1. 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

2. 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.

3. 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.

4. 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.

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

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

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

8. 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

9. 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

10. 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

11. 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.

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

13. 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

14. HABIT

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

16. How Habits Develop
Pavlov: Conditioned/Response

17. 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.

18. PSYCHOLOGICAL

19. 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

20. 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.

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

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