Transcription:
Stamping Out a Smoking Addiction

Melanie Cole (Host): The UVA Cancer Center offers free assistance to tobacco users wanting to address their addiction to tobacco. My guest today is Connie Clark. She's a tobacco treatment specialist at the UVA Cancer Center. Welcome to the show, Connie. So, what are some of the most common approaches you hear or see every day for smoking cessation?

Connie Clark (Guest): Well, I have to tell you, Melanie, it's a very individual thing. Basically, when I have someone that comes to see me, we meet for an hour in person at first because in a perfect world, it would be a one size fits all, but it's not. So, I kind of meet with them to try to figure out what their motivation is, how inspired they are to quit, and then we talk about options: medication, behavioral changes and oftentimes it's a combination of both and also coming back to see me, really up to a year. I try to check in with them to make sure that they've quit and stayed quit.

Melanie: So, how do you help individuals determine which approach is best for them? There are so many ways to quit and medications on the market. How do you help someone decide?

Connie: I do motivational interviewing and spend time with them figuring out is it--oftentimes it's habitual behavior that comes with the nicotine addiction--and figuring out what combination will work for them. If someone suffers from mental health issues, then obviously Chantix is not going to be for them. Wellbutrin is an option but oftentimes it does have its own side effects as well. So, it's kind of figuring out what will work for them. I worked with somebody this morning who is going to try acupuncture, kind of figuring out where their mindset is and what they feel comfortable with.

Melanie: What a hard thing to do--quitting smoking. So, what is the first thing you recommend for those people that want to quit? What do you tell them to do day one?

Connie: Day one: set a quit date. Because when you set a quit date, even if it's two months from now, I think that that is a commitment that they make and helps them formulate a plan. It's helping us work towards a goal and I think that that's always helpful.

Melanie: So, tell us about some resources in the Charlottesville community for those who are trying to quit smoking.

Connie: So, in the Charlottesville community, we are very fortunate that we have quite a few resources. The Health Department offers free acupuncture every Tuesday from 5.30pm - 6.30pm. We also have Quit Smoking Charlottesville, which is a support group offered also by the Health Department. They meet in the fall and then again in the spring, and offer a support group service in addition to some other strategies that people might try. There's Quit Now Virginia, which is a helpline that they can call and offers free counselling to people who want to quit and they will follow up with them as well. So, those are a few of the resources that we have.

Melanie: Connie, how long does it take for somebody to get over that nicotine dependence?

Connie: The nicotine dependence and withdrawal symptoms usually last about 3 weeks. So, if they can get through those 3 weeks of crankiness, lack of sleep, headaches--that kind of thing--it's really good. I also tell them when I meet with them that the craving for nicotine when you're trying to quit, if you can push through that 5-7 minutes and get through that craving, then you're good to go for a while. Will the craving come back? Absolutely! But, if you tell yourself, “5-7 minutes. I can do anything for 5-7 minutes”, then you're good to go for a while longer.

Melanie: So, then, there's the behavioral aspect. That's really one of the more difficult as well because people have their routines, they either go outside or they need something to do with their hands. What do you tell them about that behavioral aspect?

Connie: Well, that's another challenge that I have to personalize for each of the patients that I work with. And, that's part of that hour I spend with them trying to figure out, is it the coffee in the morning that's a trigger for you? Is it stress? Is it after every meal you're used to having something in your hands? For a female patient I work with, it is that kind of inhaling motion with her mouth and so she was able to replace that with lemon drops. I have another person that, actually, it's the reaching in his overall pocket and grabbing something and keeping it in his hands that he was missing so he replaced that with pretzel sticks and salt-free pretzel sticks, actually, because he had some teeth issues that he was coping with as well, so that he has something in his mouth and can grab something out of his pocket. Pringle sticks works for some people. I have some people with the coffee in the morning that are using the Pepperidge Farm Pirouettes. It's something in their hand and something to replace that "I have to have something with my coffee" feeling. Sometimes it can be as simple as changing the behavior. If you smoke inside, go outside. If you're an outside smoker and that's where you have your cigarette and coffee, then do it inside. Changing the habit and creating a new one.

Melanie: So, if they've planned how to deal with those urges to smoke and those behavioral issues then, how long does it take somebody? You said 3 weeks for those cravings. Is that true for behavior as well? Is it generally like a 3-week kind of time that they have to put up with?

Connie: It can be longer and I should have said from the get go, oftentimes people will try to quit 4-5 times before it sticks. When you think of nicotine, people think of it as being so acceptable socially, but the two most addictive drugs are heroin and crack. Nicotine is number 2. So, it's very difficult to quit. And I tell people I work with all the time, is it going to be in 3 weeks that you're going to feel great and not want it? Probably not. It takes a long time to change the behavior, to change habits. I was speaking with a patient this morning. I learned recently about something called a “mini-quit” that he's going to try which is try to dwindle down the 10 cigarettes he smokes but also implementing those behavioral things now so that when he gets to his quit date, those are already in place and when he gets stressed out he knows what's going to work and what to go to. So, it's kind of a process for each person and I wish there was a 'in 21 days you're going to feel great', but it's very individual.

Melanie: What about the weight gain that people associate with quitting smoking? What do you tell people that are concerned about that?

Connie: Typically, science says that on average, you might gain up to 10 lbs. And, some people don't gain any. I think it's kind of a matter of putting in place, if that's something that they are concerned about, making sure that they don't go to food and, if they do, it's something that won't cause weight gain. It's also kind of putting it into perspective in saying, “If you put on 5 or 6 lbs. while you're trying to quit, the perspective of what health concerns that is versus smoking or using tobacco on a daily basis which affects every part of your body and is the most preventable cause of cancers that we deal with.” So, kind of putting it in perspective and helping them come up with some strategies that they can use to kind of combat that.

Melanie: And, what if they have a slip? What do you tell them about those guilt feelings?

Connie: I tell them don't feel guilty. As long as you have a desire, you are never a failure. And, I remind them that it is the second most addictive drug and that it is hard to stop and people oftentimes will try 4 or 5 times before they are completely successful. But, if you have a desire, you are never a failure.

Melanie: And are there some systems like e-cigarettes or any of those kinds of things that you like or approve of? Do you like the patch? You mentioned Chantix and Wellbutrin. So, just for a minute here, speak about some of the ways to quit and the ones that you like and the ones that you don't.

Connie: So, e-cigarettes, I just will say this: I know that when they came out a few years ago, they were marketed as a method to help people quit. What we know is that e-cigarettes actually have more nicotine in them than regular cigarettes and the FDA is just getting involved, as you know, in August. There is kind of that 2-year span where people who are selling e-cigarettes have the opportunity to show them what's in them before they kind of make a final decision. But, I absolutely do not support that as a way to quit because they actually have more nicotine and they weren't regulated. So, it was really a big problem. As far as some of the other things, there's the patch, the gum, lozenges, the nasal spray, inhalers and, again, I would say it's very individual. I have people that the gum won't work for because they have dental issues that have been caused by either dipping or smoking. So, that isn't a possibility for them. Patches work. I'm a huge proponent of patches if they're used correctly. The idea isn't to put on two patches and still continue to smoke a pack of cigarettes, though. As with everything, they have to be used the way that they were designed. The inhaler and the nasal spray, they can work for some people if they're open to that idea. It's really about figuring out what each person is going to be okay with. Some people come to me very adamant about “I don't want any medication. I want to be able to do this on my own.” Okay. I respect that. And then, there are other people who are very open to that. So, it's really about doing that motivational interviewing and figuring out where they're at and what they would be okay with.

Melanie: And, how is UVA Health System helping patients quit smoking?

Connie: Well, here at the Cancer Center, they have me now as a full time person who works with all cancer patients who are dealing with cancer and also have tobacco issues. They can be referred to me. I can meet with them as many times as they want either in person or by phone, follow up with them for as long as they are open to me following up with them. They also have the early detection low dose CT scans that they do here on programs that Melissa Stanley, who is a nurse practitioner here, is helping to work with people who smoke to do some early detection so that it doesn't get to the point where it has caused any kind of cancer. I know “Hoo’s Well” has a program for employees who have a desire to quit that they have implemented here. So, I think it's something that they feel very strongly about and are really becoming very active and proactive in dealing with.

Melanie: Thank you so much for being with us today, Connie. It's great information and so important for people to hear. You're listening to UVA Health Systems Radio and for more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.