Seaside Doc: Smoking and You

The words from a 16th century song, kept repeating in my head recently as I conducted medical revisions on Spanish construction workers.

FTR Smoking“Tobacco, tobacco. Sing sweetly for tobacco. Tobacco is like love.”

Considering the historical connection Spain has with tobacco  – after all, it brought tobacco to Europe 500 years ago and the first cigarette factory was opened in Sevilla in 1620

I should not have been surprised that 70% of my construction worker patients smoked. Still, no matter how deeply ingrained tobacco is in Spanish history, culture and habits, it was my responsibility to challenge their smoking addiction.

So, what can I tell a smoker that can help them quit? With giant black letters marking each pack of cigarettes with phrases like “Smoking Kills,” they already get the point that smoking is bad for them. So, why don’t they quit?

Because smoking makes them feel good. Make that really, really good.

Within eight seconds, after a drag off a cigarette, nicotine starts a chemical cascade of neurotransmitters– brain chemicals – that flood over the brain’s pleasure centres. The brain starts working better with nicotine; improving memory, concentration, reaction time. Nicotine works to convince the brain that it is as needed for survival as food, sex and water, which explains why it is a very powerfully addictive substance.

So, how can a smoker quit? While making the decision to stop smoking is important, don’t rely on willpower alone. There are several evidence-based options out there to make quitting a lot easier. Nicotine replacements, such as gums, lozenges or patches, work well for many people and are safe. It is the burnt carcinogens in tobacco that are harmful not the nicotine. Using two different types of nicotine replacements, like a patch and the gum, at the same time can work better for some people than using only one.

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There are new pharmacological treatments like Bupropion, which changes the way your body responds to nicotine, and Varenicline, which bonds to the nicotine receptors in your brain thus reducing your cravings for a cigarette.

Combining some good behaviour therapy to help unlearn the habits and rituals that go along with smoking will increase chances for success. Counselling really helps to cope without nicotine and to learn to recognise the cues that provoke that cigarette urge.

While current smoking restrictions protect non smokers from second-hand smoke, these restriction have turned smokers into a new type of  ‘social pariah.’ My construction worker patients told me that they started smoking when they were teenagers. They could not have possibly known that their brains would get rewired in a way that would make them lifetime slaves to the habit. These patients need sympathy and understanding that smoking is something extremely hard to give up. Fortunately, there are these new treatments and medications to give them the support they need.

If you want to stop smoking, work with your physician to come up with a tailor made plan for you.

(Feature: Seaside Doc – Smoking)

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