Get ready for a smoke-free 2009

So here we are approaching the end of 2008 and the beginning of 2009. Wouldn’t it be great to reach this time next year having gone the whole year without smoking? So now is the time to really get yourself ready to quit. One of the first things to do is to choose a Quit Date.

Many people at this time of year will choose January 1, and that is as good a time as any. Some may choose to put it off a little for good reasons. One reason might be “I’m going to be drinking and smoking on New Year’s eve and I want to start my quit day with a clear head and without having smoked at all after midnight the night before.” In that case why not pick January 2 as your quit day?

Another reason to delay a little bit might be because you intend to use Chantix or Zyban and havn’t got your prescription yet, and so won’t have time to get it and take it for 7 days (as advised on the labeling) prior to the quit day by January 1. In that case see your doctor and get started on your medicine as soon as possible.But regardless of which individual day you choose to quit on, don’t delay it for too long. I’d suggest that any date that is more than two weeks into the year is delaying too long unless you have an exceptionally good reason. And once you have chosen your date, its immediately time to start getting ready.You may want to review my post on the health effects of smoking to remind yourself of some of the main reasons for quitting:How bad is smoking for your health? 2/18/07 http://www.healthline.com/blogs/smoking_cessation/2007/02/how-bad-is-smoking-for-health.html

You may want to plan how you might cope with nicotine withdrawal symptoms, as suggested in this post: Ten tips for coping with nicotine withdrawal. 3/7/07 http://www.healthline.com/blogs/smoking_cessation/2007/03/ten-tips-on-coping-with-tobacco.html

You will certainly want to make a plan to get rid of all your tobacco:
Get rid of all your tobacco. 6/16/07 http://www.healthline.com/blogs/smoking_cessation/2007/06/get-rid-of-all-your-tobacco.html
…and you should consider whether you are going to use a pharmacological aid to smoking cessation, like nicotine replacement therapy:Which nicotine replacement therapy? 6/19/07 http://www.healthline.com/blogs/smoking_cessation/2007/06/which-nicotine-replacement-therapy.html

It may also be worthwhile checking out some of the best websites for helping people quit smoking. These are discussed at: “Become an Ex”: (April 30, 2008)
http://www.healthline.com/blogs/smoking_cessation/2008/04/become-ex.html

It is also a good idea to be thinking about what has tripped you up on any prior quit attempts, and what you can do differently this time in order to succeed. In particular, its worth anticipating specific things coming up in your life in the next week or two that may be a risk for relapse. Make a plan of how you will manage these situations without smoking.

I’d be interested to hear from anyone out there who is currently planning to quit smoking at New Year. Use the “comment” option on the blog to tell us how you are planning to quit, and let us know of your progress.

Labels: 2009, cessation, cigarette smoking, jonathan foulds, preparation

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Happy Holidays

I’d like to wish everyone good health and a merry time this holiday season.
This is often a time to overindulge with good food and drink (at least it is for me), quickly followed by a period of thinking about what we’d like to change for the better in the year ahead. Here in the States I think there is a strong sense that some changes are required, together with a new positive belief that we can.
I hope some of that positive spirit can carry over into people’s plans to quit smoking, and I hope this blog might provide some useful information, and your comments some inspiration for others to succeed.
But for now I’d like to leave you with a photo of my favorite Christmas tree here in New Jersey. Funnily enough its not in some big city center, but is at a mobile home park (I guess what we usually call a trailer park) right on route 1 in Monmouth Juntion. It is very big and totally covered in bright lights. If you are ever driving through this part of New Jersey in December its worth stopping off for a look. http://www.flickr.com/photos/55075113@N00/314610103/
Have a great one.

Labels: happy holidays, jonathan foulds

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How to Quit Smoking With Varenicline (Chantix).

A friend recently told me that her mom was about to try to quit smoking by using Chantix. She had heard some scary things about the drug and wanted some simple advice on how to use it effectively and safely, and also on what she could do to help.

Of course the most important thing to do in that situation is to tell your mom you love her and that you are really pleased she is trying to quit smoking. Support and encouragement from a family member can be a great help, particularly when there has been a history of unsuccessful quit attempts and the person may be discouraged by fear of failing again.

The next obvious thing to say is that it is important to follow the advice of the doctor who prescribed the medicine, and to thoroughly read the labeling and instructions for use that come with the medicine. I say this because the fact is that most of us forget the detailed instructions given by our doctor, within five minutes of leaving the appointment. Similarly, many of us don’t read the labeling properly at all (me included). But stopping smoking is a life-saving intervention and these medicines are not without their risks and side effects so it is worth taking the time.
One problem with Chantix is that it causes some side effects, with nausea being the most common (around 30% of users experience some nausea). The medicine should be taken for 7 days prior to the “Quit Date” (day 8 of the medicine), on an increasing dose (0.5mg once per day on days 1-3, the 0.5mg twice per day days 4-7) until starting the full dose (1mg twice per day) on day 8. One important tip is to take the tablet with a large glass of water, after eating. This will tend to reduce the severity of nausea. If the nausea is too much (happens in less than 5% of patients) then it is worth going back to the doctor, who can prescribe a reduced dose of 0.5mg tablets that can be supplied in bottled form at the pharmacy. This dose has much less severe side effects and is almost as effective at reducing cigarette cravings and withdrawal symptoms.
Chantix works via two separate mechanisms. Firstly it stimulates nicotine receptors in the brain in a way that reduces nicotine withdrawal symptoms and cravings. Secondly it blocks those receptors so that the nicotine from a cigarette cannot have its usual satisfying effect. Many patients find that though they continue smoking during the first 7 days of therapy, those cigarettes become less satisfying. Similarly a “lapse” cigarette after day 7 will likely also be less satisfying and less likely to lead to a full blown relapse. Although it is important to aim for complete abstinence from smoking (i.e. not a single puff) from the target quit day, slips needn’t be viewed as a complete disaster or a reason to give up. With Chantix these slips may actually serve to teach the brain that it will no longer get satisfaction from smoking (at least while taking Chantix).

There have been some other widely publicized side effects of Chantix, including some that may not be directly caused by the drug. It is clear, for example that Chantix (like the 24-hour nicotine patch) stimulates vivid dreams, or at least causes more of these to be remembered on wakening. This can be troubling if the dreams are nightmares, although they are frequently not nightmares. There have also been reports of other “neuropsychiatric side effects” in people taking Chantix. These have included agitation, depression and suicidal thoughts. It is not clear that Chantix causes any of these symptoms, but it is recommended that patients be monitored for this kind of adverse reaction while taking Chantix. So family members should keep an eye on the person trying to quit, and check how they are feeling. If there are any signs of very troubling thoughts or behavior, then the doctor should be called without hesitation. Of course some moodiness is absolutely normal on quitting smoking, even while taking Chantix. It is wise to check back with the prescribing doctor within a week of the target quit date to let him/her know about progress and any side-effects.

Although Chantix comes with its own online/telephone support plan (“Get Quit), I think it is wise to obtain as much additional support as possible. Ideally this would involve attending a local specialist smoking cessation service and being assessed by a trained counselor. If such a service is not available locally, it is certainly worth phoning the national telephone “Quitline” at:
1-800 QUITNOW (1-800 -784-8669)

The service provided may vary by state, but usually includes an option for telephone counseling.
In addition, I would recommend getting additional support from some of the excellent quit smoking websites that are available. Two of the best are:
www.quitnet.com and www.becomeanex.org

Sometimes when taking a medicine to quit smoking it is easy to build up expectations that it will be a wondercure, and then be disappointed when the cravings still occur and it gets hard. So the most important thing is to continue to be supportive when the going gets tough. Helping the would-be quitter to keep trying even when it is tough, and even after some failed attempts , is key. Many people have a few slips along the way and may even go back to full-blown smoking for a while, but if they set a new quit date, and keep taking the medicine, they will still stand a good chance of successfully quitting.

Sometimes people stop taking Chantix after a month or so because they feel it has worked and they no longer need it. However, the evidence suggests that taking the full course will likely produce better outcomes, and after 12 weeks on the medicine the doctor can prescribe for another 12 weeks to help prevent relapse. In addition to taking the medicine, making sure no tobacco is left around the house, making sure every success is celebrated and continuing to support the quit attempt beyond the initial few weeks, will all help prevent relapse to smoking.
Sometimes people taking Chantix are pleased that they can cut down their smoking without too much effort. But I think its critical to keep going until you get to zero cigarettes per day, and stay with it. To do that you need to get rid of all the cigarettes and be clear that the aim of the game is quitting, not cutting down. Unfortunately most people find that when they have cut down for a while they increase again when a period of stress comes along.

So the main advice is to keep trying, focusing on not taking a single puff of tobacco, and taking it a day at a time.

Labels: Chantix, jonathan foulds, side effects, stopping smoking, varenicline

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Facts and fiction on stopping smoking

One of the reasons I decided to write this blog was that over the years I’ve seen a lot of nonsense written by so-called experts on smoking, and I felt that the public could do with some accurate information for a change.
So just now I’m sitting at an ice-hockey rink watching my daughter play and thought I’d check out the accuracy of information that pops up when I do a search on ”smoking” on the healthline website. The first hit listed was an article on “nicotine withdrawal” that had been reviewed by the “A.D.A.M Editorial team”. Unfortunately it has the usual smattering of inaccuracies, so I thought it might be worth correcting a few:
1. It lists “headache” and “drowsiness” as nicotine withdrawal symptoms. In fact neither of these symptoms are reliably caused by withdrawal from nicotine
Nicotine withdrawal symptoms are: irritability, depressed mood, anxiety, poor concentration, sleep disturbance, restlessness, hunger/increased appetite. Reduced heart rate also occurs on nicotine withdrawal, but smokers don’t notice or complain of it.
2. It mentions buspirone (Buspar) and fluoxetine (Prozac) as medicines that have been shown to help smokers quit. In fact the best evidence suggests that these medicines are not effective in helping smokers quit. The medicines that are approved by the U.S. Food and Drug Administration as safe and effective for smoking cessation are the nicotine replacement therapies (patch, gum, nasal spray, lozenge and inhaler), bupropion (Zyban) and varenicline (Chantix). In addition, nortriptyline and clonidine have good evidence supporting their efficacy for smoking cessation but are less often used, partly because no company has applied for FDA approval for that indication, and partly because they tend to have more side effects.
3. It states that nicotine itself has antidepressant effects. I am not aware of any solid evidence showing that nicotine has antidepressant effects, other than perhaps in individuals suffering acute nicotine withdrawal. I would not recommend that non-smokers who are depressed should try chewing nicotine gum (or using tobacco) to treat their depression, as there is not sufficient (or indeed barely any) evidence to suggest it might be helpful.

The problem with some of these inaccuracies is that they will tend to lead readers to the wrong conclusions in trying to understand their symptoms and seek remedies for them. When you are seeking advice on how to quit smoking, it is always a good idea to ask the person what training and experience they have had on the topic. Unfortunately most medical doctors and other health professionals have had as little as an hour total training on it as part of their primary degree, and may not have had any more training on it for decades.

You can find a thorough summary of the best evidence on what works for treating tobacco dependence at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.section.28164

Labels: facts, fiction, jonathan foulds, nicotine nasal spray smoking cessation, nicotine withdrawal

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Cigarette health warnings and bogus buy-ology

Apologies to regular readers for my recent blog down-time. I’ve had a lot on my plate recently and so had a break from blogging. But I’m now back with some catching up to do (including responding to many of your thoughtful comments). There has been plenty to write about in the field of tobacco and health.

You may have recently seen a newspaper article (there have been many) stating that the new pictorial health warnings on cigarette packs in many countries (e.g. Canada) don’t work. These news items have been largely based on the work and publicity created by Martin Lindstrom, a marketing guru and author of “Buy-ology: truth and lies about why we buy.’

Now Martin Lindstrom is clearly a clever guy who knows a lot about marketing. But when it comes to interpreting studies of how people’s brains respond to images, I’m afraid he’s not so hot. Lindstrom got funding for some research that involved using modern brain scanning techniques to examine the effects of certain pictures on specific parts of the brain. Part of this research apparently involved showing pictures of cigarette packs (including the health warnings) to 32 people. He claims that these images stimulated activation of the same parts of the brain that “light up” (excuse the pun) when a smoker craves for a cigarette. He then suggests that this shows that pictorial health warnings on cigarette packs are a waste of time and may even stimulate the desire to smoke.

Even without knowing the details of the research (as it hasn’t been published in a peer-reviewed scientific journal) there are a few problems with the logic here. Here are a few to start with:

1. The research does not sound as if it directly compared the effects on the brain of viewing a standard cigarette pack (without large pictorial health warnings), with the effects of viewing packs with large pictorial health warnings. So without such a direct comparison the research says nothing about the effects of adding pictorial health warnings.

2. The idea that smokers may have cravings stimulated by viewing cigarette packs (with or without warnings) isn’t exactly new. Clinicians have long been advising smokers to throw away their packs and other smoking paraphernalia and avoid smoking cues. You really don’t need a brain scan to figure out that when a smoker hasn’t smoked for a while and you show them a cigarette pack they might want to smoke a cigarette!

3. People who buy cigarettes are going to be exposed to cigarette packs, and by the time they are close enough to one to see the health warning then it is quite likely that the health warning isn’t going to stop them smoking a cigarette from that particular pack. But that’s not the way the warnings are likely to work. By seeing a number of large, pictorial and emotionally evocative images that change regularly over a period of time…there is more likely to be a cumulative “drip, drip, drip” effect that contributes (along with many other factors) to the decision and act of finally quitting.

There is more one can say on this topic, but for now there is much stronger research evidence from a number of countries, all concluding that introducing larger pictorial health warnings increases smokers’ interest in quitting and makes a positive contribution to reducing the number of cigarettes being smoked.

Mr Lindstrom knws how to help companies to sell bottles of water for $60, and that requires the ability to get people to believe things without any evidence. He’s done a good job in marketing the idea that his unpublished brain scan study can give us deep insights into how to market things. But like the $60 bottle of water, there appears to be more hyperbole than substance behind his claim that pictorial health warnings are a waste of time. But I can think of one industry that may like his message…maybe even pay for it. If he was right, wouldn’t the tobacco industry support the idea of adding larger pictorial health warnings onto cigarette packs? So why does the tobacco industry oppose it? Maybe they have looked at the wider evidence on cigarette sales before and after the introduction of large pictorial health warnings around the world? Seems more reliable evidence to me than brain scans from 32 people.

For further information on pictorial health warnings, including a link to view the warnings from around the world, check out the link below. I’d be interested in your comments on the pictorial health warnings from around the world. Do they make you want to smoke?

Its time for pictorial warnings on cigarette packs. 6/18/07
http://www.healthline.com/blogs/smoking_cessation/2007/06/its-time-for-pictorial-warnings-on.html

Labels: cigarette sales, cigarette smoking, health warnings, jonathan foulds, pictorial

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