Vassilis N. Panagopoulos, MD
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Smoking Cessation


Is smoking tobacco really addictive?

Yes, it is. The reason for this is that tobacco smoke contains nicotine, a molecule that gets absorbed from the lungs and stimulates specific parts of the brain thus producing a feeling of euphoria (at least at the onset of use). The brain spontaneously adapts to the frequent presence of nicotine in the body in an attempt to decrease its effects on the brain's function within a matter of days to weeks of frequent use. Consequently, if a person who smokes daily stops smoking suddenly, the brain has to abruptly readapt to the absence of nicotine and therefore one experiences a specific set of symptoms, collectively known as the nicotine withdrawal syndrome. Nicotine is the addictive ingredient of tobacco smoke.


What does nicotine withdrawal syndrome consist of?

The main symptoms include dysphoria, depressed mood, irritability, anxiety, restlessness, impairment in concentrating, insomnia, increased appetite.


What are the harmful consequences of smoking?

Unfortunately, smoking is so toxic that it can harm almost every part of the body. Below follows a list with the most important medical problems that are linked to smoking tobacco:

  1. coronary artery disease including myocardial infarction, angina pectoris (the risk is increased by 2-4 times in comparison to nonsmokers),

  2. cerebrovascular disease including stroke (the risk is increased by 2-4 times),

  3. peripheral vascular disease (a narrowing of the blood vessels, known as the arteries, that carry blood with oxygen and nutrients, to all the parts of the body),

  4. cancer of many different parts of the body including: lung cancer (the risk is increased by 25 times), mouth cancer, esophageal cancer, laryngeal cancer, stomach cancer, liver cancer, colon cancer, cervical cancer, bladder cancer, kidney cancer, leukemia, pancreatic cancer,

  5. chronic obstructive lung disease (a serious illness of the lungs that makes it difficult to breathe, can cause severe disability and can be life-threatening), tuberculosis, exacerbation of asthma,

  6. sexual dysfunction including erectile dysfunction in men,

  7. reproductive problems in women, including early menopause, reduced fertility, increased risk for miscarriage, premature birth,

  8. congenital defects for the embryo (unborn baby) including heart defects, cleft lip or cleft palate and higher risk for sudden infant death syndrome.


Why is cigarette smoking a major public health issue?

Well, cigarette smoking is the most important preventable cause of illness and death. This is the case, because if a smoker quits, they decrease significantly their risk for developing a smoking-related illness. Approximately 50% of smokers will die prematurely and on average this will be approximately 14 years earlier.


Why should I not just quit on my own? Why should I need medical treatment from a physician to quit?

If one would like to quit smoking on their own, they are strongly encouraged to do so. However, an important fact is that even though 2/3 of current smokers want to quit, only 3-6% of smokers who make an attempt to quit on their own are able to successfully do so. In contrast, 25-35% of smokers who receive tobacco cessation treatment by a trained physician are able to quit long-term. In other words, one can increase the chances of quitting long-term by almost 5 times by receiving help by a trained physician.


What does smoking cessation treatment consist of?

There are two aspects of treatment: 1) medications and 2) psychotherapy.

There are a few different categories of medications with a different mechanism of action and a different side effect profile. Please see next section for details.

The other important treatment method for smoking cessation is psychotherapy (counseling or talk therapy). It involves meeting regularly with a trained mental health professional (counselor, psychologist, psychiatrist) and discussing about how one thinks, feels and acts in relation to smoking as well as designing individualized changes one can implement to increase the possibility of quitting smoking for good.

Combining medical treatment with psychotherapy leads to higher smoking cessation rates than either treatment modality alone.


What pharmacologic treatments are available and approved for smoking cessation?

1) nicotine replacement therapy: This comes in different forms, including a nicotine patch, nicotine lozenges or nicotine gums. Basically it quite simply involves administering the dose of nicotine the person who is trying to quit would have received by smoking tobacco by using a vehicle different than tobacco smoke. Nicotine is absorbed by the skin in the case of the nicotine patch or the mucosa of the mouth (inner lining of the mouth) in the case of the nicotine gum or the lozenges.

2) varenicline: This is a newer medication that comes in a pill form. It works by stimulating partially the same receptors that nicotine normally stimulates when a smoker is smoking tobacco. It therefore reduces the symptoms of withdrawal from smoking as well as the cravings for tobacco.

3) bupropion: This is an antidepressant that has also been proven to be effective in smoking cessation. It has an excellent side effect profile for most patients in the absence of certain medical conditions (such as epilepsy).


Why should I take medication to quit smoking?

Even though taking medication to quit smoking is not by any means mandatory, receiving optimal smoking cessation treatment including medication as indicated increases almost 6-fold the possibility for permanent abstinence. Would it not be worth it to take medications that have been thoroughly tested in large clinical trials for safety and effectiveness for a few or several weeks to increase significantly the chances of quitting a highly toxic substance (tobacco smoke) that you have likely already used daily for years and that clearly causes cancer and premature death?


What pharmacologic treatment is right for me?

The medication is selected on an individual basis by the treating physician after a detailed medical and psychiatric history has been obtained to minimize the risk of side effects and maximize the chances of quitting. Patient preference is definitely an important factor in this process. Therefore, an open discussion with the person always takes place.


Why not just use an electronic cigarette (E-cigarette)?

Even though the e-cigarette has been exceedingly popular among smokers who attempt to quit smoking, surprisingly it has not been studied extensively in terms of its safety and efficacy for this purpose. This happened, because it introduced in most countries as a consumer product rather than a medication, and therefore it is not strictly regulated in most countries. In contrast, prescribed medications have to undergo vigorous testing in double-blind clinical trials and receive approval by dedicated government agencies (the European Medicines Agency in the E.U. or the FDA in the U.S.A.) prior to becoming available. E-cigarettes come in many different shapes and forms produced by many different companies, containing a variety of different ingredients as well as nicotine. Each different version would have to be studied individually so that definite conclusions can be reached. E-cigarettes do not expose their users to many of the toxic ingredients of tobacco smoke. Therefore, most experts believe that their use is probably less harmful to health than smoking tobacco. However, exposure to toxic molecules may occur even with the use of e-cigarettes. These toxic molecules which may include propylene oxide, acrolein, formaldehyde, acetaldehyde can get produced during the use of e-cigarettes. To date, we lack data in regard to the long-term health effects of e-cigarettes; therefore, their use cannot currently be recommended and they should be used for the shortest amount possible to minimize any unknown, potential risks.


What type of treatment does Dr. Panagopoulos offer for smoking cessation?

Dr. Panagopoulos as an addiction psychiatrist will obtain a comprehensive medical and psychiatric history during the first session. Based on the latest up-to-date clinical practices, Dr. Panagopoulos will present all available treatment options and will design an individualized treatment plan for smoking cessation for each person based on the presence of any medical comorbidities as well as the individual's preferences. Dr. Panagopoulos offers both psychotherapy as well as pharmacologic treatment concurrently depending on the needs and preference of each individual.


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