You've tried to quit smoking and finding it more difficult than you ever imagined.
You've decided it's time to quit but don't know where to begin.
Should I try e-cigarettes?
Will I gain weight?
Is there any medication that could help?
Dr. Brian Tiep, Staff Physician, Division of Pulmonary and Critical Care Medicine at City of Hope, is here to answer these and other important questions to aid you in your attempt to quit smoking.
Selected Podcast
Can You Quit Smoking? Yes You Can!
Featured Speaker:
Brian Tiep, MD
Dr. Brian Tiep is a pulmonologist. He received his medical degree from Meharry Medical College and has been in practice for 49 years. Transcription:
Can You Quit Smoking? Yes You Can!
Melanie Cole (Host): If you’ve ever tried to quit smoking, you know how really hard that can be. Or if you have a loved one that smokes, you know how hard it is to try and get them to quit. My guest today is Dr. Brian Tiep. He’s the Director of Pulmonary Rehabilitation and Smoking Cessation at City Of Hope. Welcome to the show, Dr. Tiep. Tell us a little bit about what is tobacco dependency.
Dr. Brian Tiep (Guest): Well, Melanie, tobacco dependency is nicotine addiction. It’s a disease of the brain that causes the victim to ingest over 7000 toxic chemicals into its body over 200 times a day and find it to be a pleasurable experience.
Melanie: Wow. That’s quite a statement to make. So, it is our brains telling us this. Why does that happen?
Dr. Tiep: Well, actually nicotine exposure actually starts you into thinking about getting nicotine. In other words, it changes your brain. It changes your brain for good. It develops what we call a grove in your brain in which you sort of fall into that grove when you have been deprived of nicotine for any period of time. So, it’s definitely an addiction, a very strong addiction and it’s very difficult to quit smoking. But it’s certainly doable.
Melanie: So, it is so hard to quit smoking. What is the first thing; your best piece of advice for people who want to quit smoking? Because there’s medications on the market now, there’s patches and there’s all kinds of things and aids to help you quit smoking but they don’t all seem to work for everybody.
Dr. Tiep: Well, that’s true and everybody’s an individual but it does take a degree of motivation and willpower. Willpower just doesn’t carry the day alone. In fact, if you try to quit by willpower alone, each time you try to quit by willpower, it’s about a 3-5% success rate. But it does take passion and commitment but we do have medications to either slow or stop the withdrawal symptoms and they include Varenicline, which is known as Chantix, bupropion, which is known as Zyban and then, the nicotine replacement therapies. Nicotine replacement therapies, you can think of the model as like asthma. When you’re treating asthma, you try to control the inflammation and with long-term controller medications, they usually involve an inhaled steroid. Well, in the case of tobacco cessation, one example would be using the nicotine patch as the controller medication and then, for breakthrough symptoms, then you use the gum or the lozenge or the inhaler. But the main thing is to work through this, to utilize the medication because the medication can help control the withdrawal symptoms. It’s very easy to continue to smoke. It’s very difficult to quit smoking because of the withdrawal symptoms. So, the medication is essential in controlling the withdrawal symptoms. But for each person we have to find not only the medication but the proper dosage to make it work. And I tell my patients, don’t struggle. We’re there for you. We’ll struggle along with you, but don’t struggle, we’ll do the struggling. And if you should relapse, don’t give up. Come back to us. You’re only one step closer to actual success.
Melanie: So, with Chantix and Wellbutrin and all these different things on the market, as you say, they help control that nicotine addiction but the behavior: the standing in the garage to have a cigarette, the need for your fingers to hold something, that feeling of--whether it’s relaxation or whatever it does to your brain that makes you want to quit smoking--how do you then deal with the behaviors if you’re also trying to deal with that addiction?
Dr. Tiep: Well part of success is not only the medication but also with programs like our program. We have a program at the Biller Center at City Of Hope and it’s a support program. So what we do is, we get together with patients, let them know exactly what nicotine addiction is--and that it’s not a casual effort to try to quit smoking. Then we come up with strategies to break the habit pattern. The habit is the way the brain gets its nicotine. The brain is always looking for its nicotine. The reason for that is that the brain needs nicotine in order to release dopamine and some other chemicals that make you feel good, make you feel centered, make things okay.
Melanie: Okay, so…
Dr. Tiep: So, we deal with the behavioral patterns of things. For example, a lot of people need their first cigarette in the morning with their first cup of coffee. Well, the brain has linked a cup of coffee with a cigarette. So, when you grab a cup of coffee, you don’t even have to think about it. It’s a habit pattern and it’s in the habit section of the brain that says, “Okay. Grab your cigarette as well.” So, we break that habit pattern by taking the first cup of coffee at a place where you can’t smoke. In California, in almost every place you go out, you can’t smoke.
Melanie: Well, it certainly is becoming less and less as people can’t smoke near doorways, and it certainly is not something that people want to smell when they walk into a restaurant, so people aren’t able to do it out in the open quite as much as they used to, which does make them feel like a bit of a pariah. So, besides medications and behavioral therapy some people are switching to e-cigarettes because they think this vapor is less harmful but it’s still got that behavior factor, doesn’t it?
Dr. Tiep: Yes. In fact, the behavioral factor is kind of reassuring. E-cigarettes were invented back in the 1960’s by a Chinese inventor named Hon Lik but they didn’t become popular until the 2000’s. They’re considered to be safer than tobacco cigarettes because there is no combustion but we really don’t know if they are any safer and certainly they’re not absolutely safe. Now, patients take to it as there’s a vibrant vape support system. People have their vape support groups that actually encourage them to utilize this substance. All these vape shops are cropping up all over the place, including near schools. In fact, probably on purpose near schools. Now, it’s considered by some people in smoking cessation as harm reduction. Get the patient on an e-cigarette and then get them on nicotine replacement or Varenicline. It tends to be tactile, just like a cigarette in a way. That’s the psychosocial part of the addiction. So, on the positive side, it is kind of like smoking a cigarette but not getting all those 7000 toxic chemicals that are involved in cigarettes. Then there’s some evidence that e-cigarettes may be able to help patients quit smoking but when you dig deeper a lot of those patients not only smoke e-cigarettes, or vape e-cigarettes but actually smoke their regular cigarettes as well. They’re inexpensive; they’re accessible. Now e-cigarettes contain a liquid which sometimes contains--not always, but sometimes--contains nicotine, but it contains propylene glycol, nicotine, tobacco essence, vegetable glycerin and various different flavorings. But, some of the flavorings and some of the chemicals in these cigarettes are known to be harmful such as nitrosamine, which can be cancer producing. There are other chemicals. There is a flavoring called diacetyl which can cause bronchiolitis obliterans, sometimes known as popcorn lung. So, they’re not absolutely safe. The safest part of the chemicals are supposed to be pure and crystal, in other words absolutely clear like water, like glycerine like propylene glycol but if you take a look at the e-cigarette fluid, it’s sort of a brownish fluid. And do you really want to heat up that fluid and then inhale it?
Melanie: And then inhale it into your lungs? If you look at it, it does make it a little bit tougher. Now, we don’t have a lot of time but why is weight gain associated with smoking cessation? What can people do to prevent that?
Dr. Tiep: What people can do to prevent weight gain is to recognize that it is common. It doesn’t happen to everybody who quits smoking. In fact, some people actually lose weight in that process but I won’t say that they’re in the majority at all. But weight gain is common because nicotine is helpful in controlling weight, for some people, again. So, if you take that away then they replace everything with food. Withdrawal symptoms include all kinds of anxiety and depression and symptoms that are reversible sometimes by having comfort foods. So, it’s very common to gain weight. The best thing to do is to start a walking program, an exercise program that includes a walking program, which also, if you do it enough, it actually can produce some of the chemicals that you rely on in cigarettes.
Melanie: Well, it certainly can. And I just the last minute, Dr. Tiep, if you would, give your best advice for people that want to quit smoking and what you want them to know, what you want them to do first--their first decision--and to help them make that decision; what they should do first and why they should consider coming to City Of Hope for their smoking cessation?
Dr. Tiep: Okay. Again, it takes commitment and passion. Realize that it can be done and it should be done. If a person is getting cancer treatment, it helps to quit smoking in order for the cancer treatment to be more effective and enable certain surgeries--for example, reconstruction surgery--to actually take place because they won’t have the opportunity for those surgeries if they’re still taking nicotine. We don’t use nicotine replacement for those patients either. Then realize that you do have to take medication; that we’re there for them; we have a support group and we have some wonderful people. I’m talking about not only people to help patients but the patients themselves who are helping each other and helping us help other patients. So, it’s good to have good support. We come about strategizing. We know withdrawal symptoms can be overcome. Chances of success are better if you take the medication and if you have support and that’s in sort of in a dose dependent fashion. It’s not your fault for having smoked. It’s an addiction. Treat it as an addiction. It’s a disease of the brain and it’s going to be a relapsing disease of the brain so be aware of that, work on it and we’re there to help.
Melanie: That is absolutely great advice and so beautifully put. Thank you, so much, Dr. Tiep. And for more information on smoking cessation at City Of Hope, you can go to CityOfHope.org. That’s CityOfHope.org. You’re listening to City Of Hope radio. This is Melanie Cole and thanks so much for listening.
Can You Quit Smoking? Yes You Can!
Melanie Cole (Host): If you’ve ever tried to quit smoking, you know how really hard that can be. Or if you have a loved one that smokes, you know how hard it is to try and get them to quit. My guest today is Dr. Brian Tiep. He’s the Director of Pulmonary Rehabilitation and Smoking Cessation at City Of Hope. Welcome to the show, Dr. Tiep. Tell us a little bit about what is tobacco dependency.
Dr. Brian Tiep (Guest): Well, Melanie, tobacco dependency is nicotine addiction. It’s a disease of the brain that causes the victim to ingest over 7000 toxic chemicals into its body over 200 times a day and find it to be a pleasurable experience.
Melanie: Wow. That’s quite a statement to make. So, it is our brains telling us this. Why does that happen?
Dr. Tiep: Well, actually nicotine exposure actually starts you into thinking about getting nicotine. In other words, it changes your brain. It changes your brain for good. It develops what we call a grove in your brain in which you sort of fall into that grove when you have been deprived of nicotine for any period of time. So, it’s definitely an addiction, a very strong addiction and it’s very difficult to quit smoking. But it’s certainly doable.
Melanie: So, it is so hard to quit smoking. What is the first thing; your best piece of advice for people who want to quit smoking? Because there’s medications on the market now, there’s patches and there’s all kinds of things and aids to help you quit smoking but they don’t all seem to work for everybody.
Dr. Tiep: Well, that’s true and everybody’s an individual but it does take a degree of motivation and willpower. Willpower just doesn’t carry the day alone. In fact, if you try to quit by willpower alone, each time you try to quit by willpower, it’s about a 3-5% success rate. But it does take passion and commitment but we do have medications to either slow or stop the withdrawal symptoms and they include Varenicline, which is known as Chantix, bupropion, which is known as Zyban and then, the nicotine replacement therapies. Nicotine replacement therapies, you can think of the model as like asthma. When you’re treating asthma, you try to control the inflammation and with long-term controller medications, they usually involve an inhaled steroid. Well, in the case of tobacco cessation, one example would be using the nicotine patch as the controller medication and then, for breakthrough symptoms, then you use the gum or the lozenge or the inhaler. But the main thing is to work through this, to utilize the medication because the medication can help control the withdrawal symptoms. It’s very easy to continue to smoke. It’s very difficult to quit smoking because of the withdrawal symptoms. So, the medication is essential in controlling the withdrawal symptoms. But for each person we have to find not only the medication but the proper dosage to make it work. And I tell my patients, don’t struggle. We’re there for you. We’ll struggle along with you, but don’t struggle, we’ll do the struggling. And if you should relapse, don’t give up. Come back to us. You’re only one step closer to actual success.
Melanie: So, with Chantix and Wellbutrin and all these different things on the market, as you say, they help control that nicotine addiction but the behavior: the standing in the garage to have a cigarette, the need for your fingers to hold something, that feeling of--whether it’s relaxation or whatever it does to your brain that makes you want to quit smoking--how do you then deal with the behaviors if you’re also trying to deal with that addiction?
Dr. Tiep: Well part of success is not only the medication but also with programs like our program. We have a program at the Biller Center at City Of Hope and it’s a support program. So what we do is, we get together with patients, let them know exactly what nicotine addiction is--and that it’s not a casual effort to try to quit smoking. Then we come up with strategies to break the habit pattern. The habit is the way the brain gets its nicotine. The brain is always looking for its nicotine. The reason for that is that the brain needs nicotine in order to release dopamine and some other chemicals that make you feel good, make you feel centered, make things okay.
Melanie: Okay, so…
Dr. Tiep: So, we deal with the behavioral patterns of things. For example, a lot of people need their first cigarette in the morning with their first cup of coffee. Well, the brain has linked a cup of coffee with a cigarette. So, when you grab a cup of coffee, you don’t even have to think about it. It’s a habit pattern and it’s in the habit section of the brain that says, “Okay. Grab your cigarette as well.” So, we break that habit pattern by taking the first cup of coffee at a place where you can’t smoke. In California, in almost every place you go out, you can’t smoke.
Melanie: Well, it certainly is becoming less and less as people can’t smoke near doorways, and it certainly is not something that people want to smell when they walk into a restaurant, so people aren’t able to do it out in the open quite as much as they used to, which does make them feel like a bit of a pariah. So, besides medications and behavioral therapy some people are switching to e-cigarettes because they think this vapor is less harmful but it’s still got that behavior factor, doesn’t it?
Dr. Tiep: Yes. In fact, the behavioral factor is kind of reassuring. E-cigarettes were invented back in the 1960’s by a Chinese inventor named Hon Lik but they didn’t become popular until the 2000’s. They’re considered to be safer than tobacco cigarettes because there is no combustion but we really don’t know if they are any safer and certainly they’re not absolutely safe. Now, patients take to it as there’s a vibrant vape support system. People have their vape support groups that actually encourage them to utilize this substance. All these vape shops are cropping up all over the place, including near schools. In fact, probably on purpose near schools. Now, it’s considered by some people in smoking cessation as harm reduction. Get the patient on an e-cigarette and then get them on nicotine replacement or Varenicline. It tends to be tactile, just like a cigarette in a way. That’s the psychosocial part of the addiction. So, on the positive side, it is kind of like smoking a cigarette but not getting all those 7000 toxic chemicals that are involved in cigarettes. Then there’s some evidence that e-cigarettes may be able to help patients quit smoking but when you dig deeper a lot of those patients not only smoke e-cigarettes, or vape e-cigarettes but actually smoke their regular cigarettes as well. They’re inexpensive; they’re accessible. Now e-cigarettes contain a liquid which sometimes contains--not always, but sometimes--contains nicotine, but it contains propylene glycol, nicotine, tobacco essence, vegetable glycerin and various different flavorings. But, some of the flavorings and some of the chemicals in these cigarettes are known to be harmful such as nitrosamine, which can be cancer producing. There are other chemicals. There is a flavoring called diacetyl which can cause bronchiolitis obliterans, sometimes known as popcorn lung. So, they’re not absolutely safe. The safest part of the chemicals are supposed to be pure and crystal, in other words absolutely clear like water, like glycerine like propylene glycol but if you take a look at the e-cigarette fluid, it’s sort of a brownish fluid. And do you really want to heat up that fluid and then inhale it?
Melanie: And then inhale it into your lungs? If you look at it, it does make it a little bit tougher. Now, we don’t have a lot of time but why is weight gain associated with smoking cessation? What can people do to prevent that?
Dr. Tiep: What people can do to prevent weight gain is to recognize that it is common. It doesn’t happen to everybody who quits smoking. In fact, some people actually lose weight in that process but I won’t say that they’re in the majority at all. But weight gain is common because nicotine is helpful in controlling weight, for some people, again. So, if you take that away then they replace everything with food. Withdrawal symptoms include all kinds of anxiety and depression and symptoms that are reversible sometimes by having comfort foods. So, it’s very common to gain weight. The best thing to do is to start a walking program, an exercise program that includes a walking program, which also, if you do it enough, it actually can produce some of the chemicals that you rely on in cigarettes.
Melanie: Well, it certainly can. And I just the last minute, Dr. Tiep, if you would, give your best advice for people that want to quit smoking and what you want them to know, what you want them to do first--their first decision--and to help them make that decision; what they should do first and why they should consider coming to City Of Hope for their smoking cessation?
Dr. Tiep: Okay. Again, it takes commitment and passion. Realize that it can be done and it should be done. If a person is getting cancer treatment, it helps to quit smoking in order for the cancer treatment to be more effective and enable certain surgeries--for example, reconstruction surgery--to actually take place because they won’t have the opportunity for those surgeries if they’re still taking nicotine. We don’t use nicotine replacement for those patients either. Then realize that you do have to take medication; that we’re there for them; we have a support group and we have some wonderful people. I’m talking about not only people to help patients but the patients themselves who are helping each other and helping us help other patients. So, it’s good to have good support. We come about strategizing. We know withdrawal symptoms can be overcome. Chances of success are better if you take the medication and if you have support and that’s in sort of in a dose dependent fashion. It’s not your fault for having smoked. It’s an addiction. Treat it as an addiction. It’s a disease of the brain and it’s going to be a relapsing disease of the brain so be aware of that, work on it and we’re there to help.
Melanie: That is absolutely great advice and so beautifully put. Thank you, so much, Dr. Tiep. And for more information on smoking cessation at City Of Hope, you can go to CityOfHope.org. That’s CityOfHope.org. You’re listening to City Of Hope radio. This is Melanie Cole and thanks so much for listening.