UNDERSTANDING NICOTINE DEPENDENCE HIGHMARKBLUESHIELD.COM

WHAT IS A DISEASE? Disease is often used broadly to refer to any condition that causes: Discomfort Dysfunction Distress Social problems Death

COST TO EMPLOYERS The CDC estimates that the total cost of smoking in the U.S. exceeds $193 billion per year.

TRENDS IN TOBACCO USE 443,000 Americans die each year from smoking related diseases. Smoking is responsible for 30% of all cancer deaths, 90% of lung cancer cases and most causes of emphysema and chronic bronchitis. Tobacco use is linked with cancer of the mouth, throat, esophagus, bladder, kidney, pancreas, stomach, colon, skin and cervix. Source: University of Michigan Health Systems 2006 Fact Sheet

NICOTINE FACTS Nicotine produces physical and mood-altering effects in the brain that are temporarily pleasing. These effects reinforce the continued use of tobacco and nicotine dependence.

SYMPTOMS OF NICOTINE DEPENDENCE Efforts are in vain… No matter how much one tries, they can’t give up smoking. Repeated attempts to stop smoking prove futile. Experience withdrawal symptoms… Having many physical and mental discomforts when one tries to give up smoking means they are “hooked” to the smoking habit.

WHY DO PEOPLE SMOKE? To satisfy a physical need Because it’s a habit To satisfy a psychological need To feel “normal”

THE CHALLENGE OF QUITTING It’s important to understand that it is VERY hard to quit tobacco. Smoking is physical. Smoking is a learned behavior. Smoking is psychological. 75% of the people who quit relapse after one year. It takes an average of seven attempts to quit for good.

WHAT THE EXPERTS SAY… The combination of hundreds of toxic chemicals in cigarettes makes addiction to tobacco more difficult to overcome than addiction to cocaine.

ADDICTION: THE PHYSICAL SIDE Nicotine is a psychoactive drug. It causes lasting changes in the brain’s reward area. Nicotine induces an enduring “memory trace” that amplifies the pleasing effect of the drug. Nicotine stimulates the release of the neurotransmitter dopamine in the brain’s pleasure circuit.

WHAT NON-SMOKERS FEEL Normally, pleasurable feelings come from food, comfort and the company of other people we love. The completion of a task or goal would be another natural feeling. Smokers get these same feelings from nicotine.

WHAT SMOKERS FEEL The nicotine/dopamine connection is in charge of making the smoker feel good. “We smoke to feel normal.”

NATURAL PLEASURES DIMINISH The smoker has trained the limbic system (the part of brain associated with emotions, motivation and memory) to crave nicotine. In adjusting to the presence of nicotine, the brain cuts production of the natural levels of dopamine. The smoker needs nicotine just to create normal levels of dopamine in his or her brain. Without nicotine the smoker feels irritable and depressed. The smoker smokes to feel normal.

SMOKING FILLS TIME Smoking may help participation in social activities or it may itself be a primary social activity. Smoking may also increase feelings of isolation given the trend toward social censure. Smoking relieves boredom. Smoking may play a role in building and maintaining relationships between employees.

SMOKING RELIEVES STRESS Smokers often report that smoking cigarettes helps relieve feelings of anxiety and stress. Smoking is used as a stress coping mechanism.

WHAT’S REALLY GOING ON? The craving (i.e. withdrawal symptoms) makes a smoker feel stressed. All smokers have a blood level of nicotine that needs to be maintained to stay out of withdrawal… a comfort level. When the nicotine in their blood drops below a certain level, the smoker craves a cigarette.

“Doesn’t my boss know that I have to keep my nicotine level up to feel good?” “It’s great to have these smoke breaks.” When a smoker’s nicotine levels drop SMOKER’S NICOTINE LEVELS Feelings of stress rise

RESPONSE TO WITHDRAWAL Depression Tension Difficulty concentrating Irritability Anger Nervousness Emotional withdrawal Dizziness Frustration Inability to focus Anxiety Restlessness and boredom Fatigue Mood Swings

THE NICOTINE CYCLE Nicotine-Induced Stress “I feel nervous and tense because my body needs a cigarette.” Nicotine-Induced Relief “I feel normal now since I’ve replenished my nicotine level.”

BECOMING A NON-SMOKER The person must be committed. Commitment will not guarantee success but without a commitment, failure is guaranteed. Smokers need support to become non-smokers. A supportive environment at work and home increases the likelihood of success. Research shows that smokers are much more likely to succeed if they seek advice from their physician and use pharmacological support.

TOBACCO CESSATION PROGRAMS Empower participants to become experts and take ownership Engage participants in dialogue Promote learning through reflection and discovery Encourage two-way communication Invite questions Help participants learn how to live without nicotine

PROGRAMS FROM YOUR HEALTHCARE COMPANY Blues On Call Members can call Blues On Call at BLUE-428, 24 hours a day, 7 days a week for educational resources on tobacco and tips on how to quit. My Health Assistant An online digital coaching program, that lets you create a quit plan that works for you

HOW CAN MANAGERS AND SUPERVISORS HELP EMPLOYEES WHO WANT TO QUIT SMOKING OR USING TOBACCO? Understand the addiction. Recognize that work stressors can reduce nicotine levels, which causes withdrawal symptoms. Show support of those trying to quit smoking. Encourage former smokers to mentor employees trying to quit.

Quitting smoking is the single most important step a person can take to impact their future health.

25 DISCLAIMER The material contained in this presentation has been selected to provide general background and useful information regarding health screenings. It is not intended to be complete or tailored to your specific needs, or to diagnose or treat medical conditions, and does not replace medical advice or medical treatment. You should discuss the information, facts and tips with your doctor, who is always your best resource for determining if you are at an increased risk for a condition. If you engage in physical activity, it may have injuries and health risks associated with it. You should confirm with your doctor that physical activity is appropriate for you. If you experience any pain or discomfort, call your doctor. Highmark Inc. does not endorse any product or service, and does not provide medical or legal advice or medical treatment. If you have questions about your health care coverage, you should call the toll-free Member Service number on your health insurance identification card. Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Blue Shield and the Shield symbol are registered service marks of the Blue Cross and Blue Shield Association. Highmark is a registered mark of Highmark Inc. Copyright © Highmark Inc. All Rights Reserved.