Nicotine dependence: Don't be discouraged; you can quit

Posted: Sunday, January 24, 2010

Many recall their first cigarette. For me it was high school, leaning my pouted lips to my boyfriend's light, like the movie stars. Only I coughed and couldn't smoke.

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Courtesy Of David Sachs
Courtesy Of David Sachs

Years later during the stress of medical school after seeing the blackened thick lungs of cadavers in our anatomy class, I visited England where everyone smoked at the clubs. I declined, explaining I couldn't inhale. They said, "Don't inhale." By morning I bought my first pack.

This was the same girl who ran all the way home from school in sixth grade after learning smoking caused cancer, assuming my parents didn't know. My reaction changed them and they never smoked again. Kennedy and the surgeon general had just mandated new cigarette labeling hazardous to health.

None of that haunted me when I returned from England a smoker. I joined the smokers in my med school study group and increased consumption during the pressures of exams.

Thankfully after those few smoking years I finished medical school, separated from the study group and quit smoking on my third attempt. 10 years later living here in Juneau I had to fight my urge to join the smokers outside our clinic on stressful days. Strong and unmistakable the urge appears out of the blue even 25 years later.

What we know about smoking now is that it is a chronic relapsing medical disease, like diabetes or hypertension, not a habit. It's a fatal disease with lousy statistics, killing 50 percent. It is the chief avoidable cause of death in our society. Two Alaskans die a day from smoking. Deaths related to smoking equal three 747 jet crashes a day. Would you board a jet if there were 3 crashes a day and your chance of dying was 50 percent?

Why are so many attracted to smoking? Many reasons, but the bottom line is brain rewiring. Nicotine binds brain receptors and causes the brain to adapt.

The lungs efficiently deliver nicotine rich air to the brain in breath-by-breath huge doses that cause the brain to grow extra receptors. This affects neurotransmitters - the brain hormones that communicate with the whole body, mind and spirit. These increased numbers of receptors feel "hungry" if they are not fed more nicotine. Smokers quickly increase nicotinic receptors by 300 percent, and as soon as nicotine is taken away the receptors scream for more, giving withdrawal symptoms.

The receptors are part of the complex feel good pathways in the brain that modulate sleep, eating, drinking, sex, concentration, memory, relaxation, anxiety control, performance and even finding beauty in things. So not feeding the receptors can be unpleasant, usually leading to repeated failures when people attempt quitting.

Most quitters succeed only after multiple quitting failures. But now we know effective treatment takes time, anywhere from six weeks to many years. In fact up to 35 percent need lifetime treatment. Most require a combination of behavioral management counseling and drugs to deal with the increased nicotine receptors. The mood changes from smoking and quitting sometimes need more than one drug.

Even though over the counter nicotine replacement therapy is available, a professional can help identify triggers and formulate your personalized strategy for quitting. This is as important as the nicotine replacement therapy for successful quitting. Treatment needs to be individualized to fit the particular person and their symptoms and readjusted on follow up visits tweaking the therapy to counteract the desire to smoke while avoiding the unpleasant symptoms of withdrawal.

Several prescription drugs minimize withdrawal symptoms. Complimentary medicine modalities also affect neurotransmitter release in the brain and give the quitter one more tool for battling their increased receptors. Acupuncture, acupressure, massage therapy, energy healing, hypnosis and therapeutic touch can help smokers quit. Find a health provider who is comfortable treating smoking cessation.

Some services are free or covered by insurance like a doctor's visit. Call your health provider, or Bartlett's Certified Tobacco Treatment Specialist Nurse Lynda Koski, at 796-8920, or national services like 1-800-QUIT NOW,, or

Don't be discouraged by failure. You can quit!

My next Energy Healing class, Sunday, Jan. 24 and repeated Sunday, Feb. 7, "Time for a Change?" will teach the Liver Stream energy from sunlight for self-balancing your immune system to help make changes and control behavioral addictions. Call 5BE-WELL or

Information included from Dr. David Sachs with his permission.

• Maureen Longworth is a family physician certified in holistic medicine. She owns Alaska Holistic Family Medicine and also offers women's health clinics at Southeast Medical Clinic.

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