percent in 2007.

But for those remaining 40 million people nationwide, smoking remains a tough habit to break. That’s why a number of associations, medical practices and businesses offer counseling and support groups to help tobacco users kick the habit – and they have a plethora of prescription medications at their disposal to help users overcome their physical and psychological dependence.

 

A Desire to Quit

“Like anything in life, the patient’s desire to do something about a health problem they’re facing is a tremendous part of being successful,” says Steven Ames Ph.D., a clinical health psychologist who has provided smoking cessation counseling for patients at Mayo Clinic Jacksonville since 2001.

“It’s like any health behavior,” he explains. “Like when your doctor advises you to get more exercise to lose weight, or eat less and more nutritionally...it’s the same thing with smoking. It’s obviously enjoyable to you on some level or you wouldn’t do it, and it’s not a pleasant thing to do without.”

But unlike one’s love of fatty foods or French Fries, the patient is facing an additive drug when it comes to nicotine. Whether they are smoking, dipping or chewing, tobacco brings both a physical addiction and psychological dependency that can be very hard to overcome.

“For some, the most difficult thing is what to do with their hands when they quit,” Dr. Ames says. “Some associate smoking with having coffee or drinking a beer, for example. There’s no chemical dependency there; it’s all psychological. It’s like having popcorn at the movie theater. That’s not a chemical dependency, but that’s what years of conditioning have made us think when we go out to see a movie. For those who don’t smoke, that’s how I describe ‘the habit.’”

Dr. Ames says he uses different approaches, or a combination of several, to motivate and compel people to quit using tobacco.

“Certainly, it isn’t good for you from a health standpoint, but sometimes you appeal to their love of family,” he says. “Tobacco use, especially smoking, isn’t good for the people around you, either.”

Despite the enjoyment of the habit, Dr. Ames says most people have an interest in stopping. He imparts to his patients that there’s a process to change, even if it’s to come sometime in the future.

“The patients referred to me will typically set a quit date for themselves,” he says.

 

Pharmaceutical Aids

Before about 1980, there weren’t many options available to smokers beyond quitting cold turkey. But today there are many pharmaceutical aids on the market to help them – nicotine patches, nicotine gums and lozenges, nasal sprays and medications in pill form, like Chantix or Zyban.

“Chantix versus quitting cold turkey at least doubles the chance a tobacco user can kick the habit,” Dr. Ames says.

As a clinical health psychologist, Dr. Ames doesn’t prescribe medications, so he refers those recommendations to the patient’s primary care physician. Dr. Ames, who works within Mayo Clinic’s Oncology Division and serves as chairman of Cancer Prevention and Control within the hospital’s comprehensive cancer center, notes that the medication he recommends depends on the patient’s needs.

“A very small percentage of Chantix users exhibited some psychotic side effects, thoughts of suicide and things of that nature, but it’s quite uncommon and I haven’t encountered anything like that in my practice,” he says. “But if a patient had a history of alcoholism, depression and they’ve struggled with mental health issues in the past, I wouldn’t suggest Chantix in those cases.”

As with any medical treatment, Dr. Ames says the patient should have plan that includes counseling.

“The medications only help conquer the nicotine addition,” he says. “What you do about the friends you have who continue to smoke, how you handle the triggers like drinking coffee or a cocktail...you have to address all those things when you decide to quit.”

Dr. Ames says he hasn’t seen an increase in the number of patients he counsels in smoking cessation, which are referred by their primary care physicians at Mayo Clinic, but does note that many seek out his help as smoking has become more restrictive.

“Restaurants are smoke-free, workplace restrictions, indoor clean air laws, and the additional cost – all of these efforts are having an effect,” he says.

 

A Helping Hand

As the restrictions have extended to public areas outside of buildings, many healthcare facilities have introduced cessation classes to help their employees kick the habit.

Mark McIntosh, M.D., who has served as an emergency physician with UF & Shands Jacksonville for more than five years, put his background in integrative medicine to work in developing a wellness program.

“I’d say about 70 percent of the people I come into contact with in the emergency room wind up there because of some habitual medical problem – be it poor nutrition, alcoholism, smoking and other things like that. I figured if we can somehow build a fence at the top of the cliff before they jump off, we might have a profound impact on their lives. That’s what wellness is all about,” he says.

Dr. McIntosh’s wellness programs incorporated smoking cessation classes to help smokers cope when the hospital campus went smoke-free in 2008.

“When Shands went smoke-free last November, it was a big deal...just like it is with any corporation,” he says. “As a medical facility, we need to model good health. When we completely eliminated smoking on campus it made it inconvenient for employees to continue the habit, but we wanted to support our employees and help them through it.”

Over a six-month period, nearly 125 physicians supported the program through referrals. Dr. McIntosh helped Shands set up an employee-based program to identify tobacco users and refer them to employer-based group cessation programs provided by the Northeast Florida Advanced Health and Education Center (AHEC) where employees could receive education and also receive nicotine replacement aids.

“I’d say about 70 percent of the time people who smoke want to quit, but they need something to the action phase to do something about it – to motivate them to stop,” he says.

Smoke Free At Last

Karen Nutter, who worked with Shands as the Lead Tobacco Cessation Specialist for the Northeast Florida AHEC, says the state legislation that increased the cost of a pack of cigarettes by one dollar in July caused a notable surge of people registering for cessation programs. She administers both worksite classes and community classes, with each lasting one to one-and-a-half hours and held once a week. (The AHEC Tobacco Cessation Programs are available free by contacting 877-QUIT-IT-NOW or by visiting the agency’s website at www.fdhc.state.fl.us.)

Nutter notes that AHEC cessation classes are designed for all tobacco users, not just smokers.

“Whether its cigarettes, cigars, chewing tobacco, or they’re dippers, they spit tobacco or they use hookahs, we address their particular use,” Nutter says.

She says the reasons people choose to attend her classes are varied.

“With some it’s the health consequences, and others are reluctant participants who come with a friend who wants to quit,” she explains. “Others say their wives will leave them if they don’t stop, or the boss will fire them if they don’t quit. But I must say most of the people who attend have a willingness...they want to stop because they know tobacco is bad for them. They’re really no different than any drug user.”

And the success rate among her participants varies as well.

“Certainly, some participants don’t stop, but I’ve had people who smoked 50 years who took Chantix, quit immediately and never started again,” she says. “Some have quit using nicotine lozenges, others going cold turkey. Different things work for different people.”

Former-smoker Bob White, one of Nutter’s past “students,” quit smoking on Christmas Day last year. Now 54 years old, he started smoking after high school. White, who works with an event security company, says his doctor referred him to the AHCA class – but not for any immediate medical concern.

“I always wanted to quit,” White admits. “I always knew it was bad for me. My uncle died from smoking, and my mom was always on my back to stop before she passed away three years ago. I still hear her words in my mind.”

White had cut his pack-a-day habit in half, and then began smoking them half-way down before putting them out – all on his own – before he mentioned it to his doctor, who suggested White attend a community cessation class.

Attending the meetings led him to the nicotine patch and, finally, quitting for good.

“Once I put my mind to it, I knew I could stop,” he says. “I just stuck to my guns.”

But, does he miss it?

“I’m still smoking in my dreams, but that’s it,” he says. “The classes, the breakfast meetings, all those things help you during the weak moments.”

Nutter, who has been in her role for nearly two years, facilitates about 500 such classes over northeast Florida each year. She says the one concern shared by most participants is the fear of weight gain once they stop using tobacco – especially in today’s current economy.

“They don’t want to be forced to buy a new wardrobe if they gain weight,” she says. “But I tell them they can avoid that through exercise, or by finding other healthier ways to spend their time. The bottom line with anyone who wants to stop is this: you can’t bank on a barrier if you want to be successful.”