Monday, March 1, 2010

President Obama continues to struggle to quit for good

The White house released the results of President Obama's first physical which noted that occasional use of nicotine replacement therapy (NRT). Obama admitted to smoking an occasional cigarette but what does that mean -what is "an occasional" cigarette. Regardless of his apparent health--no one who smokes is healthy. One cigarette increases the heart rate, blood pressure, releases carbon monoxide into the blood system and damages the blood vessels. But the bigger threat of having "just one" is that many former smokers relapse by thinking they can have "just one" every now and then. The addictive nature of nicotine is vastly underestimated when it comes to relapse prevention. Smokers have an abundunce of nicotinic acetylcholine receptors in their brain. Nicotine fits into those receptors and the brain lights up and craves another cigarette. I've treated smokers that had quit for over 20 years and relapsed back to full time smoking very quickly after having "just one".

But to quit for good, President Obama should track when he has those occasional cigarettes--when is it, what is going on--there is probably a pattern that will show up. Often men relapse in positive social situations whereas women often relapse due to stress and negative emotions. It is assumed that because he has a stressful job that he is smoking out of stress but that may not be the case. An occasional cigarette is not due to the physical craving but it is a behavioral challenge and we don't know what his triggers are. Instead of stress, it could be that it's when he's out on the golf course, socializing with his buddies , we just don't know. Everyone is connected to their cigarettes in a unique way--there is NO one size fits all, or even one size fits most when it comes to quitting--it must be a personalized plan that fits the individual, not what worked for someone else. By tracking when he has those occasional cig's, his pattern will emerge and then he can formulate a plan to deal with his individual triggers.
My hope is that because the President understands the difficulty in quitting that he will pave the way to increase treatment options and coverage for other smokers struggling to quit.  Smoking is NOT just a bad habit or a lack of willpower but a physical addiction. Right now, it's not popular to pay for treatment. Non-smokers don't understand why the smoker just doesn't put them down and walk away, former smokers state that if they can quit anybody can quit and current smokers scream that it is their right to smoke. Yet I work everyday with those who struggle, who think that something is wrong with them  because they just can't put them down and walk away. Former Surgeon General Koop called nicotine more addictive than heroin or cocaine--yet if someone was a heroin addict, 30 days of in-patient treatment is paid for and then 90 meetings in 90 days is suggested--4 months of treatment, yet for a substance (nicotine) that is more addictive, we blame the smoker for lacking willpower, and for many years we promoted the product (both in our military and overseas) and we protected the pusher (the tobacco companies).

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