Breaking the habit
What you need to know
Doctor's insight
Dr Ronan Clancy
New years come with the potential for change. They’re an opportunity to reflect and make new goals. Remember, those goals should be realistic and planned in time frames that are physically and mentally sustainable. A slow jog to our destination is better than a poorly planned dash that leaves us panting and shaking our heads! Here, we’ll look at smoking cessation, which tops many a new year’s wish list.
The facts
Approximately one million (29 percent) of Irish adults smoke, increasing to around 35 percent in teenagers. Close to 7,000 people die each year in Ireland directly due to smoking related diseases. Overall, smokers will have 10 less disease-free years, and half will die from smoking related diseases. These figures are disturbingly accurate statistics from the 2007 HSE Slán study.
The tobacco industry is a wealthy and powerful entity with huge political and legal firepower. Supposedly supportive of government initiatives to tackle tobacco related disease, tobacco companies continue to fight and obstruct many of these measures and are now aggressively targeting poorer countries with lower education levels as the future power houses of tobacco sales.
The risks
Cigarette smoke contains over 70 cancer causing chemicals (carcinogens) which can cause and increase the risk of cancer of the lung, mouth, throat, lip, nose, sinuses, oesophagus (food pipe), stomach, liver, pancreas, kidney, cervix, bowel and ovary. Smoking may increase the risk of breast cancer.
Smoking also causes emphysema and chronic bronchitis in the lungs. Accelerated narrowing of the blood vessels, in the heart causes coronary artery disease, stroke in the vessels of the brain, and limb amputation when severe in the vessels of the limbs. It also causes erectile and sexual dysfunction when affecting genital blood supply. Smoking also increases the risk of infertility and miscarriage, as well as low birth weight and cot death in babies.
The good news
The obvious health benefits include avoiding the above diseases and rapidly feeling healthier and wealthier! In fact after 20 minutes without cigarettes, your blood pressure and your carbon monoxide and oxygen levels in the bloodstream begin to normalise. After 24 hours, heart disease risk begins to decline and after one year is half that of an active smoker. At ten years, lung cancer risk is halved and at 15 years the same as non smokers.
The path to quitting
Although other chemicals in tobacco smoke produce the physical diseases, nicotine causes the addiction. Rapidly, the brain gets used to higher levels of nicotine. When not given this, the unpleasant symptoms of craving and withdrawal occur. The habit and craving relief that comes with each cigarette smoked creates dual psychological addiction. In short, tobacco addiction is a double edged sword.
When quitting, smokers must confront physical addiction to nicotine and after that, psychological addiction. Intense cravings occur initially due to nicotine withdrawal which are very challenging (mood swings, anxiety and increased appetite lasting about four weeks) followed by longer-term psychological temptation.
Treatments comprise psychological aids such as behaviour counselling, smoking cessation courses, self-help books and hypnosis. These help smokers develop a stronger resolve and mental techniques to cope with withdrawal, temptation and craving.
Nicotine Replacement Therapy (patches, inhalers, gums, lozenges and so on), provide a smoker with slowly reducing amounts of nicotine during the tough early withdrawal stages.
Newer tablet drugs such as Champix (varencycline) reduce craving and the satisfaction associated with smoking in the brain. They too help smokers over the initial hurdles.
Both therapies are useful initially but when completed, a smoker will face residual psychological addiction. To this end, strong resolve and good psychological techniques and support are key.
Keep at it
Overall, quitting cigarettes is difficult. The initial decision and first quit attempt is the most important step on the road to a longer, healthier life. The evidence hugely favours success with continued quit attempts and perseverance.
If you fail, see it only as a missed step on a ladder to success. Your GP is well trained and placed to provide advise, treatment of a supportive shoulder for your objective.
Remember, no journey can begin without a first step. Never give up giving up!
For advice, encouragement and support, people wishing to stop smoking can contact the National Smokers Quitline on 1850 201 203 or visit www.quit.ie.
Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.
