Question: (Sent 1-11-2001)
Though I have been able to quit smoking for shorts periods (3-10 months), I still return to it due to the enhanced concentration,
focus, and stimulation it gives me when I work on my writing. I'm a novelist (in my spare time), and almost every writer I've
known (with so few exceptions) seems drawn to nicotine. I feel that my problem with quiting is both psychological (equating
writing with smoking) and, of course, chemical. Does the brain eventually return to "normal" after quitting for more than
a year--that is, supply the dopemanine levels, etc., which can naturally effect concentration? In other words, will I be able
to write without nicotine?
From: Chuck
Location:
Answer: Dear Chuck,
Thanks for sending in such a great question. I took the liberty of discussing your observations with our chief psychologist,
Dr. Bradley Meier. In short, nicotine has been shown to improve concentration on repetitive or tedious tasks, such as balancing
your checkbook, but is in fact likely to impede your ability to concentrate on complex integrative tasks like filling out
your tax returns.
My guess is that you probably have some heavily "learned" cues to smoke that surround your work, and respond to the stress
of writing a bit like Pavlov's dog responded to the bell. The best way to stop smoking in this situation is to anticipate
the times that you'll be drawn to smoking and map out new creative ways to break the association. Call your doctor for advice,
or call your local chapter of the American Lung Association for more information. Good Luck!!!
Question: (Sent 2-1-00)
Dr. Leone, I would like to become a participant in your study. I have been a cigarette smoker since the age of 16. I'm now
46yrs old and have tried everything from dyban, nicotrol inhaler as well as smoking cessation. What else is there to offer
someone in my situation? I thank you for your reply.
From: Genetta
Location: Philadelphia
Answer: Dear Genetta
The important thing is that you don't stop working on the problem. There are lots of tools and tactics available to us to
help people like you stop smoking. Don't give up. Give us a call at (215) 955-STOP and we'll get you information Re: our
ongoing studies.
Question: (Sent 1-23-00)
Dr. Leone, I am 27 years old and have been smoking at least 5 cigarettes a day for maybe 8 months now. I pretty much do it
because I enjoy smoking after I eat or when I take breaks at work as well as socially. Does that mean that I am addictive
to nicotine or the "habit" of smoking. I really don't feel like I have a problem with cigarettes and there have only been
a few times that I wanted to smoke during stressful situations. I feel like I can "kick the habit" at anytime if I wanted
to. I appreciate your time in answering my questions. Thanks.
From: david
Answer: Dear David -
It probably means you're not addicted to the nicotine in the classic sense. However, smoking the cigarettes is definitely
triggering some reward circuit in your brain and keeping you coming back for more. It sounds like you feel like you can quit
any time, but are maybe reluctant to do so, despite the fact that you realize the risks of smoking.
Try this test:
1. Ask yourself if you're *really* just smoking because you like it.
2. If yes, then ask yourself what you like about it.
3. Once that's done, ask yourself if you could put up without those things for just 7 days.
4. If yes, put the cigarettes down today.
5. If no to any of the above, you probably should look into getting some advice on quitting.
The habit of smoking is a very difficult one to overcome. Let me know if you need some advice.
Question: (Sent 8-27-99)
I HAVE BEEN CHEWING TOBACCO SINCE MY 2ND YEAR OF COLLEGE (1994) AND I WOULD LIKE TO QUIT. ONE SO MY MOUTH DOESNT FALL OFF
AND I DONT GET CANCER. ARE THERE ANY PRODUCTS OUT THERE THAT IS EFFECTIVE IN HELPING TO STOP CHEWING?
From: GREG
Location: WAYNE PA
Answer: Dear Greg,
It turns out that chewing tobacco acts in much the same way as cigarette tobacco. Once the effect of the nicotine is fully
entrenched in your body, it can be VERY difficult for many people to stop. You'll need to consider getting advice from a physician,
a decision which will improve your chances of quitting three-fold in itself. If you were my patient, I would consider using
nicotine gum with you, the dose and frequency of use should be adjusted according to amount of tobacco use and severity of
cravings. In addition, there are a few case reports of successful chew tobacco cessation using Zyban (bupropion), even though
the prescribing information only claims utility in smokers.
Your concern over mouth cancer is justified. I commend you for wanting to get off the stuff now while you're young. Get a
doctor's opinion. Quitting can be complicated for some people. You should also know that a few of our chew tobacco patients
have resorted to smoking in order to manage cravings... don't substitute! Nicotine gum is safe, cigarettes are not.
Let me know what you decide to do. Good luck!!!
Question: (Sent 6-27-99)
Dr. Leone,
I am looking for a way to really stick to and suceed at quitting smoking. I realize your sessions arent free. Is there anything
you can suggest? I am unable to attend any meetings due to my odd work schedule. Do you have any pamphlets or books that outline
a way to personalize a schedule or pointers to assist me?
From: Dana
Location: Wisconsin
Answer: Dear Dana,
Quitting smoking is one of the hardest things a person can do. Did you know that nicotine is more addictive than heroin? That
it can take up to a year before the basic biological changes associated with nicotine use in the brain are back to "baseline"?
I'm not surprised that you're feeling a bit frustrated with your lack of "success" so far, but I want you to understand the
magnitude of what you're dealing with. A cigarette "habit" is not the same as biting your nails.
First off, contact the local chapter of the American Cancer Society, the American Lung Association or the American Heart Association,
and have them send you every bit of information they have on hand.
Second, see your physician. Set up the appointment just so you can talk about quitting strategies. Getting a physician's advice
can triple your success rate in and of itself. If appropriate, your physician can also prescribe medications that, alone or
in combination, have been proven to help smokers quit.
Finally, don't stop smoking until you've spent at least one week thinking about why you want to quit, and what sorts of things
have gotten in the way the last time you tried. Those same things are bound to come up... preparing a strategy and writing
it down is likely to help you "deal" successfully in a time of crisis.
Remember, don't stop trying. You CAN quit. It takes some work and some time but each time you try, you're that much closer
to being successful. Good Luck!!!
Question: (Sent 6-21-99)
Are there any hypnotists within the Jefferson Health System who provide the service of hypnosis to quit smoking? Weight loss?
From: LOUISE TAYLOR
Location: BLOOD DONOR CENTER
Answer: Dear Louise
Great question. In my view, the information available on the effectiveness of hypnosis on smoking cessation / weight control
is mostly anecdotal in nature. To my knowledge, there has never been a well done clinical trial looking at the outcome of
hypnosis in an organized way (at least with respect to smoking cessation). Because of our commitment to offering only scientifically
proven methods in our clinic, we've elected not to provide hypnosis as a generalized part of our approach.
Having said that, I'll be the first to admit that different things help different people. If you're still interested in learning
more, I suggest contacting the Center for Integrative Medicine at (215) 879 - 5121. They have some very well respected clinicians
with specific interests in stress reduction and nutritional therapy, and they may be in a better position to give you the
full "skinny" on hypnosis. Good Luck!!
Question: (Sent 3-2-99)
We are working on making this work site Tobacco Free..any ideas or suggestions on how we might be the most successful?? At
present time, employees are only allowed to use tobacco at 2 outside sites ( gazebos ). In the past we have offered incentives
to quit such as $$ rebates to attend SmokerStoppers and the like. Our insurance plan does pay for Zyban.
From: Marilyn Durand, RN, COHN-S
Location: DuPont Co., Towanda, PA
Answer: Dear Marilyn -
Your efforts to make your work site smoke free are commendable. There is some research to show that capitalizing on the "community"
of the workplace increases success rates nicely, however a few important points must be kept in mind:
- Any program must be voluntary; efforts to make employees quit are far less well received than efforts to help employees become
more health aware.
- There should be some incentive to participate, above the benefit of the free intervention; i.e. one half day off with pay,
T-shirts, etc.
- It is often helpful to incorporate other matters of health into your tobacco intervention efforts; i.e. think about setting
up a "Heart Healthy" month, and provide diabetes screening, blood pressure screening, diet, exercise and stress management
information in addition to your smoking cessation efforts
Our "Corporate Partners Project" has been very well received so far. In general, the most frequently sought service is a lecture
series / workshop we set up where employees can learn an awful lot about nicotine addiction and management. It's been very
rewarding for all of us. Please let us know if we can help. You can call us at (215) 955-STOP.
Best of Luck!
Question: (Sent 12-26-98)
Dear Doctor,
I am A social smoker. I can go all week with out smoking and then smoke a whole pack in one night. I only smoke when I drink.
I DON'T want to do that anymore. Is that new inhaler that looks like a cigarette an option for me.
Thank you ,
Miserable in Mpls
From: Carol
Location: Minneapolis, Mn
Answer: Dear Carol,
We see quite a few smokers with a similar habit pattern. Those weekend cigarettes can be devastatingly difficult to give up.
But don't give up yet! Even though you are not strictly "addicted" to nicotine in the classic sense (evidenced by your ability
to stay smoke free all week), the nicotine has definitely affected your ability to abstain permanently. Going out with friends
can be a cue to smoke, but alcohol very frequently makes the urges much more difficult to control.
I would suggest the following:
1) For the next several weeks, avoid alcohol while being social. Be with your friends and have a good time, just stick to
club soda for a while.
2) Tell all of your friends what you're doing. If they understand your need to quit, they'll understand your alcohol avoidance
and they're likely to be supportive of your efforts.
3) See your physician for advice and counseling. Products like bupropion (Zyban) are likely to help you more than nicotine
inhalers since it suppresses the sudden uncontrollable urges effectively (even when you're with your friends in a bar).
4) Don't be miserable. Feel good about your efforts to quit. Realize that nicotine is an incredibly difficult thing to give
up. This is not just a matter of will power. You're dealing with some pretty complex behavioral and biological issues.
Question: (Sent 12-26-98)
I'd like to quit, but I'm so afraid of failure. I want to make the commitment to a healthier lifestyle, but $585 is a lot
of money. What's a girl to do?
From: Mary
Location: Mars, PA
Answer: Dear Mary -
Thanks for taking the time to write and ask this very important question. Fear of failure is a very common reason that people
have for avoiding the quitting process. It's not so much that people are afraid of failing per se, but instead they seem to
be afraid of "going through all of that discomfort and anxiety" while facing the very real possibility of relapsing in the
future. An organized cessation program can help an awful lot.
You're correct in stating that some of these programs are expensive. Please be careful when you evaluate a program that you're
interested in joining. More expensive doesn't necessarily mean more effective. You'll want to find out a couple of important
things about them BEFORE you give them your money.
For example:
- What is their success rate?
- What methods will they use to reduce or even eliminate those feelings of "discomfort and anxiety?"
- How long will they stay "connected" to you (i.e. how much access to their resources does your money buy)?
- How do they help you manage and avoid relapse in the long term?
All in all, you will recover the cost of any program many times over if it does help you quit, both financially and in terms
of better health. Most reputable programs can help make it easier by offering a payment plan. Check with your insurer first
to find out if the program you're interested in qualifies you for some reimbursement.
Question: (Sent 11-13-98)
1)I quit smoking February 19th, 1998 with the help of Wellbutrin. I quit taking Wellbutrin after I started to feel basically
"high" from it. I was a very happy person and quit smoking very easyly, but couldn't trust my self with driving and many
other tasks that required concentration. Is this a side effect of Wellbutrin? Now it is November 13th and I haven't bought
a pack of cigarettes yet. I did a few times smoke when I was out and around people who I smoked with before. Is it ever going
to be possible for me to go out and have a beer without dyig to smoke a cigarette? Is there any other way of making this process
any easier without feeling drowsy?
2)Eversince I quit Wellbutrin I have been feeling very tired and find it hard to concentrate. Can it be due to the med? Thanks...
From: Esra
Location: Cherry Hill
Answer: Dear Esra,
Bupropion in either form has been associated with insomnia and some degree of "mood elevation." To my knowledge, the feeling
of "being high" has not been reported. It's possible that what you were experiencing may have been related to nicotine withdrawal.
It would be good to know what dose of bupropion you were on at the time you experienced these symptoms.
There WILL come a time when you will be able to have a beer with friends and not feel the need for a cigarette. Unlike a lot
of other things in life though, this particular effect of nicotine addiction can last quite a long time. Don't give up! In
general, bupropion helps to relieve or eliminate these cravings effectively, even early on in the process. I would suggest
reviewing your situation with your physician as soon as you can... S/he may be able to change the dose or schedule so that
it is better tolerated.
Finally, your situation really highlights the importance of behavioral counseling in smoking cessation. A good counselor can
help you review your cues and triggers, and find ways to either eliminate them or come up with ideas for managing them in
an effective way.
Best of Luck! You've made it 3 1/2 weeks now... You can certainly be proud of yourself. The addiction is not quite over yet
though, so please write back and let me know how you come along.
Question: (Sent 11-11-98)
Dear Doctor,
I have been taking Zyban for 8 days now. I do not feel a thing. No side effects that other people complain of other than slight
constant headache but nothing strong. What is Zyban suppose to do for me? I feel at times that it is doing nothing for me.
From: Len
Location: Ontario
Answer: Dear Len,
Zyban works by helping to control the urge to smoke. It's great that you're not feeling anything! The very best thing that
could happen would be that you "feel" nothing, including cravings for nicotine, and that smoking slowly becomes a distant
memory. The Zyban dramatically reduces your risk of relapsing. Please don't stop taking the medication. Stay in close contact
with your doctor and let him/her know how things are going. Best of luck!
Question: (Sent 11-6-98)
Dr. Leone,
What seems to be the average length of time patients are on Zyban? I know it is indicated from 7-12 weeks.
From: Tony
Location: North Carolina
Answer: Dear Tony,
Excellent question! The current recommendation is to use the medication for about three months. In our experience however,
many patients are simply not ready to come off of their Zyban at that point. One of the problems we've seen is that patients
who have recently quit smoking will begin to feel well, and will stop their medicines prematurely. Cravings can still be high,
and there is a significant risk of relapse if the medication is discontinued too early. We always recommend very close follow-up
with one of our physicians after getting started on Zyban and will often continue the medication for substantially longer;
the decision about when to discontinue treatment is highly individualized. It wouldn't be unusual to stay on the medicine
for 6 to 9 months before coming off completely.
The best advice I can give you is to stay in touch with your doctor and be careful about stopping on your own. Best of luck
with all of your efforts!
Question: (Sent 10-26-98)
I have been using Zyban to help me quit smoking, and it has helped me to overcome cravings. BUT!! I am very concerned about
gaining weight: and although I have not gained weight yet, I have become swollen enough around my waist and hips that my clothes
no longer fit. Is this a reaction to the Zyban? Or is this a response to no longer using nicotine?
From: Stephanie
Answer: Dear Stephanie,
What a timely question! Dr. Ashwin Patkar, one of the faculty members in our program, has just recently posted some insight
into similar problems that Pat experienced while quitting. Please check under the "Weekly Updates" section of the site for
more general details about smoking cessation and weight gain.
To answer your question specifically though, to our knowledge, neither swelling nor weight gain have been reported as adverse
reactions to Zyban. The kind of size change that your describing, especially if you haven't gained any measurable weight,
is probably multi-factorial in nature. Though I can't guarantee it, my bet is that this type of "growth" is temporary, and
probably related to changes in your metabolism now that your off the nicotine, further compounded by an increased appetite
I understand your concern about weight. It's a very real problem, and should not be underestimated. However, keep in mind
that any weight gain can be controlled with the proper counseling. Your body is adjusting to your new life as a non-smoker...
you may need a little time to get back to "baseline."
PLEASE remember that smoking will literally take years off of your life. I would certainly encourage you to seek out whatever
help you need to overcome this problem, without sacrificing your weight. Don't give up this fight... you CAN be successful
with BOTH goals!
Question: (Sent 10-9-98)
What do you mean by "biochemical modification"?
From: Louise
Answer: Dear Louise,
While answering Rudy's question, I stated that "Quitting is not a simple matter of will power or strength of character, but
instead a complex interaction between behavioral and biochemical modification that science is just beginning to understand."
The biochemical modification part refers to the fact that nicotine actually changes some of the physical / chemical make-up
of your brain, so that part of the problem with quitting smoking is the process that the brain must go through in order to
shed the influence of nicotine. For example, we know that nicotine receptors in the brain begin to get excessively stimulated
once a person begins smoking. The brain's natural reaction is to change its response to the nicotine, so tolerance develops.
The problem is, because we respond this way, many people then begin to need keep the nicotine in their system in order to
keep from feeling poorly. This is the hallmark of addiction.
In order to quit successfully, some people require some help with the "biochemical" part, so we often prescribe nicotine replacement
therapy, or bupropion (trade name Zyban), or sometimes both, depending on the individual's particular symptoms. Pills and
patches alone may still not be enough for some people, so behavioral training is often utilized to help people over the "rough"
spots.
Question: (Sent 9-10-98)
I've tried to quit a few times, but have been usuccessful. Will I ever be able to quit?
From: Rudy
Answer: Dear Rudy,
Yes! I tell all of my patients that quitting is a "process" and not an event. The addiction to nicotine is one of the most
difficult addictions to overcome. Quitting is not a simple matter of will power or strength of character, but instead a complex
interaction between behavioral and biochemical modification that science is just beginning to understand.
What this all means to you is that, as hard as it is, freedom from nicotine addiction CAN be achieved! Knowledge is power.
Every time you tried to quit in the past, you learned a little something extra about your strengths, weaknesses, and needs.
Use this information to plan your next attack! Best of Luck!
