Why do smoking cessation drugs work?

Reuters reported on 01/03/11 on a study which appears in the January, 2011 issue of the journal, Archives of General Psychiatry, which describes speculations about why smoking cessation drugs, bupropion (Zyban, Wellbutrin) and varenicline(Chantix) work. You can access the Reuter's article by clicking here.

Does nicotine gum help pregnant women stop smoking?

Does nicotine gum help pregnant women stop smoking?

No.

You can read about the study in the April 15, 2009 issue of the American Family Physician journal by clicking here.

FDA puts black box warnings on Chantix and Zyban

Reuters Health Day News reported on July 1, 2009 that the FDA has placed "black box warnings on two smoking cessation drugs: Chantix and Zyban. Here is a snippet from the article:

Two drugs prescribed to help people quit smoking, Chantix and Zyban, will now carry "black-box" warnings on the potential risks of psychiatric problems, including depression and suicidal thoughts, U.S. health officials said Wednesday.

The U.S. Food and Drug Administration said it was mandating the black-box warnings, the strictest possible, based on reports to the agency of these side effects and on a review of clinical trials and scientific literature.

"We are requiring the manufacturers of the smoking-cessation drugs Chantix and Zyban to add a new boxed warning highlighting the risk of serious mental health symptoms with use of these products," Dr. Curt Rosebraugh, director of the FDA's Office of Drug Evaluation II, said during a Wednesday teleconference.

The agency's review found that some people who used Chantix (varenicline) and Zyban (bupropion) experienced unusual changes in behavior, became depressed, or had their depression worsen and had thoughts of suicide or dying, the FDA said.

Rosebraugh said there were reports of 98 suicides and 188 suicide attempts involving Chantix, and 14 suicides and 17 attempts reported with Zyban.

You can read the whole article by clicking here.

To read the FDA News Release click here.

Admissions to addiction treatment centers dip with institution of tobacco ban according to Treatment Magazine

The Treatment Magazine released an article on 03/21/09 claiming that admissions to addiction treatment centers in New York State is off 1/3 and that AMA, Against Medical Advice, discharges are significantly up since the implementation of OASAS tobacco regulations.

Here is a snippet from the article:

After regulators banned smoking at addiction treatment centers throughout the state mid year last, treatment providers across New York are complaining bitterly, saying that admissions have plummeted in the wake of what is increasingly looking like an arbitrary and ill considered move on the part of the state addictions industry overseer OASAS.

John Haley, the highly regarded chief operating officer of Westhampton-based Seafield Center, estimates that admissions statewide may have fallen by an astounding one-third in the six months or so since state regulators promulagated the no smoking rule. "This has had a devastating impact on the operations and financials of treatment centers virtually everywhere in the state, including ourselves," says Haley, adding that the highly unpopular move by state regulators has served as a kind on one-two punch for addictions services providers. "The recession hit and now this," Haley says. "It hasn't been easy to say the least."

And the financial impact from the addiction center smoking ban is being driven not just by lower admissions, according to Haley. "We have seen our AMA's ["against medical advice" discharges, meaning clients are leaving treatment early, before completion, in droves] soar since the rule was put into effect," he said, adding that he has heard of similar effects at many other centers with which he has been in contact in recent months.

You can access the whole article which is short by clicking here.

GCASA fully supports the OASAS policy and has implemented it for almost one year now beginning in April 8, 2008. While it is a challenge to implement and enforce because nicotine is the biggest and most powerful addiction in the United States, detoxing from tobacco is one the best things people can do for their health.

Also, there is evidence that while admissions may dip at the beginning of a tobacco ban they usually rebound in 6 months. So the cited article may be a bit alarmist, and enabling patient's addictions is not good practice.

How advertising influences teen smoking

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Dangers of smokeless tobacco - Don't dip snuff

Video about Sean Marsee who died at age of 19 from tongue cancer after dipping.

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Success in quitting smoking during pregnancy influenced by psychosocial stressors

There is an interesting study which will appear in the April, 2009 issue of the journal, Addictive Behaviors, which studies pregnant women in Holland to see who stopped smoking during pregnancy and who didn't. Not suprisingly, the women who did not stop smoking had signicantly more psychosocial stressors. Here is a snippet from the abstract of the article:

After adjustment for sociodemographic and smoking-related covariates, low and high levels of pregnancy-related anxiety, exposure to physical/sexual violence, and high job strain were significantly associated with continued smoking during pregnancy. Intensive and comprehensive smoking cessation programs are required for pregnant women, which includes the management of psychosocial problems.

The last sentence has import for us in the substance abuse field in that quitting smoking is not just a matter of nicotine replacement therapy or the desire to quit but also attention to the triggers (stressors) and alternative ways of managing distressful emotions. At GCASA, we offer such treatment in our counseling services.

You can read the abstract of the article from Addictive Behaviors by clicking here.

Parental smoking enhances the liklihood of their teens smoking

Both my parents smoked when I was growing up and neither I nor any of my other 4 siblings became smokers. However, a study published in the February, 2009 issue of the journal Pediatrics found that kids 12 - 17 are more likely to smoke if their parents smoke and the tendency is increased if both parents smoke as compared to just one. Here is a brief snippet from the article:

Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use.

You can read the whole article by clicking here.

An additional concern about smoking is that it is also predictive of other substance abuse, so cigarettes are considered a gateway drug in our current society.

At GCASA we offer smoking cessation services to our clients who would like to stop smoking and we work hard to prevent smoking to begin with with programs such as Smoke Free NOW.

Smokers more highly addicted to nicotine than ever before

Reuters HealthDay reported on October 28, 2008 on research to be presented at an upcoming annual meeting of the American College of Chest Surgeons that smokers seem more addicted to nicotine than ever before. Here is a snippet from the article:

Almost 75 percent of current smokers trying to kick the habit are now highly nicotine-dependent, which is a 15-year high, a new study finds.

In fact, nicotine dependence has risen 12 percent from 1989 to 2006, and the number of highly nicotine-dependent people has gone up 32 percent, according to research expected to be presented Tuesday at the American College of Chest Physicians annual meeting, in Philadelphia.

Nicotine dependence can vary from smoker to smoker, experts noted.

"My clinical perception has been that over the last five years, patients that I am seeing require much more intensive treatment because tobacco dependence is more severe," said lead researcher Dr. David P. Sachs, from the Palo Alto Center for Pulmonary Disease Prevention in California.

Studies have shown that the more nicotine-dependent an individual is, the less effective standard treatment will be, Sachs said. "These people will suffer severe nicotine withdrawal symptoms, and they will be more likely to relapse back to cigarette use," he explained.

85% of people who struggle with alcohol and other substances are also addicted to nicotine. Usually these folks are more heavily addicted than smokers without these problems. Treating people with substance abuse problems for nicotine addiction is very challenging and GCASA staff are increasinly getting better at it.

Most health care providers don't know how to help patients quit smoking

According to a survey reported in Reuters HealthDay on October 27, 2008, most health care providers don't know much about smoking cessation. Here is a snippet from the article:

Few doctors or other health-care providers have enough smoking cessation training to help their patients quit smoking, a U.S. study suggests.

It found that 87 percent to 93 percent of doctors and other health-care workers receive less than five hours of training on tobacco dependence, and less than 6 percent know the U.S. Agency for Healthcare Research and Quality (AHRQ) treatment guidelines for tobacco dependence, including the signs of nicotine withdrawal. This lack of knowledge about treating tobacco dependence may affect quit rates among smokers, suggested lead researcher Virginia Reichert and colleagues at the North Shore-LIJ Health System Center for Tobacco Control in Great Neck, N.Y.

Research has shown that one of the predictors of a quit attempt is if a patient perceives his/her health care provider as being interested, willing, and able to help with a smoking cessation plan.

Here at GCASA we are in the process of surveying staff to determine the extent of their interest, willingness, and ability to help our clients quit smoking.

Tobacco companies are not our friends

This material is taken from the OASAS November, 2008 Wellness If For You newsletter.

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Chris Lewis describes Smoke Free NOW activities in Genesee, Orleans, and Wyoming Counties

Chris Lewis, Coordinator of GCASA's Smoke Free NOW program, describes efforts to decrease the use of tobacco at the Orleans United Against Substance Abuse Drug Free Communities quarterly coalition meeting at Tillman's Inn in Childs, NY on October 8, 2008.

Chris Lewis can be reached at 585-815-1871 or CLewis@gcasa.org

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57% of pregnant patients in New Jersey report that their doctors didn't tell them to quit smoking

Reuters reported on October 2, 2008 on a study published in the October, 2008 issue of the American Journal of Preventive Medicine which found tht many doctors don't tell their pregnant smoking patients to quit. 57% of patients in New Jersey said that their doctors did not tell them to quit. Here is a snippet from the Reuters article:

Pregnant women who smoke share this information with their health care providers, but as often as not their provider doesn't counsel them on how to quit, new research shows.

"Because counseling only achieves modest quit rates, we've heard anecdotally that physicians are somewhat unwilling to take the time to counsel pregnant smokers," Van T. Tong of the Centers for Disease Control and Prevention in Atlanta, a researcher on the study, told Reuters Health. "So our results confirmed what we expected."

Smoking during pregnancy can cause a number of problems for mother and child, from preterm delivery to developmental and behavioral problems, Tong and her colleagues note. More than 1 in 10 women who had babies in the US in 2004 said they smoked while they were pregnant.

To better understand how to help pregnant smokers quit, the researchers analyzed 2004 and 2005 data from the New Jersey Pregnancy Risk Assessment Monitoring Program on 4,473 women who had recently given birth.

Among the 16 percent of women in the study who said that they were smokers before they got pregnant, half said they quit before they began receiving prenatal care. Just 5 percent of smokers quit after starting prenatal care, the investigators report in the American Journal of Preventive Medicine.

Among the women who were still smoking in late pregnancy, only 11 percent reported trying some type of smoking cessation aid, such as counseling or self-help materials.

Almost all of the study participants said that their health care provider had asked them if they smoked, but just 57 percent said that their provider had counseled them on how to quit.

Counseling is the preferred smoking cessation approach for pregnant women, given the potential risks of nicotine gum or patches, or medications like Zyban, Tong commented.

"However, particularly for heavier smokers (more than a pack a day), the potential benefit of quitting smoking may outweigh the risks of the cessation medication," she added. "Women need to talk with their providers to see what would be the best smoking cessation aid for them."

The results can only be generalized to New Jersey, which has one of the lowest rates of smoking during pregnancy in the US, Tong and her colleagues note, possibly thanks to its extensive tobacco-control policies and programs. "However, even in a state with low prenatal smoking, there is a need for improvement to make sure we get women the help they need to quit smoking," Tong said.

"We need to get more providers to offer it despite their fears that it won't achieve success," she added. "Every woman counts, so if they could counsel and refer every pregnant smoker, that's really our goal."

This article makes me wonder how many substance abuse counselors encourage their clients to quit?

Smoking has nothing to do with IQ

Reuters reported on October 1, 2008 on a study in the September, 2008 issue of Psychosomatic Medicine which found that smoking has nothing to do with IQ but seems more influenced by social factors such as socioeconomic circumstances. Here is a snippet from the article:

Smoking may not be the smartest habit in the world, but a person's intelligence has little to do with whether he or she begins smoking or is able to quit, Swedish researchers report.

People in lower socioeconomic levels in the Western world are more likely to be smokers, and slower to kick the habit than their wealthier counterparts, Dr. Tomas Hemmingsson and colleagues write in the medical journal Psychosomatic Medicine. Some have suggested that these individuals may be less intelligent and thus less likely to understand the risks of smoking.

To investigate, Hemmingsson and his team at the Karolinska Institute in Stockholm looked at 49,321 Swedish men born between 1949 and 1951 who had undergone IQ tests when they were 18 to 20 years old as part of conscription for military service.

At age 18, the researchers did find a relationship between lower IQ and likelihood of smoking. However, accounting for other factors known to be related to becoming a smoker, such as parental divorce, lower level of education and psychiatric diagnosis, sharply reduced the influence of IQ on smoking behavior -- although it did not eliminate it.

The researchers also found that men with lower IQs were actually at lower risk of being heavy smokers than those with higher IQ scores.

A subgroup of 694 of the men, 373 of whom smoked at age 18, were interviewed again between 1981 and 2002. At the time of follow-up, an average of 18 years later, 180 had quit. A man's IQ at 18 had no relationship with whether or not he had stopped smoking.

The study debunks the theory that people start smoking or don't quit because they have difficulty comprehending how harmful smoking is to one's health, Hemmingsson commented to Reuters Health.

In helping people to quit, he added, "the main issue would not be to explain more deeply what the health consequences are. I think most people understand the health consequences today of smoking."

Factors that are known to be associated with smoking include being a single mother and being unemployed, Hemmingsson noted. "It's other social factors that prevent people probably from stopping smoking rather than that they don't understand the health consequences of this habit."

Use of Medicaid reimbursement for smoking cessation products has increased dramatically in New York State in last 8 years

Over 30% of New Yorkers on Medicaid smoke cigarettes compared with just 14% of those with private health insurance.

Medicaid began reimbursing for prescription smoking cessation products in October 1999 and for over-the-counter products in February 2000. About one million adults are enrolled in Medicaid in New York.

Since medicaid began reimbursing for smoking cessation products, the number of Medicaid claims and the number of recipients for these products has risen dramatically. This is important because New Yorkers on Medicaid are disproportionately affected by cigarette smoking.

Hopefully this will have long term health benefits for medicaid recipients and in the long run save money for the treatment of smoking related illnesses.


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Man arrested in LeRoy, NY for giving cigarettes to a minor

They are getting tough in LeRoy when man is arrested for giving a cigarette to a minor and charged with unlawful dealing with a child and endangering the welfare of a child.

This may seem extreme but nicotine is one of the most addictiing and deadly drugs in American. It has always puzzled me why, we as a society, have had more lenient attitudes about alcohol, pot, and other drugs and ignored tobacco. Tobacco is far more addicting and deadly than alcohol and/or street drugs. It is heartening to see LeRoy police take tobacco seriously.

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Biggest predictors of youth smoking? Access to cigarettes and friends who smoke

For those of us in the field this is not rocket science, but to the less informed lay person it might be interesting to learn that access to cigarettes is one of the biggest predictors of whether kids will pick up smoking.

According to an article published by Reuters HealthDay on July 14, 2008 based on a study reported in the July, 2008 issue of Annals of Family Medicine, the researchers found that kids who reported they could easily obtain cigarettes and/or whose friends smoked were much more likely to get addicted. Of course, the easiest access to cigarettes is from friends who smoke. If your kid is hanging around with kids who smoke this is a huge risk factor and as a parent, you might want to curtail your child's hanging around with such kids.

Here is part of what the Reuters HealthDay article says:

Kids who can get their hands easily on cigarettes -- say from friends or close acquaintances -- are more likely to end up with a regular smoking habit, a new study of sixth-graders finds.

Hopefully, the information will help health care professionals help kids quit before they even start, said the authors of a study in the current issue of Annals of Family Medicine.

"We found that if you get kids to answer just two simple questions, 'Would it be easy for you to get a cigarette?' and 'Do you have friends who smoke?' you can identify those who are at high risk of becoming regular smokers," said Chyke Doubeni of the University of Massachusetts Medical School, in a school press release. "Saying yes to either should raise a red flag and prompt doctors and others to talk with parents and kids about how to avoid smoking."

Tobacco companies manipulate menthol levels in cigarettes to addict younger smokers

Reuters Health Day reported on July 16, 2008 on a study which will appear in the September, 2008 issue of the American Journal Of Public Health that finds that tobacco companies are manipulating methol levels in cigarettes to attract and addict young smokers. Here is a snippet from the article:

Tobacco companies are manipulating menthol levels in cigarettes to appeal to newer, younger smokers, part of a deliberate strategy to get younger people, particularly African-Americans, hooked, a new study contends.

Menthol makes cigarettes more palatable to the novice smoker.

"If anything, menthol is being used as a candy to help the toxin go down," said Dr. Gregory Connolly, senior author of a paper being published in the September issue of the American Journal of Public Health. "If we let the industry go ahead and willy-nilly design the product the way they want to, it's going to lead to the premature death of millions and millions of Americans. Our research says we have to go after this."

A bill pending in Congress would give the U.S. Food and Drug Administration power to regulate menthol and other additives in cigarettes.

"This study provides evidence of one of the many ways tobacco companies manipulate the ingredients in cigarettes in an effort to entice and addict new consumers," John R. Seffrin, chief executive officer of the American Cancer Society, said in a news release. "Legislation in Congress would give the FDA the authority to regulate tobacco products and put an end to tobacco industry practices that prey upon children and blatantly mislead adults. The bill would end the marketing of tobacco products to children, force companies for the first time to disclose the ingredients in their products and allow the FDA to regulate all tobacco products, including menthol cigarettes, based on science."

Menthol itself is not addictive, but it can ease the "delivery" of nicotine, which is highly addictive. More than 70 percent of African-American smokers use menthol cigarettes, compared with about 30 percent of white smokers. It's unclear if menthol cigarettes are more harmful than "regular" cigarettes, the study authors said.

Connolly and his colleagues looked at internal tobacco-industry documents which showed that companies researched how menthol levels could affect sales among different demographic groups. Cigarettes with milder menthol levels appeal to younger smokers.

Chantix appears more effective than the nicotine patch in helping people quit smoking

Reuters HealthDay reported on August 15, 2008 on a study funded by Pfizer the maker of Chantix in the August, 2008 issue of the journal Thorax which found that Chantix worked better in helping smokers quit smoking than the patch. Here is a snippet from the Reuters article:

The anti-smoking drug Chantix appears more effective than the nicotine patch in helping people stop smoking, European and U.S. researchers report.

In a study of 746 smokers, the investigators found that 56 percent of those who took for Chantix for 12 weeks were cigarette-free during the last month of treatment. That compared with 43 percent of those who used a nicotine patch.

The study, funded by Chantix maker Pfizer Inc., is published in the medical journal Thorax.
Chantix, also known as varenicline, acts on a brain receptor affected by nicotine; the drug blocks some of nicotine's effects, while also providing a nicotine-like "buzz" to curb withdrawal symptoms.

OASAS Tobacco Free Regulations take effect July 24, 2008

Here is part of the OASAS Commissioner's letter in her Quarterly Newsletter for Summer, 2008 regarding the new tobacco free regulations which take effect on July 24, 2008. GCASA came into compliance on April 1, 2008.

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