Interventions in Smoking Cessations

Frank Vitale, M.A.School of Pharmacy

Director, International Smoking Cessation Program through the

University of Pittsburgh

Coordinator, UPMC Smoking Cessation Program

Smoking

Cessation

Skills:

The Basics

Program Objectives1. Provide a fundamental understanding of the intricacies of the smoking behavior.

2. Define and examine the stages of the quitting process.

3. Review basic cognitive and behavioral interventions.

4. Briefly detail currently available smoking cessation medications.

Three aspects of smoking

AddictionHabitPsychological

Nicotine Addiction

Nicotine - Ganglionic cholinergic-receptor agonist with dose related pharmacologic effects

- Basic; liquid alkaloid

- Addiction Reinforcer Withdrawal Time to Addiction

Theory of Addiction - Release of neurotransmitters in brain

- Pleasure reinforces repeated administration

- Acclimation occurs

- Abrupt cessation leads to withdrawal

Nicotine Absorption and Metabolism Readily absorbed from

- respiratory tract - buccal membranes - skin - minimal stomach absorption due to acidic environment

Highly metabolized by liver and lungs when inhaled

Predicted Concentration of Serum Nicotine During the Smoking Day

0

5

10

15

20

25

30

35

40

0 4 8 12 16 20 24

Hours since waking

Pro

ject

ed N

icot

ine

Con

cent

rati

on(n

g/m

l)

Cigs I II I II I III II II I II I I I I

Nicotine’s Effects on the Body

CV - dirrect effect: increases BP and HR - indirrect effect: stimulates release of catecholamines from adrenal

Periphery - skeletal muscle relaxant CNS - causes tremor, increases respirations,

facilitates memory, decreases aggression, and decreases weight

GI - increases tone and motor activity

Symptoms of Nicotine Withdrawal irritability, impatience, anxiety, restlessness,

depression, drowsiness, nighttime awakening (lasts approximately 7 days)

decrease in short-term memory (lasts approximately 14 days)

increase in appetite, craving, and difficulty concentrating (can last weeks to months)

Nicotine Replacement Therapy

Contols -cravings, irritability, impatience, anxiety, restlessness, difficulty concentrating, drowsiness, nighttime awakening, decreased short-term memory

Delays/Decreases -appetite, weight gain

Determination of Nicotine Toxicity Perspiration dizziness headache confusion and

weakness differences -

withdrawal and toxicity symptoms

Abdominal pain hearing and visual

disturbance nausea/vomiting/diarrhea

HABIT

“Automatic” Smoking Repeatedly pairing smoking with other

behaviors Paired behaviors create unconscious

urges to smoke

How Habits Develop

Pavlov: Conditioned/Response

Situations That May Trigger Smoking Morning Routine Coffee After Meals In the car On the phone Alcohol

Stress Anger Anxiety Boredom Celebration

PSYCHOLOGICAL

Smokers’ Misconceptions

The belief that cigarettes are doing something positive for the smoker

The belief that this is something the smoker cannot do on his or her own

Perceived Benefits of Smoking

Stress ManagementWeight ManagementMood RegulatorOthers

Cigarette as “Friend”

What’s in a Cigarette!

The price of smoking

Saying Goodbye

I can live without cigarette!