Interventions in Smoking Cessations Frank Vitale, M.A. School of Pharmacy Director, International Smoking Cessation Program through the University of Pittsburgh Coordinator, UPMC Smoking Cessation Program

Smoking Cessation Skills: The Basics In this lecture I will briefly overview our School of Pharmacy program. Good news that there are a lot you can do quickly with smoking cessation. Best prevention strategy for smoking - not to start! From this point most important issue is how to prevent kids from starting smoking. Bad news - there are still a lot of work in this field.

Program Objectives 1. Provide a fundamental understanding of the intricacies of the smoking behavior. 2. Define and examine the stages of the quitting process. 3. Review basic cognitive and behavioral interventions. 4. Briefly detail currently available smoking cessation medications. Our task to help you understand just a simple plan to decrease number of smokers.

Three aspects of smoking Addiction Habit Psychological Smoking is a complex behavior, not just addiction to nicotine. It is physical addiction, habit and psychological dependence.

Nicotine Addiction People smoke to feel good. They like it.

Nicotine - Ganglionic cholinergic-receptor agonist with dose related pharmacologic effects - Basic; liquid alkaloid - Addiction Reinforcer Withdrawal Time to Addiction

Theory of Addiction - Release of neurotransmitters in brain - Pleasure reinforces repeated administration - Acclimation occurs - Abrupt cessation leads to withdrawal

Nicotine Absorption and Metabolism Readily absorbed from - respiratory tract - buccal membranes - skin - minimal stomach absorption due to acidic environment Highly metabolized by liver and lungs when inhaled

Predicted Concentration of Serum Nicotine During the Smoking Day Projected Nicotine Concentration(ng/ml) Just a good feeling occurs, nicotine deteriorates very, very rapidly. Cigs I II I II I III II II I II I I I I Hours since waking

Nicotine’s Effects on the Body CV - dirrect effect: increases BP and HR - indirrect effect: stimulates release of catecholamines from adrenal Periphery - skeletal muscle relaxant CNS - causes tremor, increases respirations, facilitates memory, decreases aggression, and decreases weight GI - increases tone and motor activity

Symptoms of Nicotine Withdrawal irritability, impatience, anxiety, restlessness, depression, drowsiness, nighttime awakening (lasts approximately 7 days) decrease in short-term memory (lasts approximately 14 days) increase in appetite, craving, and difficulty concentrating (can last weeks to months) We should explain that symptoms of Nicotine withdrawal will stop during 7-10 days.

Nicotine Replacement Therapy Contols -cravings, irritability, impatience, anxiety, restlessness, difficulty concentrating, drowsiness, nighttime awakening, decreased short-term memory Delays/Decreases -appetite, weight gain

Determination of Nicotine Toxicity Perspiration dizziness headache confusion and weakness differences - withdrawal and toxicity symptoms Abdominal pain hearing and visual disturbance nausea/vomiting/diarrhea Toxicity: Dizziness, Perspiration, GI Withdrawal: Anxiety, Depression, Irritability

HABIT

“Automatic” Smoking Repeatedly pairing smoking with other behaviors Paired behaviors create unconscious urges to smoke

How Habits Develop Pavlov: Conditioned/Response

Situations That May Trigger Smoking Morning Routine Coffee After Meals In the car On the phone Alcohol Stress Anger Anxiety Boredom Celebration We may explain that it is easy to change a patterns. Instead of smoking in these situations people may walk, drink a tea, deep breathing etc.

PSYCHOLOGICAL

Smokers’ Misconceptions The belief that cigarettes are doing something positive for the smoker The belief that this is something the smoker cannot do on his or her own

Perceived Benefits of Smoking Stress Management Weight Management Mood Regulator Others Most of people who smoke think that smoking gives them some kind of benefit, relax for example. But nicotine is stimulant, he doesn’t relax! Also cigarette create more stress on your body.

What’s in a Cigarette! The price of smoking Cigarette as “Friend” What’s in a Cigarette! The price of smoking

Saying Goodbye I can live without cigarette! We should provide information that smoking do not provide anything good.