1、 Smoking Is Not Just a Personal Matter Secondhand smoke increases health risks of those around the smoker1,2:Increased risk of life-threatening diseases in spouses Higher rates of smoking by children of smokers Increased risk of serious illness in children of smokers Increased risk of premature deat
2、h in nonsmokers breathing secondhand smokeSmoking also affects a familys resources by increasing overall family health care costs and burden of illness.In a study of health care utilization in 20,831 employees,those who smoked compared with nonsmokers had3:More hospital admissions per 1000 employees
3、(124 vs 76 admissions)Longer average length of stay(6.47 vs 5.03 days)6 more visits to health care facilities per year Higher average lifetime medical care expenses Fiore MC,Bailey WC,Cohen SJ,et al.Treating Tobacco Use and Dependence.Clinical Practice Guideline.Rockville,Md:US Department of Health
4、and Human Services.Public Health Service;June 2000:32-33.Centers for Disease Control and Prevention.Annual smoking-attributable mortality,years of potential life lost,and productivity lossesUnited States,1997-2001.MMWR.2005;54(25):625-628.American Cancer Society.The cost of smoking to business.Avail
5、able at:http:/www.cancer.org/docroot/NWS/content/NWS_2_1x_The_Cost_of_Smoking_to_Business.asp.Accessed November 7,2005.Key PointNicotine stimulates dopamine release in areas of the brain which is believed to result in the reward and satisfaction effect associated with smoking.BackgroundNicotine acti
6、vates 42 nicotinic receptors that are localized to the neuronal bodies and terminal axons of the cells in the ventral tegmental area.This activation thereafter causes dopamine release at the nucleus accumbens,which is believed to result in the short-term reward/satisfaction effect associated with ci
7、garette smoking.Reference 1.Picciotto MR,Zoli M,Changeux J.Use of knock-out mice to determine the molecular basis for the actions of nicotine.Nicotine Tob Res.1999;Suppl 2:S121-S125.1/Picciotto,p.S121,para 11/Picciotto,p.S121,para 1 Key PointNicotine addiction is a cycle which begins with nicotine b
8、inding to receptors in the brain causing the release of dopamine which in turn results in feelings of pleasure and calmness.BackgroundThe distribution of nicotine is very rapid.It can reach the brain within 10 to 20 seconds after inhaling cigarette smoke.1The binding of nicotine to its relevant rece
9、ptors results in the release of multiple neurotransmitters,most critically dopamine.The release of dopamine in the nucleus accumbens neurons is thought to play a critical role in the addictive nature of nicotine.This release of dopamine requires binding of nicotine to 42 receptors.1,2Absorption of c
10、igarette smoke from the lungs is rapid and complete,producing with each inhalation a high concentration of arterial nicotine that reaches the brain within 10 to 16 seconds.Nicotine has a terminal half-life in blood of 2 hours.Smokers therefore experience a pattern of repetitive and transient high bl
11、ood nicotine concentrations from each cigarette.Nicotines activation of acetylcholinergic receptors induces the release of dopamine in the nucleus accumbens.This is similar to the effect produced by other drugs of misuse,such as amphetamines and cocaine.The symptoms of nicotine withdrawal are a majo
12、r barrier to smoking cessation.Smokers start to experience impairment of mood and performance within hours of their last cigarette.These effects are completely alleviated by smoking a cigarette.Withdrawal symptoms include irritability,restlessness,feeling miserable,impaired concentration,and increas
13、ed appetite,as well as craving for cigarettes.Cravings,sometimes intense,can persist for many months.References1.Jarvis MJ.Why people smoke.BMJ.2004;328:277-279.2.Picciotto MR,Zoli M,Changeux J.Use of knock-out mice to determine the molecular basis for the actions of nicotine.Nicotine Tob Res.1999;S
14、uppl 2:S121-S125.1/Jarvis/p 278,para 11/Jarvis/p 278,para 11/Jarvis/p 278,para 11/Jarvis/p 278,para 21/Jarvis/p 277,para 51/Jarvis/p 278,para 1,2,32/Picciotto,p.S121,para 12/Picciotto,p.S121,para 1 Key PointCigarette smoking is a chronic relapsing medical condition.Tobacco dependence is a chronic co
15、ndition with addiction comparable to that caused by other drugs of abuse.1 Long-term clinical intervention for nicotine addiction is needed,just as it is for other addictive disorders.Clinicians may fail to appreciate the chronic nature of nicotine addiction and,therefore,fail to treat smoking consi
16、stently and over the long term.It should be considered a chronic condition,such as diabetes,hypertension,or hyperlipidemia,and treated as such.2 Smoking is a relapsing condition,and it is easy to understand why the vast majority of smokers who attempt to quit fail over multiple attempts.2References1
17、.Jarvis MJ.Why people smoke.BMJ.2004;328:277-279.2.Fiore MC,Bailey WC,Cohen SJ,et al.Clinical Practice Guideline:Treating Tobacco Use and Dependence.US Department of Health and Human Services.Public Health Service;June 2000.Available at:www.surgeongeneral.gov/tobacco/default.htm.1/Fiore/pg 9,para 61
18、/Jarvis,p.278,para 11/Fiore/pg 9,para 32/Fiore/pg 9,para 62/Fiore/pg 9,para 32/Jarvis,p.278,para 1 So Why Do People Continue to Smoke?Most people smoke because they are addicted to nicotine.Use of nicotine1-3:Causes changes in the brain that make people want to use it despite its deadly potential.Ca
19、uses unpleasant psychological and physiological withdrawal symptoms when its use is stopped.Historically is one of the hardest substance use dependencies to break.The 1988 Surgeon Generals Report,4“Nicotine Addiction,”concluded that:Cigarettes and other forms of tobacco are addicting.Nicotine is the
20、 drug that causes addiction.Pharmacologic and behavioral characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.American Heart Association.Nicotine addiction.Available at:http:/www.americanheart.org/presenter.jhtml?identifie
21、r=4753.Accessed September 30,2005.Jarvis MJ.Why people smoke.BMJ.2004;328(7434):277-279.Dani JA,De Biasi M.Cellular mechanisms of nicotine addiction.Pharmacol Biochem Behav.2001;70:439-446.US Department of Health and Human Services.1988 Surgeon General Report:The Health Consequences of SmokingNicoti
22、ne Addiction.US Department of Health and Human Services,Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health;1988.Available at:http:/www.surgeongeneral.gov/library/reports.htm.Accessed November 1,2005.Nicotine Add
23、iction Is Both a Physical and Psychological Condition1-3Most withdrawal symptoms resolve in 3 or 4 weeks.However,hunger for nicotine can persist for several months.Craving may persist for monthsor even yearsespecially if triggered by certain situations.1Craving and withdrawal symptoms are the major
24、hurdles towards a smoker achieving cessation.1 It is often the environmental triggers that can cause a relapse.4This can occur even after an extended period of cessation during which the nicotine-mediated cycle of craving has been interrupted or eliminated.1,4There is evidence that having even one c
25、igarette after a period of successful smoking cessation can rekindle the same level of addiction that existed before cessation.5A period of smoking cessation that is vulnerable to relapse can last months or years.6,7 Jarvis MJ.Why people smoke.BMJ.2004;328(7434):277-279.Rigotti NA.Treatment of tobac
26、co use and dependence.N Engl J Med.2002;346(7):506-512.Hughes JR,Higgins ST,Bickel WK.Nicotine withdrawal versus other drug withdrawal syndromes:similarities and dissimilarities.Addiction.1994;89:1461-1470.Smolka MN,Buhler M,Klein S,et al.Severity of nicotine dependence modulates cue-induced brain a
27、ctivity in regions involved in motor preparation and imagery.Psychopharmacology(Berl).2005:1-12 Epub ahead of print.Westman EC,Behm FM,Simel DL,Rose JE.Smoking behavior on the first day of a quit attempt predicts long-term abstinence.Arch Intern Med.1997;157(3):335-340.Velicer WF,Prochaska JO,Fava J
28、L,Nornam GJ,Redding CA.Smoking cessation and stress management:applications of the transtheoretical model of behavior change.Homeostasis.1998:38:216-233.Health A to Z:Your Family Health Site.Blumenthal RS(reviewer).The stages of quitting.2004.Available at:http:/ August 15,2005.Smoking Cessation Is E
29、xtremely DifficultHealth care providers should understand that nicotine dependence is a chronic,relapsing,addictive disease and that quitting smoking is a journey that may involve relapses.1-3Smoking cessation is extremely difficult and requires pharmacologic and behavioral intervention to be succes
30、sful at quitting and staying quit.4Those trying to quit will need to have a strong support system.1When a smoker who is motivated to quit is identified,his or her health care provider should offer information and assistance and provide smoking cessation treatment that includes3:Education about what
31、to expect during withdrawal.Behavioral and environmental modification.Medication for withdrawal support.Jarvis MJ.Why people smoke.BMJ.2004;328(7434):277-279.Rigotti NA.Treatment of tobacco use and dependence.N Engl J Med.2002;346(7):506-512.Fiore MC,Bailey WC,Cohen SJ,et al.Treating Tobacco Use and
32、 Dependence.Clinical Practice Guideline.Rockville,Md:US Department of Health and Human Services.Public Health Service;June 2000:26-31.Schroeder SA.What to do with a patient who smokes.JAMA.2005;294:482-487.Motivational Stages of Smoking Behavior1 In the journey toward quitting smoking,the stages of
33、change are2:1.PrecontemplationSmokers may not see health advice applying to themselves.The goal is to get them to think about change and personalize their risk factors.2.ContemplationSmokers are considering the benefits of quitting but also the barriers to quitting.3.PreparationNow is the time to develop a personalized quit plan,which involves setting a quit date.4.ActionThere is no one right way
