Caitlin Whyte (Host): This is WakeMed Voices. I'm Caitlin Whyte, and with me is Stacy Thiedeman, a Physician Assistant and Tobacco Treatment Specialist at Quit with WakeMed. Today we're talking about how to stop smoking and vaping.

Well, Stacy, this episode hits super close to home for me because I'm actively trying to quit vaping myself right now. So, to start us off, can you go through the physical and psychological grip that nicotine can have on someone like me?

Stacy Thiedeman PA-C: Absolutely. So nicotine stimulates the release of dopamine, serotonin, and norepinephrine in the brain. And those are good feeling neurotransmitters that produce pleasure, calm, and assist with focus. And they're naturally produced, but over time the brain becomes dependent on nicotine, to feel good or normal.

It's very difficult for somebody who's working on smoking or vaping to quit. From a psychological perspective or behavioral standpoint, smoking or vaping becomes linked to certain activities. So tobacco users will often smoke or vape with coffee in the morning or after meals or while driving.

 They may use smoking or vaping as a way to take a break. It becomes very ingrained in their behavior. It can become a go-to for stress. But although it provides some short term relief for stress or anxiety, it often increases baseline stress over time. So it's a real detriment to mental health.

Host: Well, knowing that, why is it so hard to quit nicotine?

Stacy Thiedeman PA-C: Back to those neurotransmitters. Nicotine increases dopamine and serotonin. So when it's removed, it takes time for the brain to rebalance. And so for a period of time, it's very uncomfortable. And dopamine is low and symptoms of depression can occur. Serotonin is low and anxiety or irritability is the result.

These are withdrawal symptoms and can often drive users back to smoking or vaping. So then there's the behavioral side of smoking or vaping. It's a habit, it's part of a routine and it's a coping mechanism for some. And so taking that nicotine away, and taking that behavior of smoking or vaping away, can feel really overwhelming. And it's difficult to change behavior.

 It takes a certain amount of, of determination to get it done.

Host: I feel that. Now let's talk about the difference between vaping and smoking. Is there really a difference between the two and is one worse for you than the other, or is one better? I've heard all kinds of things.

Stacy Thiedeman PA-C: Right. Well, so they are different. Um, smoking involves burning tobacco and releasing over 7,000 chemicals and 70 plus known carcinogens. It causes damage to every organ. And it's strongly linked to heart disease, stroke, COPD and lung cancers. Vaping on the other hand, heats a nicotine containing liquid to create an aerosol.

It has toxic chemicals as well. It causes inflammation in the lungs and impairs blood vessel function increasing the risk of heart disease. They both have nicotine, right, which is very addictive. We know that smoking has terrible long-term effects. It's been around for decades. It's been well studied.

Vaping is newer, so long-term risks are still being looked at and we don't have all the information there. But the point is that both have risk. So vaping is not a good option for an alternative to smoking. It's not the way that we want to work on smoking cessation. 80% of the time when a smoker starts vaping to help them quit smoking, they end up addicted to the vape or they end up addicted to both.

So that's not a desirable outcome.

Host: Well, let's get into some quitting and cessation advice here. What are some medication options to start out?

Stacy Thiedeman PA-C: Yeah, so we don't have an unlimited supply of medications, but we have several good options for patients. Nicotine replacement is a great option. It provides a controlled dose of nicotine without the harmful chemicals and the smoke. So when we transition somebody from smoking or vaping to nicotine replacement, we've already accomplished a major goal, right?

We're eliminating those harmful, harmful things from the body. Not to say that nicotine doesn't have negative effects, but the bulk of the negative comes from those chemicals and that combustion. So, nicotine patches provide a steady state of nicotine and work best when they're combined with some short acting nicotine replacement like gum or lozenges.

It's really the best way to manage withdrawal symptoms. And as I said, withdrawal is what takes people back to smoking or vaping. So it's very important that we manage that and minimize it. Another medication that we use commonly is a drug called Chantix, or varenicline is the generic.

It's a pill and it's by the data, it's the most effective thing that we have for smoking cessation. And what it does is bind to the same receptors in the brain that nicotine does and therefore reduces cravings and blocks the reward in smoking or vaping. So, with Chantix, patients smoke or vape, they don't get that release of dopamine or serotonin.

It doesn't feel as good and it's easier to put down. Wellbutrin is another agent that we use. It's an antidepressant. It's been around for a long time, and it mimics nicotine by increasing dopamine. So it's not the most effective thing that we have in terms of the data, but it has its place in therapy.

It's well tolerated, it's inexpensive, and it can be great to use in patients with a history of depression because it has a double benefit.

Host: And on the other side, what are a few behavioral tools that can help with cessation?

Stacy Thiedeman PA-C: Yes. So we know that behavioraltherapy as part of a smoking or vaping cessation plan is critically important. One-on-one sessions with a trained provider, combined with medications has the highest success rates for tobacco cessation. From the behavioral side, we want to identify triggers and start to separate activities or places from the act of smoking or vaping.

 We know that the strongest part of an urge is five to 10 minutes, so distraction is a great tool. Often if, if patients can busy themselves with something else for just a few minutes, they can get past an urge. We want to replace smoking or vaping with something else. Preferably something that is satisfying like gum or tea or, or something that, you know, brings some joy, some alternative plan.

 And, you know, mindfulness is a really important behavioral tool that we talk a lot about because we're asking patients to smoke or vape without any other activity and to think about the process, to consider what's driving it and then to potentially stop smoking or vaping when they feel satisfied.

So that's a great way to cut down. If you can smoke half a cigarette instead of a whole one, or take a couple of hits from a vape instead of more prolonged use. And then that's a great start to eliminating it all together.

Host: And to wrap up our episode today, of course we all know smoking and vaping are bad, but remind us what are some of those health effects that are achieved with cessation, immediate and long term?

Stacy Thiedeman PA-C: So some of the immediate effects happen within minutes, right? So, nicotine increases heart rate and blood pressure. So within 20 minutes of cessation, those numbers are lower. Within 12 hours, carbon monoxide levels start to drop, and oxygen delivery starts to improve in the body. Within 24 hours, heart attack risk goes down and within two to three weeks, lung function starts to improve.

Circulation is better. Coughing and shortness of breath start to improve within one to nine months. So lots of immediate positive effects for health. As far as long-term benefits, within a year, the risk of coronary heart disease is cut in half. Within five years, the risk of a stroke is diminished. Within 10 years, the risk of dying from lung cancer is 50% lower than a smoker's risk. And at the 15 year mark, the risk of heart disease is similar to someone who's never smoked. So I think of smoking cessation as one of the single best things that we can do for health.

We think that vaping cessation runs along those same lines, but time will tell about that long term data.

Host: Well, just so much information in this episode Stacy. Thank you so much for joining and for sharing with us. I know personally I'll be taking a lot of what you said to heart and into my day-to-day. That was Stacy Thiedeman. For more information about smoking cessation services at WakeMed, please visit wakemed.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Caitlin Whyte with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.