Bill Klaproth: Smoking leads to coronary artery disease, which is the most common type of heart disease and is the leading cause of death in the United States in both men and women. If you're a smoker and need help quitting, hang on. We've got Dr. Lash Springs, a physician at Tidelands Health, here with us to talk about smoking cessation. Thank you so much for your time today. Most smokers know that smoking is bad for them. Why is it so hard to quit them?

Dr. Lash Springs, MD: Smoking is an extremely addictive habit and there's a lot of not only just chemical properties by that but a lot of social ideas behind that as well. Speaking to more of the medical terms, smoking and nicotine in particular really affect our reward pathway in our brain. There's a particular neurotransmitter that’s called dopamine that a lot of people are familiar with that does a variety of different things, but it’s particularly responsive in our reward pathway and nicotine effects that pathway enough where it excites that reward pathway and gets people thinking ‘I need this cigarette, I want this cigarette,' and continues to just build on that habit. Therefore, people find it so difficult to quit because that reward pathway in their brain is making them want to continue smoking. It's really difficult for patients to really find that motivation to quit because it's almost as if their brain is telling them you should keep smoking. There's also the social factors of it whether it's advertising and friends or family that does it or they've done it for years, so it becomes more habitual in their everyday routine and so, therefore, you're having to try and break that routine every single day, which can also be very challenging for patients.

Bill: That’s very interesting. If the group you hang out with smokes, you'll smoke just to fit in with the group, right? A peer pressure thing?

Dr. Springs: That’s certainly more common in the teenage and adolescent groups that definitely find it as a way of being socially accepted. Certainly, as we get older, we tend to follow people who we do the same habits with and most people who smoke tend to be with others who smoke whether it’s in the workplace or socially. When people are attempting to or thinking about quitting, being around others who continue to smoke provides an additional challenge on top of the already difficult challenge of trying to quit smoking just by themselves.

Bill: It sounds like a two-prong problem. You’ve got the chemical addiction and the social addiction. How do you find that motivation to quit?

Dr. Springs: The most important thing I try to do for my patients and what I tell my patients is the patients themselves has to be motivated to quit. We have plenty of evidence to show that trying to have people quit smoking for those who are motivated versus those who are not, patients who are motivated to quite are significantly more likely to quit smoking than those not able to quit, regardless of what therapies you use. It's really to have that discussion with your patient as far as thinking about quitting smoking or being motivated. That motivation can come from a variety of different areas. Some people just feel the need to say I'm done with smoking and need to quit, some find that it’s too expensive and the habit is too expensive for them and so they need to quit. Others have some type of medical or other family members who have a medical issue related to smoking that provides either a fear factor or some type of motivation that says maybe this isn't really worth what I'm doing to myself and ought to stop smoking. That’s the biggest point, finding the patients who are willing and wanting to quit and therefore using that motivation forward into their treatment.

Bill: For people that do want to quit, do you have a general plan that you take them through to help them quit smoking?

Dr. Springs: With most patients, what I generally do is we start by having this discussion of why you want to quit, what's your motivation to quit and then building off of that motivation and then discussing the potential treatment options as far as quitting. Usually, it’s a two-prong approach for getting people to quit. One is a behavioral or counseling portion of it where you're providing that interviewing motivation to get patients to understand why it’s important for them to smoke, finding discrepancies in their thought processes if they're wanting to continue smoking and why they're maybe having some competing thoughts between wanting to smoke but yet still doing so. The other portion is the pharmacological or medicational treatment options. Usually, based on evidence, what I recommend for patients is doing two types of therapies. One is a nicotine replacement therapy, which most patients are familiar with. That would be the patches, gum, and lozenges because those help to provide this nicotine supplementation that reward pathway is looking for. The other is doing a type of prescription medication. Generally, there are two main types that we use. One is a medication called Wellbutrin or also known as Zyban. The other one that most people are familiar with is Chantix. Those are the two medications we typically use in treatment and depending on patients’ comorbidities and other medical issues is how we decide which treatment we’re going to use going forward.

Bill: How long does treatment generally take?

Dr. Springs: Treatment can vary widely based on the patient. As far as the medications that we use, the Wellbutrin and the Chantix, we typically treat people for no less than three months and generally an additional three months beyond that. Some patients can continue to take the medicine even after that, but usually base that on how well they're doing or not doing per se. As far as the nicotine replacement therapy, it’s about the same amount of time. Again, it always just depends on the patient and how they're responding to the treatment. The behavioral piece we continue to do on a regular basis, even after somebody has quit smoking because there can still be a trigger at any point that gets people to relapse and begin smoking again. Based on the evidence we’ve seen, patients take anywhere from 7 to 11 attempts to actually quit, so even though they initially quit, there's still that pressure to relapse and begin smoking again, so it’s always something that you bring up with patients every time just to make sure they're feeling comfortable with where they are, they're out of situations that may predispose them to wanting to smoke again and just continuing to encourage them when they're not smoking, and that encouragement generally helps to lead to further cessation down the road.

Bill: I know this is a general question, but how effective is the program? Can you generally say 8 out of 10 people or so that come through the program do eventually quit?

Dr. Springs: That would be difficult to say. Because it’s data that you have to extrapolate overtime for myself personally I don’t think I would have that, but just looking at data nationwide, most data would say that patients take roughly 7 to 11 attempts to quit and that usually means they’ve attempted quitting, they quit but then relapsed or they just never quit and kept going despite doing treatment. What I use that information for is just to tell patients that this is truly an addictive medication, this is not going to happen overnight, it takes a significant amount of time and effort in order to get you to quit smoking and that patient shouldn’t give up even if they do relapse a few times because they would not be alone. You really just have to continue to use that as motivation to get patients to try again.

Bill: Some people I know say ‘I don’t want to quit because I feel that smoking keeps the weight off, I keep smoking because I don’t want to get overweight.’ Can you shed some light on that for us, how people can maintain their weight after they quit smoking?

Dr. Springs: Absolutely. That’s a common thing I hear often. Smoking does actually help patients lose weight more because it does help to curb appetite, so patients feel like they eat less and generally when they quit smoking, they're finding something else to supplement the loss of the cigarette since that usually results in some type of eating or drinking something in addition and that usually leads to weight gain. There's also just the chemical properties of the nicotine that actually helps to promote losing weight, and therefore when that’s gone, they just gain weight no matter what. The biggest thing that I tell patients which is also very important just in health, in general, is along with smoking, adapting very good dietary and exercise habits. All of those are really important not only just for your general health but in smoking and quitting smoking because it helps to supplement and find a different avenue to use that energy that has been smoking; you're not gearing that towards doing something else. As we get patients to realize that, they may gain a little bit of weight, but you can eventually lose that weight and get back to the weight that you were if you adopt these good habits.

Bill: It’s kind of a holistic approach then to quitting smoking. Lastly, can you tell us why someone should choose Tidelands for their smoking cessation needs?

Dr. Springs: I would just say that it is something that every provider should do, but we specifically want to take care of patients here at Tidelands. Smoking is the leading cause of preventable disease as you pointed out specifically earlier not only cardiovascular disease but diabetes. Smoking can lead to disability and unfortunately it leads to death in many cases, usually built up over time, and so we really strive for preventive medicines to prevent these things from happening and so we really encourage patients to get in and let us help them with their smoking addiction in order to get rid of it and help them to live healthier lives.

Bill: Thank you so much for your time today and talking to us about smoking cessation. If you want to learn more, just visit tidelandshealth.org. That’s tidelandshealth.org. You can also learn more about Tidelands Health physicians, services and facilities as well. This is Better Health Radio. I'm Bill Klaproth. Thanks for listening.