1. Breaking the Chain of Addiction: Strategies to End Nicotine Dependence

2. “Quitting smoking is the easiest thing in the world
“Quitting smoking is the easiest thing in the world. I know because I have done it a thousand times.”
Mark Twain

3. Discussion Topics for Today
What is Nicotine?
Understanding the Addictive Forces of Nicotine
Nicotine and the Brain
The Nicotine Addiction: Biological, Psychological and the Social Addiction
Breaking Free from the Nicotine Addiction: The Five Roadblocks to Success
Taking the Next Step to Nicotine Independence

4. What is Nicotine .

5. Nicotine Nicotine is the addictive substance found in tobacco.
It is a naturally occurring colorless or yellowish liquid that turns brown when burned and takes on the odor of tobacco when exposed to air.
The amount of nicotine which occurs in tobacco leaves ranges from 2% to 7%.
There are many species of tobacco plants, the tabacum species is the major source of today's tobacco products.
It acts as a stimulant and is mainly responsible for the dependence-forming properties of tobacco smoking.
Nicotine is used in insecticides.
It is considered poisonous and highly addictive drug by the FDA.

6. Did You Know?
The cigarette is a highly engineered drug-delivery system.
Inhaling cigarette smoke produces a rapid distribution of nicotine to the brain.
The drug levels peak within 10 seconds in the brain.
Acute affects dissipate within minutes, causing the smoker to continue frequent dosing throughout the day.
The average smoker takes boluses to the brain per day." ?
Sources: Am J of Medicine, 2009; Centers for Disease Control 2010

7. “Let’s face facts: Cigarette smoke is biologically active
“Let’s face facts: Cigarette smoke is biologically active. Nicotine is a potent pharmacological agent. Every toxicologist, physiologist, medical doctor and most chemists know that. It’s not a secret”.
Source: Memo by Phillip Morris, October 1982; Congressional Panel on Tobacco, 1985

8. The Addictive Forces of Nicotine

9. How Does Nicotine Affect the Brain?
Nicotine mimics neurotransmitters: Acetylcholine and Dopamine
Acetylcholine
Heart Rate
Muscle Movement
Cognition
Dopamine
Pleasure
Reward Pathway
Biology of Nicotine Addiction, 2009

10. Dopamine Cycle Dopamine theory:
Addicts become accustomed to the high levels of dopamine
Dopamine plays an important role in regulation of pleasure
Over time, the brain develops a tolerance to nicotine
The body needs more and a continual supply of nicotine to have the release of dopamine
The cycle repeats

11. (Social/Psychological)
Trapped by Nicotine
Nicotine
Addiction
(Biological)
Habit
(Social/Psychological)

12. Nicotine Habit Tobacco use can be an habit
Automatic behavior
May not even realize they are smoking or chewing
Habits are usually linked to other habits
Individuals can feel emotionally trapped by nicotine
May feel lonely
Tobacco may be their “best friend”
Reliance

13. Breaking the Chain of Addiction

14. Did You Know…
According the Centers for Disease Control and Prevention, seventy percent of smokers wish to stop smoking while 13 million adult smokers (about 40%) have quit for at least a day in the past year. About 50 million adults were successful in efforts to quit and considered themselves former smokers in 2010.
Centers for Disease Control and Prevention, 2011

15. 5 R’s: Roadblocks to Living Nicotine Free
There are five common reasons often cited by tobacco users for not attempting to break the addiction to nicotine
Fear - withdrawal and relapse
Negative moods
Being around other tobacco users
Triggers and cravings
Time pressures
Source: ALA, 2006, CDC, 2008

16. Roadblock Number One: Fear
Fear is the most common reason cited by tobacco dependent individuals for not attempting nicotine withdrawal.
The two areas most associated with fear are:
Withdrawal symptoms
Failure/Relapse

17. Possible Nicotine Withdrawal Symptoms
Cravings
Physical discomfort
Depression
Insomnia
Irritability, frustration, anger
Anxiety, nervousness
Difficulty concentrating
Increased appetite
Desire to smoke
Cravings for tobacco
Change in bowel habits
Fatigue
Cough, dry throat, nasal drip, clearing throat 17 17

18. Coping Skills for Withdrawal
The Five D's
Delay until the urge passes - usually minutes
Distract yourself. Call a friend or go for a walk.
Drink water to fight off cravings.
Deep breaths - Relax! Close your eyes and take 10 slow, deep breaths
Discuss your feelings with someone close to you or with in a social support network.
Source: ACS, 2007

19. Dealing with Withdrawal
Nicotine Replacement Therapy (NRT) can help lessen withdrawal symptoms.
The FDA has approved seven NRT's to assist with nicotine dependence.
Over-the-counter NRTs Prescribed Medications
Nicotine gum Bupropion
Nicotine lozenge Varenicline tartrate (Chantix)
Nicotine patch
Nicotine nasal spray .

20. Relapse
Adding psychosocial counseling can be helpful when addressing fears of relapse.
The greatest success rates are seen in a combination of psychosocial counseling and the use of nicotine replacement therapies.
Prepare for the potential “slips” when first attempting to break the nicotine addiction.
Seek our support groups and social networks
Build your personal belief system and visualize yourself free of nicotine.

21. Successful Addiction Quit Rates
Quitting without any form of assistance: 3%
Clinician advice to quit: %
Pharmacological Treatment (NRTs) only: %
Telephone/group counseling only: %
Combination of Pharmacological and Counseling: %
"The most effective method to break the tobacco dependence cycle is a combination of
nicotine replacement therapies (NRTs)
and psychosocial counseling."
Source: American Journal of Psychology, 2008

22. Roadblock Number Two: Negative Moods
Biological action happening with the elimination of nicotine
Dopamine is not being released; no feeling of pleasure.
Feelings of anxiety, depression or nervousness can occur.
Coping with negative moods or thoughts:
Suck on hard candy
Engage in physical activity
Express yourself (journaling, write, talk)
Relax
Think about pleasant, positive things
Ask others for support

23. Roadblock Number Three: Other Tobacco Users
Breaking the addiction can be difficult if others around you continue to use tobacco.
When you cannot avoid the tobacco, here are some suggestions to help you cope:
Ask a friend or relative to quit with you
Ask others not to smoke around you
Assign nonsmoking areas
Leave the room when others smoke
Keep hands and mouth busy

24. Roadblock Number Four: Triggers and Cravings
Remember the Five D's when cravings hit hard
Delay – remind yourself the reasons for quitting
Cravings will lessen within a few weeks
Anticipate “triggers”: coffee breaks, social gatherings, being on the phone, waking up
Change routine—for example, brush your teeth immediately after eating
Distract yourself with pleasant activities: garden, listen to music .

25. Roadblock Number Five: Time Pressures
Number one reason a quit attempt fails is due to a stressful event.
Two ways to deal with time pressures and stress are:
Change your lifestyle to reduce stress and anxiety
Increase physical activity

26. Are You Ready to Break the Nicotine Addiction?

27. Am I Ready? Do I want to quit?
Have I tried to quit before? What happened?
Am I committed to trying to quit?
Do I have a support system in place to assist me?
Will I be patient with myself and keep trying if I slip?

28. Preparation Tips Follow the START PLAN S = Set a quit date.
T = Tell family, friends, and co-workers
A = Anticipate and plan for the challenges
R = Remove cigarettes and other tobacco products from home, car, and work.
T = Talk to a doctor about getting help to quit.

29. Your "Break Free" Day On Your Quit Day, follow these suggestions:
Do not smoke. This means none at all -- not even one puff!
Keep active -- try walking, exercising, or doing other activities or hobbies.
Drink lots of water and juices.
Begin using nicotine replacement if that is your choice.
Attend stop-smoking class or follow your self-help plan.
Avoid situations where the urge to smoke is strong.
Reduce or avoid alcohol.
Change your routine.
Celebrate the Break

30. Staying Quit: Adherence
To help avoid Relapse:
Review reasons for quitting - benefits to health, finances, and family.
Remember there is no such thing as just one cigarette -- or even one puff.
Ride out the desire to smoke.
Avoid old habits that are associated with tobacco - alcohol.
If you are worried about gaining weight, put some energy into eating a healthy diet and staying active with exercise.

31. Recovering from a Slip Slip versus Relapse:
Slip – one mistake; get back on track
Relapse – what caused the relapse back to tobacco; what did I learn from the quit attempt; know that you can always try again
Living free from nicotine is possible

32. Some Helpful Resources
BCBS Lifestyle Management Programs:
Tobacco and Weight Management
Call to enroll
(866)
National Network of Tobacco Cessation Quit lines
(800) or (800) QUITNOW
Quit Net
Centers for Disease Control and Prevention (CDC)
American Lung Association (ALA)
American Heart Association (AHA)
American Cancer Society (ACS)
Centers for Disease Control and Prevention (CDC)
American Lung Association (ALA)
American Heart Association (AHA)
American Cancer Society (ACS)
(866)
National Network of Tobacco Cessation Quitlines
(800) or (800) QUITNOW
Quit Net
Experience. Wellness. Everywhere.