Smoking CessationSmoking is one of the unhealthiest addictions one can have. Nicotine is very addictive and second-hand smoke is even deadlier for those around you. A little personal history from Dr_Y:I grew up with my parents smoking. I can remember long trips in a closed car with them both puffing away, a car filled with smoke. I have been plagued all my life with low resistance to colds and low lung capacity. I firmly believe it was my exposure to my parents' second hand smoke that caused these problems.One of my pet peeves even now is to see parents' driving around in a car (usually closed) with young children, cigarette hanging from their hand or mouth. I think it is absolutely criminal based on our knowledge about second hand smoke now.
Introduction & Background
In treating tobacco addiction two components must be simultaneously
addressed: physical and psychological. The physical component involves
the nicotine addiction itself and accompanying withdrawal symptoms from
the physical dependency. The psychological components involve such
factors as why the individual smokes, the triggers that set off smoking
(often stress or anxiety related), substitutions for the smoking habit,
and
relaxation techniques. The ideal smoking cessation program would offer
nicotine replacement therapy to deal with the physical addiction
component and a tobacco usage cessation program to deal with the
psychological component. The power of psychobiologically-based hypno-behavioral therapy-- Nicotine and other addictive drugs affect what is known as the "pleasure pathway" in the brain--an ancient, complex reward system that all animals possess.1 This is the system that makes us feel "flush" and euphoric after some pleasurable activity--eating a good meal, sex, etc. Biologically this pathway is very important for survival and reproduction. Its function is to motivate us to keep doing whatever we did that brought on the good feelings or felt so good. Different drugs affect this pathway at different places by binding to different neuropeptide receptor sites on the various parts of the brain's pleasure pathway. The major players in the brain' pleasure pathway are the amygdala, nucleus accumbens, ventral tegmental area (VTA), and hippocampus of the Limbic System, and the frontal lobe of the cerebral cortex. The Limbic System is the seat of our emotions and part of the old mammalian brain (as opposed to human's neo-mammalian brain). The amygdala helps to assess if an experience is pleasurable or adverse. It is the brain's center for the flight-or-fight response.2 It helps to evaluate whether an experience should be repeated or avoided and assists in integrating connections between the experience and other cues. The cells of the VTA are big producers of the pleasure neurotransmitter, dopamine. The hippocampus is involved in long term memory formation. The frontal lobe of the cortex helps to organize and process all this information. Nicotine's primary effect, like other addictive drugs, is to stimulates the release of the neurotransmitter dopamine. However, its addictiveness is enhanced because it provides an almost immediate “kick” by causing a discharge of epinephrine from the adrenal cortex. This causes a sudden release of glucose, which leads to "instant" energy. Unfortunately, this stimulation is then followed by depression and fatigue as glucose levels in the blood are depleted, resulting in the abuser seeking more nicotine.3 Other compounds act to decrease the level of a critical, key enzyme, monoamine oxidase (MAO). 4 MAO plays a key role in the breakdown dopamine: it breaks down dopamine and other neurotransmitters so that too much of them doesn't stay around. Thus, the less MAO around, the more dopamine stays around to keep on stimulating the pleasure centers in the brain. Nicotine is addictive, showing classic addictive properties of tolerance with use and withdrawal and depression when users try to quit smoking or taking it. Tolerance means as users continue their usage it takes more and more nicotine to get the same high effect. (We could go into some detail here about how the genes that code for the nicotine receptor binding sites on the brain cells' membrane are down regulated, but we won't here.) Additionally, nicotine's long term usage causes long term, if not permanent changes in the brain's chemistry and structure. How does nicotine addiction develop? Its continued usage essentially commandeers the brain's natural reward circuitry. Stimulation of this pathway reinforces behaviors to ensure you keep doing whatever it was you did to bring on the high. Continued usage induces long-lasting changes in the brain's chemistry and structure, reconfiguring how the individual neurons (brain cells) in the reward pathways process information and interact with each other. To feel right, much less comfortable or high, the brain (and you) must keep taking the nicotine. When you try to quit, your brain has trouble functioning, resulting in depression and withdrawal symptoms. The Cue-Craving Challenge: But the story doesn't end here, other studies using brain scans (PET and fMRI) of addicts have shown when someone who has quit using is exposed to the old cue's for their addiction, e.g., pictures, music, or situations, the same brain centers are activated and your craving for the drug will go way up. The same parts of the brain "light up" just as when they were using even though they haven't used the drug for a long time. So even if you haven't smoked for a long time, you will have strong cravings given the old cues. This makes social situations that you associate with smoking a deadly killer of your efforts to quit and stay quit. So the bad news is, smoking is a nasty addiction to kick. The good news is by combining nicotine withdrawal therapy (the patch, etc.) with hypno-behavioral therapy, you can do it! The power of hypno-behavioral therapy is that Dr. Yardley can directly address the above Cue-Craving problem using post-hypnotic suggestions, mental rehearsal, and extinction techniques. References1 Nester, EJ and RC Malenka. 2004. The Addicted Brain. Scientific American, March, 2004, pp 78-85.2 Marieb, EN. 1995. Human Anatomy and Physiology. 3rd edition. Benjamin, Redwood City, CA 3 NIDA InfoFacts: Cigarettes and Other Nicotine Products. March, 2005. 4 Nester & Malenka, 2004. FDA Approved Smoking Cessation ProductsFrom the American Lung Association:New products are continually emerging. You should check with your doctor or pharmacist to find out which products are appropriate for you. Over the Counter Products
A plastic cylinder containing a cartridge that delivers nicotine when
you inhale through it. Similar in appearance to cigarette, the
inhaler delivers nicotine into the mouth, not the lungs, and enters the
body much more slowly than the nicotine in cigarettes.
Puffing must be done far more often than with a cigarette. Each cartridge lasts for 80 long puffs with each cartridge designed for about 20 minutes of use. At least six cartridges per day is needed for three to six weeks for most patients, then the patient can start tapering off. (My least favorite)
|
 Custom Search
|
||||||||||||||||||||
Adult Services and Concerns Index
Custom Search
|
Add
to these diseases the deadly effects of 