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Scott Webb (Host): This is Mission in Action, a podcast from St. Mary's Healthcare in Athens, Georgia, focusing on patient centered care under our mission to be a transforming healing presence within our communities. I'm Scott Webb. And today we're discussing the Freedom From Smoking Program and how we can help ourselves and each other to quit.

And joining me today is Todd Drake. He's a Registered Respiratory Therapist and Cardiac and Pulmonary Rehab Coordinator. So, Todd, it's so great to have you on today. We're going to talk about a Freedom From Smoking and how we can help ourselves and help each other. Before we get rolling here, though, tell us about the Freedom From Smoking Program.

Chandler "Todd" Drake, RRT (Guest): The American Lung Association has the oldest stop smoking program. It started in 1981. And it's helped truly millions of people quit smoking. It's kind of based off evidence-based results on changing lifestyle to help you quit smoking. And it's been running since 1981 and done very well. It's actually offered many ways. It's offered through apps and online, and the preferred method is always when you are trying to make a lifestyle change, it is a group format where you're meeting with other students and participants who are trying to quit smoking.

Host: Yeah, there is a safety in numbers, if you will, and having that great support system. I know this program has been highly successful. As you say, it's been around since 1981, which is amazing. So, let's talk about this. Let's get into this. How do we help a loved one quit smoking or vaping? I know it's not just as simple as hiding their cigarettes or hiding their, you know, e-cigarettes and things like that. There's more to it. And I want to hear from an expert here, how do we help our loved ones quit smoking?

Todd: In And my experience of teaching stop smoking, there's always a Freedom From Smoking facilitator in your area, you can go on American Lung Association, their website and find an area facilitator that's been trained to help with smoking addiction, but the best method is really persistence with kindness and love.

And maybe also referring them to a live like we talked about safety in numbers and safety in actually face to face. The way most programs are ran is the first night just a meet and greet and they actually hand out questionnaires that you can find on the website too, to what what level of state you are in wanting to quit. Most people's cigarettes or electronic vaping or even smokeless tobacco is really sort of their best friend and trying to give that up is kind of different levels. Most people just think about it at first and then they're encouraged. And then sometimes they try and frequently they fail and don't feel good about that. And sometimes it takes encouragement and being with other people that are trying and seeing other success stories, which the Freedom From Smoking Class does allow you to meet other success stories that have come through previously. So attending the class is the number one thing. And kind of reaching out to a facilitator is probably the best thing.

Host: And is that really the key Todd for smokers or those who have a tobacco dependence? Is the key really that they have to want to quit. Does it really start there? If folks just don't want to quit fundamentally, are they going to be successful in any way?

Todd: No, they won't be successful unless they want to quit. But I do think it is a two way street I, myself am an ex smoker, not my smartest choice when I was younger. But I think, you know, nine out of 10 people that have nicotine dependence started before they were 18, and that's a whole different issue of trying to address and move our focus to trying to in the middle schools and high schools and stop them before they start. But as far as yes, a person of any age needs to, but it also takes, like I said, love and kindness from the many, many non-smokers that have never smoked. It's just kind of hard to relate to smokers who might be doing it because they started young and didn't know any better or how can you do something that hurts you so badly?

Just, it's just this kind of unknown, kinda no compassion of why somebody could be doing those, but if you talk to the anybody's individual, they usually have a vice of choice, whether it's chocolate or a cheeseburger but cigarette smoking is beyond. It's called Freedom From Smoking because most nicotine dependence is it's not about whether they're eating today and going to, what time they're going to work and getting off and are, everybody's concerned with COVID at this point, but, but the first thing they do is check their cigarettes to see how many they have for today, you know, what kind of electronic dispensary cartridge do I have and how long will that last? It's kind of hard to relate to people that have addictions that level.

And I think it takes compassion to relate to people that, and then realize you know, it just takes a kindness and encouragement of different ways. And that's something about Freedom From Smoking, where there's no one glove fit all. Many programs are like, hey, you do this and you do that. And you buy these patches and you get on this med and you get off and that's it.

And that's not true. Different people, kind of need different levels of support and encouragement and different mechanisms to quit. Some of them do need nicotine replacement therapies. Others only need a medication. It depends on the person. And that's what Freedom From Smoking does. Is it kind of tailors it to the person.

Host: Yeah. There's no one size fits all. And I think you're so right. That there's just a stigma an extra stigma. And

I'm wondering is quitting just as simple as sort of breaking your dependence on nicotine, is it just that simple as it just the nicotine or is there more?

Todd: No, they've been addressing this for over 15 years. You know, there's a physical component, people are unaware that you know, the nicotine dependence is actually done and truly done within 48 hours to one week, but the mental it's listed as social and we teach social, but I call it asocial as well in my class format because the mental addiction of, of, hey, I need nicotine or, or that break time or is kind a mental dependency and a more harder come overcome harder than the physical addiction. The other many, many people kind of use cigarette smoking or vaping, or, or even dipping kind of a relaxation method and instead of going for a walk, which is healthy you, they, they become dependent on that. The physical dependence is real. True it's significant, it's a crutch that, that people lean on, and society is still accepting as being okay right now and actually encouraging vaping in the youth, which is a whole nother kind of beast and the topic to kind of tackle, hopefully down the road.

Host: Yeah, that would be an entirely separate podcast. My son just graduated high school and the stories he would tell me of the vaping going on. Vaping in the bathrooms, that's a conversation for another podcast. For today, what effects does smoking or vaping have on COVID patients? Cause we've heard a lot about folks with comorbidities and COVID, and definitely that smokers that's a red flag, a major red flag for COVID.

So what are your thoughts smoking ,vaping and COVID?

Todd: You know, COVID is such a new thing and really scary to everybody. Cause we don't know the long-term effects, but smoking in general, makes you anywhere from two times to five times more likely being admitted to the hospital. And premature death. So, as far as COVID though, at this point, being that it's lung based and and also if you've smoked longer than two years, you've hurt your lungs some, most of the people, I respect here, the pulmonologists, they feel it makes it twice the likely that you'd probably be admitted and you know, a COVID that would be detrimental and very hard, no matter what your age is, if you smoke.

Host: Uh, let's talk about the lifestyle changes, when it comes to stopping smoking, as you were saying that becomes a part of a habit, a routine that when we have a break at work, well it's time to go outside and smoke so let's talk about some of those lifestyle changes and how we can help folks to stop smoking.

Todd: Part of the lifestyle changes that the Freedom From Smoking is, is literally accountability. It it takes, you know, a big humongous braveheart to walk up to your coworker and walk up to your spouse or your family member and everyone around you saying, hey, my quit day is, you know, whatever it is, October 31st or December 4th.

And I'm, I'm quitting with four other people in the class and, you know, accountability is part of it, of course. And the lifestyle changes we start addressing earlier on because we look for reasons people to kind of backslide, as we start addressing, hey, the easy thing to is not very well start eating more food because you're used to doing this hand to mouth and everything's going to taste great. So, some of the lifestyle changes we talk about early on is, hey, we're going to start walking or we're going to start exercising, or we're going to start going to a gym when we do quit. And we try to make it a household like a family or whole household goal to kind of implement some exercise and start watching what we eat a little bit.

The other thing we talk about dealing with stress and we even talk about some people it's, actually linked to a lot of people have a lot of emotional and stress and maybe even emotional disorders, that, that are either caused by smoking, where they started at age 12, which is a kind of whole new abstract thing is that our brain doesn't really finish kind of developing till we're 26.

And if we're smoking and doing all this, vasoconstriction and dilation in our brain, do we affect the way our brain develops, but they're starting to, so that smokers very, very, more likely to kind of have an anxiety and depression like symptoms. So, we talk about trying to address that, what do you need to do to tackle that? Is our support group enough that we have, or could you use a chaplain or maybe see a psychiatrist or a psychologist or whatever it needs because you kind of need to tackle this with everything. So, some of the lifestyle change is saying, hey, well, how am I going to do with stress? You have to learn kind of new tools to deal with stuff that you might not have had earlier It's more of a daily habits, even the way we drive to work. Most smokers will tell you, hey, I light up, you know, or I vape three times on the way to work and we talk about it sounds crazy.

You need to go the long way to work, know, don't feel that impulse to the light up at that red light every time. So it's kind of the devil in the details as far as trying to do away with smoking and vaping.

Host: Yeah, I love that devil in the details and you're so right. We sort of joked a little bit before we got started here that I had a big question coming for you here at the end. So here it is, is nicotine dependence our country's biggest drug addiction in the face of, you know, opioids and all the other addictive, you know, crises that we've had in the country and around the world? Where would you rank nicotine dependence on that scale?

Todd: There was a study in 2018 over the Substance Abuse and Mental Health Services Administration. The 2018 data says alcohol is like 164 million out of, out of that, like 139 million are actually drinking every day. So alcohol abuse, probably our number one, but nicotine and tobacco is right there is kind of the second place. And I think this data is actually only on tobacco, so it doesn't really count vaping and it talks about 47 million people or are daily users. And that's not even factoring in, I believe like we talked about earlier, I think it's growing middle schools and high schoolers. But I think a nicotine dependence and tobacco in particular, has a higher impact as far as if you have diabetes.

It always makes it worse. If you have heart problems, I mean, it takes whatever kind of disease process you have. And it's definitely the biggest preventable as far as early death and early, problems, maybe more so than alcohol. It's kind of hard to say because alcohol is legal and there's DUIs and things like that.

Host: Yeah, I think you're so right. And as you said there, deaths from smoking, you know, they are preventable, right? It is possible to quit. But a lot of folks, because we're talking about the mental and physical things to overcome, the hurdles to overcome, we need help. We need assistance from folks like yourself and also the Freedom From Smoking Program.

So as we wrap up here, what are your takeaways? What do you want folks most to know, those who really want to quit? Or they have you know, loved ones in their lives who want to help them quit. Let's go back over the benefits of the Freedom From Smoking Program and why smokers, who are really committed to quitting, should seek that program out in their local area, seek assistance, bring family members. Let's hear it from you Todd.

Todd: Being an ex smoker, I tell people most people that are ex smokers will tell you that they kind of feel like they're smokers, but they choose not to smoke and and the biggest adjunct is, you know, so many people kind of hang their hat per se on, hey, I know somebody who lived to be 96 and they smoked. You know, it's apples and oranges as far as times and what eat and they didn't have a hundred channels to sit down and watch TV and American in general, is not active as they used to be.

And the biggest thing about Freedom From Smoking while younger kids, my daughter, and so forth, they're used to FaceTime being almost as normal as face-to-face, or they're used to be in Zoom as much as face to face but most people are more open.

And talk about a change in lifestyle it's, when it is a real meeting together. So Freedom From Smoking you know, kind of offered across the US and a lot of facilitators that have been trained to to actually individualize the program to each participant in the class, so it's not that one glove fits all.

Encouraging somebody with kindness and realize that it's a struggle. On average, it takes somebody between five and eight times of trying to electively quit. So, if your spouse or loved one, they're trying to quit for the fourth time, this could be the one. So, don't get discouraged that it hadn't worked previously. They really shouldn't feel like a failure because they didn't necessarily quit the very first or second time they tried. So, really encourage them to join a live class and a local Freedom From Smoking is definitely the way to go.

Host: Yeah, I couldn't agree more. Just great advice from an ex smoker. And I do hope we do get to speak, we've identified some other topics we could speak on. So, hopefully we'll do that in the future. But in the meantime, Todd, thanks so much for your time today. And you stay well.

Todd: Thank you, scott. Have a great day.

Host: For more information on the Freedom From Smoking Program, go to freedomfromsmoking.org. This has been Mission in Action, the podcast from St. Mary's Healthcare in Athens, Georgia, focusing on how we provide patient centered care under our mission to be a transforming healing presence within our communities.

Thanks for listening.