By Adelita Medina
Monday, December 4, 2000
One doctor who smokes and treats heroin and cocaine users says the addictions are very similar. Experts say that to quit, women need to use every strategy available, ranging from support groups to nicotine replacement drugs. Second of two articles.
(WOMENSENEWS)--As in the case with other addictions, most smokers make numerous attempts to quit before they finally succeed.
"Smoking is an extremely difficult habit and addiction to give up," says Dr. Danielle Milano in New York. She knows first hand the challenges and disappointments that come with the frequent unsuccessful attempts to quit. Despite her extensive knowledge about the dangers of smoking, and her frequent words of encouragement to patients who want to stop, Dr. Milano has found it exceedingly difficult to kick the habit.
Except for a few brief intervals, Dr. Milano has been smoking cigarettes for 23 years, since she was 17.
"I started smoking with my friends in high school because everybody else was doing it. I started by trying one, then another. It's a very strong addiction."
As an adult Dr. Milano has used smoking as food control. "Every time I've quit I've gained weight," she says, "and I guess I'd rather deal with the smoking."
Dr. Milano has lately cut down her use of cigarettes by using a nicotine patch during the day while at work. "I don't want my patients to see me smoking or smell smoke on me," she says.
She removes the patch, however, when she gets home, and she admits she still smokes a couple of cigarettes a day. "One in the morning with a cup of coffee and maybe one in the evening with a glass of wine."
But she has set a "stop smoking" goal. "I plan to stop the day after I take my board exams which I'm now studying for," she says in a self-assured tone, "and this time I know it's going to work."
Beyond her knowledge of health issues, Dr. Milano has much in common with other smokers. Survey after survey indicates the vast majority of smokers polled want to stop smoking, says Dr. Elizabeth M. Whelan, president of the American Council on Science and Health.
No surprise, says Dr. Milano. She treats many patients who are addicted to other drugs in a community health center in New York City and says numerous studies show that the severity of nicotine addiction compares to that of heroin and cocaine. Nicotine has been found to have effects on brain dopamine systems similar to those of these two drugs.
Physical nicotine withdrawal symptoms are also similar to those experienced with other drugs. They include changes in body temperature, heart rate, digestion, muscle tone and appetite. Psychological symptoms include irritability, anxiety, sleep disturbances, nervousness, headaches, fatigue, nausea and cravings for tobacco that can last days, weeks, months, years--or an entire lifetime.
Because nicotine is so addictive, and the smoking habit so hard to break, medical experts say quitting requires a comprehensive arsenal. One method alone rarely does it.
In order to maximize the chances of quitting for good, experts say smokers need to use social support, behavior modification and pharmaceutical support--less harmful drugs. Current nicotine replacement therapies include nicotine gum, nicotine patches, nicotine inhalers.
Zyban, made by Glaxo Wellcome Inc., is the first smoking cessation drug that does not contain nicotine. Called bupropion, the drug originally was approved as an antidepressant under the name Wellbutrin. Three years ago, the FDA approved it for smokers. Zyban works on chemicals in the brain related to nicotine addiction, including dopamine, according to the American Cancer Society. It must be prescribed and taken under the direction of a physician.
A 60-year-old middle school teacher, Carmen Rodriguez, says that during her almost 40 years of smoking she has tried to quit about five times. "I've tried everything--Nicorette gum, herbal tablets, acupuncture, more gum, nicotine patches, even cold turkey. But I've never been able to quit for more than one year." In her next attempt, she plans to join a support group, a method she hasn't tried before. But she hasn't set a target date.
Grace Perez, 39, who heads a Latina domestic violence program in New York, is familiar with most of the dangers associated with smoking. "I've read or heard about them and know people who have struggled with the problem. My own grandmother died of throat cancer at the age of 65," she says.
"I'm an intelligent woman, I'm told I am very attractive, I really should know better. But I'm embarrassed to say I have no will power."
The stress and "crisis nature" of her job contributes to her smoking and prevents her from trying to quit, Perez says. "I don't even want to set a goal for stopping, because I know when that next crisis comes around, I'm going to need that pack of cigarettes to help me resolve it.
"I can't begin to problem solve unless I have that box next to me. It gives me a sense of security."
And no amount of pleading from her husband or her children has helped strengthen her resolve.
"I know that I need to stop, that I should, but I don't want to set myself up to fail."
"I have stopped smoking three times in the past," says Perez, "during each of my pregnancies. But, as terrible as it may sound, during my second delivery, I was already thinking about my next cigarette."
Rodriguez, who started smoking in college, agrees it's tough to quit. All the times that she has stopped, she has felt jittery, moody and unable to sleep.
"And when I do sleep I dream I'm smoking," she said. "I see myself enjoying a pleasurable cigarette."
This too is typical, says addiction expert Dr. Milano.
"While many smokers believe that smoking relieves stress, it is actually a major cause," Dr. Milano says. "Smoking only appears to reduce stress because it lessens the irritability and tension caused by the underlying nicotine addiction--but what a cigarette actually does is to replace the level of nicotine when it becomes low in a smoker's body."
Smoking cessation experts say the key to ultimate success is individual determination to quit. None of the available techniques work without that fundamental underlying desire to quit.
Rita Prats' struggle to stop smoking took 10 years.
"My father died of lung cancer when he was in his early 40s," she says. "I started smoking when I was about 20 and always said I would stop when I reached 30, but I didn't."
Although she tried several of the cessation methods, it wasn't until she was 40 that she finally succeeded. "The patch helped me a lot," she says, "I wore one for a year, but what really made me stop was a decision that I wanted to protect my health."
Facts That Women and Girls Should Know About Smoking: http://www.womensenews.org/article.cfm?aid=353&mode=today
Given the severity of nicotine addiction, experts say it is critical to prevent adolescents from ever taking up the habit and to develop cessation programs that help them break the addiction while it's still a new experience.
"Health is not a major motivator for young people, because they don't think they are going to die," said Dr. Rigotti, director of the tobacco research and treatment center at Massachusetts General Hospital.
Last year, the National Council on Women's Health launched a new anti-smoking initiative for teens called the Mothers & Daughters Race Against Teen Smoking, recognizing the significant impact a mother can have on her daughter's smoking future. The initiative's five kilometer run and 1.5-mile walk in New York City helped catapult mothers and daughters to the frontline, as community co-leaders in the war against teen tobacco addiction.
Plans for the Race Against Teen Smoking 2001 are currently underway.
Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, says aggressive counter-marketing, school and community-based education programs, cessation programs and tough enforcement of youth access laws are needed to keep children away from the dangers of smoking and addiction. He suggests that states spend tobacco settlement funds on comprehensive tobacco prevention programs.
The campaign has teamed up with several organizations, including the National Education Association and the Public Relations Society of America, to teach advocacy skills to young people. The campaign awards several scholarships and program funds to several youth organizations to help them continue their anti-tobacco work. Throughout the year, they remain engaged with the campaign as local and national spokespersons.
The Institute of Medicine of the National Academy of Sciences and a National Cancer Institute panel believe increasing tobacco prices is the single most effective deterrent to tobacco use.
Support is also growing for youth smoking assessments legislation, such as that proposed by President Clinton in the fiscal year 2001 budget, as an effective way to reduce youth smoking rates. The threat of a financial assessment of $3,000 per youth smoker would provide a strong disincentive for tobacco companies to cease marketing to youth and assist in curbing youth access to tobacco. If the industry fails to reach the target of reducing youth smoking by half, the imposition of the financial assessments would force tobacco companies to raise the price of tobacco products, resulting in a decline in tobacco use.
Adelita Medina is a free-lance writer, researcher and fundraising consultant. Originally from northern New Mexico, she now lives in Brooklyn, N.Y.