An ‘ex’ you would be proud to claim

Imagine a treatment that would reverse skin aging, whiten teeth and improve one’s sense of taste, sense of smell and personal odor. Add to this a substantial decrease in your risk for devastating breathing disease, heart attack, stroke and a multitude of cancers. Furthermore, this treatment would not cost money but, in fact, save money — possibly several hundred dollars a year.

This “treatment” exists, of course, for every tobacco user in the act of quitting smoking. It’s no secret. I’ve never met a smoker who doesn’t know the myriad reasons for needing to quit. I’ve rarely met a smoker who doesn’t want to quit.

Convincing smokers to begin the act of quitting, however, remains a tough sell. This seems to be especially true within the LGBT community, where individuals are twice as likely to smoke as non-LGBT populations, thought to be a result of aggressive targeting of our community by the tobacco industry.

As with other kinds of addictions, any attempt to quit smoking involves understanding both the pharmacologic and the behavioral basis for the addiction. Nicotine has long been implicated as the addictive substance in tobacco. When inhaled, it is rapidly absorbed through the lungs into the bloodstream and quickly concentrates in the brain. Nicotine has many different effects throughout the brain — activating excitation and reward pathways similar to those implicated in cocaine and heroin. As a response to this excitation, the brain increases its capacity to be stimulated by nicotine. This increased capacity is thought to intensify the cravings for and withdrawal from nicotine.

The rapid transit of nicotine to the brain is a crucial part of associating the reward of nicotine with the behavior of smoking. The behavioral associations do not, however, end with the act of smoking. Every smoker can identify other cues that trigger cravings. These can include smoking cues, such as ashtrays; situational cues, such as drinking at the bar or finishing a meal; and mood cues, such as feeling anxious or depressed.

Although a few people can successfully quit “cold turkey,” the negative effects of quitting and withdrawal symptoms make this profoundly challenging for most smokers. That’s why I advise people to consider both the chemical and behavioral components of their addiction.

Nicotine replacement therapies were some of the first medications developed to assist in the chemical addiction to smoking. There are many different methods of replacement — patches, lozenges, gum and inhalers — most of which are available without a prescription. An important distinction to consider between these methods is the continuous nicotine replacement of a patch, which allows for a gradual weaning off of the addiction to smoking, compared to the on-demand replacement of gums and lozenges, which can immediately manage cravings but may still encourage a strong behavioral association with nicotine. With any nicotine-replacement therapy, it’s important to pay attention to the dosage of nicotine, as poisoning can occur.

Other prescription medications are available to assist with quitting. These medications work in altering the excitation and reward pathways and reducing the effectiveness of nicotine. After a few weeks using these medications, many patients report a loss of interest in cigarettes.

Although many intensive therapies are available to assist with quitting, my advice in facing the behavioral addiction to smoking is simple: plan ahead. Anticipate situations that may bring on a nicotine craving, and plan ahead to better control them, so they don’t control you. If you rely on tobacco to soothe anxious feelings or take a break from work, then consider some alternatives to manage these situations, such as taking a walk or chewing gum. If smoking is a complement to your routine activities, like driving or eating a meal, then you may need to work on developing new, different habits.

Be warned: Most smokers do relapse after their first attempt at quitting. I encourage people to view unsuccessful attempts not as failures, but as learning experiences to better prepare them for their next attempt.

I have often heard that quitting smoking is one of the hardest things to do. While I don’t think this gloomy prophecy is helpful for someone facing the challenge of quitting, I do appreciate the difficulty of that challenge. I would encourage any smoker who is ready to stop to talk with a medical provider, develop an individualized plan for quitting and become an “ex-” — the kind that anyone would be proud to claim.

Dr. Andrew Goodman is a physician at Mazzoni Center, the region’s only LGBT health center.

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