Pharmacotherapy for Quitting Smoking: NRT, Chantix, and Wellbutrin

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What's the Best Way to Quit Smoking? - GoodRx

Quitting doesn’t look the same for everyone, which is why there are so many different strategies and remedies to assist people with reducing, and eventually quitting smoking all together. I want to present the whole “menu of options” of pharmacotherapy to you, so that you are best equipped to make an informed decision that is right for you and your goals with your tobacco use.

First, let’s do a general walk through of pharmacotherapy and how it can be helpful

What is pharmacotherapy?

Pharmacotherapy is the use of FDA regulated medication to assist an individual with medical conditions, such as addiction. Regarding nicotine dependency specifically, there are two types of pharmacotherapy: nicotine replacement therapy (NRT) and medication in the form of a pill.

Evidence-based studies have proven that people who use tobacco products are two times more likely to be successful in their quit attempt if they combine nicotine dependency counseling with some form of pharmacotherapy, compared to using either pharmacotherapy or counseling alone.

There are many factors at play that make quitting so hard (societal, cognitive, the length of time someone has been smoking, etc.) but today we are going to focus on nicotine withdrawals and utilizing pharmacotherapy as a means to reduce the negative effects caused by withdrawals. Nicotine withdrawals can be a lot more difficult than most people think, and are a huge barrier to quitting tobacco use due to the extreme discomfort they can cause. For this reason, it is crucial that you know your options as someone who is trying to quit using tobacco products.

Chemical formula of Nicotine with spilled tobacco - Buy this stock ...

What are nicotine withdrawal symptoms and why do they occur?  

Nicotine withdrawals occur as symptoms of your brain adjusting to the new “normal” as nicotine levels fall within your brain, and eventually leave your system. Nicotine can leave your body entirely within a few days, thanks to the short half-life of the drug. It is important to note that just because the nicotine leaves your system so quickly does not mean that withdrawals will leave as quickly. Most people who quit smoking experience extreme symptoms to nicotine withdrawal for 1-2 weeks with withdrawal usually reaching its peak by day 3, and it can take a few months for them to be gone entirely. This is because it takes up to 3 three months for your brain chemistry, specifically dopamine receptors, to return to “normal” pre-smoking levels.

A more thorough explanation of how withdrawal happens, and why it takes so darn long for things to feel “normal” or for life to feel good again after quitting

Before you smoked, your brain created its own pleasure response (flood of dopamine) to daily activities such as spending time with people you enjoy, eating, having sex, and plenty of other activities. When you start smoking, your brain “doubles down” on the pleasure response thanks to nicotine increasing the volume of the pleasure response that becomes available to you as you smoke (or chew).

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Over repeated use, your brain drastically reduces the amount of pleasure response that is created on its own, without cue from nicotine, since the nicotine makes it so readily available anyways. Think of it this way- if you have a child who regularly cleans their room every day, but you start cleaning their room while they’re at school, they will stop doing it themselves. This is what your brain is doing (or not doing) as nicotine triggers the release of dopamine When you stop using tobacco products, your brain doesn’t catch on right away, so you are receiving much less pleasure response (dopamine) than you were when you were using tobacco, but now you’re also receiving less pleasure response than before you started smoking in the first place. This results in life feeling less satisfactory in a variety of ways.

After increased abstinence, your brain plays catch up, and the dopamine levels in your brain return to the pre-smoking levels. Life is bearable, and even enjoyable again. Understanding this aspect of nicotine withdrawal can help make the experience much less daunting, and give hope that better days really are to come and that all pleasure is not lost once you kick the cigarettes out of your life.

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Below is a list of common nicotine withdrawal symptoms:

  • Cravings (can be general, also the sense of needing something in your mouth constantly)
  • Irritability
  • Trouble concentrating
  • Anxiety
  • Depression/crying spells
  • Increased hunger/ weight gain
  • Fatigue
  • Headache

Now, time to see all of your options for keeping the above withdrawals at bay during your quit journey.

Your Guide to Pharmacotherapy for Reducing or Quitting Tobacco Use

***This information is purely educational, so that you understand what all of your options are and how each works. It is always wise to consult with a doctor or tobacco treatment specialist when utilizing any medication to help with reducing or quitting smoking in order to make sure that the dosing and recommendations are safe and make sense for your unique smoking pattern and nicotine dependency.***

Nicotine Replacement Therapy (NRT)

There are many options for someone who wishes to utilize nicotine replacement therapy, and nicotine replacement therapy seems to be the most popular form of assistance from my clientele base. There are five different types approved by the FDA, outlined below.

The Patch

How you use it: The nicotine patch is a transdermal patch that you put on each day (most people find it easiest to remember by replacing it each morning) and keep on throughout the day. It gives you a steady stream of nicotine throughout the day, in order to help stave off withdrawal symptoms while reducing or quitting.

How it works: The nicotine patch is the only NRT that is slow acting. What that means, is that the patch slowly releases an equal amount of nicotine into your bloodstream for the full day that you wear it. This is important, because the slow and steady release of nicotine into your system helps your body fight the nicotine addiction by making its presence less enforcing as you are no longer self-medicating as a direct response to triggers that may have effected your smoking patterns in the past. It is encouraged to pair a slow acting and quick acting NRT together to maximize success in quitting.

Dosing: Depends on recommendations made by your Tobacco Treatment Specialist (TTS) or Physician, but most people who smoke 1 pack per day or more utilize the 21mg patch to start. It also comes in 14mg and 7mg quantities.

Cautions: Using the patch can be very helpful as a means to help individuals reduce their tobacco use but please utilize caution and consult with your doctor or TTS if you are using the patch while still smoking. Nicotine poisoning can cause rapid heartbeat, nausea, and in  severe cases, result in a heart attack.

Nicotine Gum

How you use it: You chew the gum until it begins to taste “peppery” or not enjoyable. This change in taste as you chew it is the nicotine being activated to be released. Once the taste changes, you “park” the gum between your lip and your gums and keep it there for 15-30 minutes as the nicotine being released will then be absorbed by the mucous membranes that line your cheek.

NRT Gum AND Patch

How it works: The nicotine gum delivers nicotine to your system within a few minutes. It is a fast-acting NRT, meaning that it kicks in relatively quick. The dosing is quite small, making it a great companion to the patch when you quit. I usually recommend that clients utilize the gum in addition to the patch, as something to supplement getting through mornings or rough triggers, as they are waiting for the patch to kick in. Even with the gum delivering nicotine to your bloodstream within a few minutes, it is helping your body kick the withdrawals while also continuing to eliminate the positive reinforcement of smoking/utilizing nicotine as a stress response. This is because the delivery of nicotine to your bloodstream within a few minutes is still relatively slow when compared to the 7 seconds that it takes for nicotine to be delivered to your bloodstream when you are smoking a cigarette.

Dosing: The nicotine gum comes in 4mg and 2mg doses.

Cautions: Please make sure that you do not continue chewing the gum past the peppery taste and NEVER swallow the gum. Spit it out into the trash when you are done. With the dosing being so small with the gum, the chances of getting nicotine poisoning are extremely low, but you’re in for a nasty stomach ache and/or nausea if you swallow the nicotine gum directly.

Nicotine Lozenge

Nicotine lozenge

How you use it: Move the lozenge from one side to the other side of your mouth often, allowing it to slowly dissolve for about 20-30 minutes. Avoid chewing the lozenge.

How it works: The nicotine lozenge acts very similar to the Nicotine Gum and delivers nicotine to your system within a few minutes. It is a fast-acting NRT, meaning that it kicks in relatively quick. The dosing is quite small, making it a great companion to the patch when you quit. I usually recommend that clients utilize the lozenge in addition to the patch, as something to supplement getting through mornings or rough triggers, as they are waiting for the patch to kick in. Even with the lozenge delivering nicotine to your bloodstream within a few minutes, it is helping your body kick the withdrawals while also continuing to eliminate the positive reinforcement of smoking/utilizing nicotine as a stress response. This is because the delivery of nicotine to your bloodstream within a few minutes is still relatively slow when compared to the 7 seconds that it takes for nicotine to be delivered to your bloodstream when you are smoking a cigarette.

Dosing: The nicotine lozenge comes in 4mg and 2mg doses. It also comes in a variety of flavors (mint, cinnamon, fruit).

Cautions: Do not chew or swallow the lozenge, as this can cause a stomach ache and/or nausea. It is advised to not use more than 1 lozenge an hour- especially if you are already using it with the patch.

Nicotine Inhaler

*This product is only available by prescription from a doctor

How you use it: You should not begin to use an inhaler until after you have stopped smoking (on your quit date). It is also advised to not eat or drink 15-30 minutes before using the inhaler, to avoid irritation of the mouth. Once you put a nicotine cartridge into the inhaler, you inhale similarly to using an asthma inhaler, slowly letting the nicotine vapor absorb into your mouth and throat area.  nicotine inhaler

How it works: The inhaler mimics the look of a cigarette and contains a cartridge that fits in the inhaler, containing nicotine. Since you are absorbing the nicotine through your mucous membranes (inside of mouth, throat), you do not receive the same “hit” in your lungs like if you were to smoke a regular cigarette. The nicotine inhaler does not deliver nicotine to your brain as quickly as smoking a cigarette which helps prevent the positive reinforcement of nicotine consumption, allowing you to slowly taper down your use and prevent the onset of extreme nicotine withdrawal. The inhaler is great for heavier smokers (1-2 packs a day), as it helps you slowly ease out of your routine of grabbing a cigarette and putting it to your mouth.

Dosing: One nicotine cartridge contains enough nicotine for 20 minutes of “puffing.” It is recommended to use each cartridge in four separate five minute sessions, and to stick to less than 16 cartridges a day unless otherwise advised by a doctor. Most people end up using between six to ten cartridges a day.

Cautions: Make sure you dispose of the nicotine cartridges safely when finished, as there could be lingering nicotine inside that could harm pets or small children that come in contact with it. Discontinue use after six months. The mouthpiece should be regularly cleaned and disinfected to prevent bacteria build up.

Nasal Spray

*This product is only available by a prescription from your doctor

nicotine nasal spray

How you use it: When you have quit smoking completely, you may start using this product (quit date and beyond). You use this product just like you would use a nasal spray for colds/nasal congestion. After washing your hands, you should blow your nose in order to clear your nasal passageways.

How it works: This nicotine replacement therapy enters the blood stream quicker than the other forms of NRT due to it being absorbed through the nasal passage way. This increases the chance of the nasal spray being more habit forming than the other methods.

Dosing: Most people start with one or two doses an hour, but this can vary based on how many cigarettes you smoked a day before your quit date. Never use more than five doses an hour, or 40 doses within a 24 hour day.

Cautions: Wait at least five minutes after use before driving or  operating heavy machinery. Use the nasal spray regularly to help your body adjust to the following side effects that most people experience within the first week of us: hot, peppery feeling in the back of the throat or nose, sneezing, coughing, watery eyes or runny nose. If you are recovering from drugs that required a similar method of use, this product might not be right for you.

Quit Smoking Medications

There are currently two types of medications that have been approved by the FDA to assist individuals with quitting smoking. They are proven to be as effective as NRT.

*Both of these medications require a prescription by a doctor

Chantix (Varenicline)

chantix

How you use it: You can start taking Chantix before you quit smoking, as it takes some time for the medication to build up in your system. Some people take Chantix a week before their quit date, and others try an even more gradual quit approach and take Chantix for 12 weeks as they are working towards quitting and then remain on Chantix for an additional 12 weeks after quitting. When you do start taking Chantix, there is a specific protocol that you will take so that you can slowly increase the dose over the first week. It is advised to take the pill after eating a meal with a full glass of water.

How it works: When you start taking Chantix, as it builds up in your system, it attaches to the nicotine receptors in your brain. This makes smoking less enjoyable as the nicotine receptors are blocked in your brain and the nicotine is unable to release the flood of dopamine that usually occurs when you smoke. In turn, this helps break the reward cycle of smoking, which ends up lessening your urges to smoke. And if you do smoke while taking Chantix, the effect is significantly less pleasurable. Additionally, since Chantix is now binding to the nicotine receptors in your brain, it does produce a small amount of dopamine to mimic the effect of smoking… only on such a small level that it is not addictive, and just to serve the purpose of easing nicotine withdrawal symptoms.

Dosing: The dosing schedule can vary based on specific needs, but generally follows the following protocol: Days 1-3 you take 1 white pill (.5mg) daily, on Days 4-7 you take 1 white pill (.5mg) in the morning and 1 in the evening. Finally, on day 8 until the end of your treatment regimen you take 1 blue pill (1mg) in the morning and 1 in the evening. This allows the medication to slowly build up in your system in a safe way.

Cautions: If you have a history depression or other mental health conditions, or a history of seizures, this may not be the best option for you. A variety of side effects can occur with this medication and it is important to discuss these with your doctor if you are thinking about using this method to quit smoking.

Zyban / Wellbutrin (Bupropion)

bupropion

How you use it: Most people will start taking Bupropion 1-2 weeks before their quit date, or as they are reducing, to allow the medication to build up in your system before you officially quit.

How it works: It is still unclear precisely how Bupropion works, though it has been proven to be effective in easing irritability, concentration problems, and the urge to overeat while quitting smoking. Researchers do know that Bupropion blocks some of the chemicals in your brain that interact with nicotine, making smoking and other tobacco use less re-enforcing, leading to reduced cravings. Bupropion is also commonly prescribed as an anti-depressant.

Dosing: Days 1-3 you take one 150mg tablet each morning, day 4 to the end of your treatment regimen you take one 150mg tablet twice a day- once in the morning and once in the evening (about 8 hours between doses).

Cautions: If you have a history of anxiety, anorexia, binge drinking, or seizures, this medication might not be for you. It is important to discuss your medical history with your doctor if you are interested in taking this medication for smoking cessation.

Additional Notes

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If you are pregnant, breastfeeding, or are under the age of 18 you should consult with a doctor before using any of the above medications or NRT.

Get a prescription anyways and save your money to use on other things that will assist your reduction or quit, such as gum, sugar-free candy, toothpicks, etc.

Although you can get the patch, gum and lozenge over the counter at most stores, they can get quite expensive. Especially if you plan to use them for 6 months (the maximum amount of time suggested to help prevent relapse after quitting). With a prescription from your doctor, you can receive these products for free or a substantially reduced price, as many insurance companies will cover the cost to help individuals quit smoking with evidence based interventions. Why pay for it if you don’t have to? In the light of COVID-19, it might not be possible to go into your doctor’s office physically. Instead, you can schedule a virtual “telehealth” visit or try calling the office to explain your situation.

QUITLINE

 

If you are uninsured or underinsured, call the Michigan Quitline at 1-800-QUIT-NOW (1-800-784-8669) to see how you can get NRT mailed directly to your door.

 


Feel like you need to adjust your tobacco treatment plan due to COVID-19 or just interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit:
Amber Jager – (269) 350-3826
ajager@miunified.org

Ypsilanti/Jackson:
Caitlyn Clock – (734) 489-9916
cclock@miunified.org 

 

COVID-19 and Tobacco: What You Should Know, and How to Protect Yourself

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A month ago we had no idea that life as we previously knew it was starting to change in a drastic way, and that public spaces would close indefinitely. Then COVID-19 came. We are flooded with news articles, videos, and interviews talking about the social and health implications of such a pandemic– so COVID-19 might be the last thing that you want to read about right now. But I believe that we need to fully understand the implications that this virus has on people who smoke, and what can be done to protect yourself if you do smoke. In order to understand why COVID-19 should be a concern for people who smoke, it is important to understand how tobacco affects your immune system.

Tobacco use and your body

Tobacco use causes damage to nearly every organ of your body, and is especially harmful to your upper and lower respiratory systems due to the smoke and many chemicals that are inhaled through your mouth, down your throat and into your lungs. As the various gases (ammonia, formaldehyde, and carbon monoxide to name a few) make their way to your lungs, they cause cell damage and abnormalities.

Even more, as soon as you inhale the smoke from a cigarette, those chemicals cause irritation to your whole upper airway. This causes your nose and sinuses to produce more mucus. With healthy mucus production, the mucous we produce daily drains healthily down our throats and helps to rid our body of bacteria. When we produce an excess that is caused by irritation, our body does the reverse. It starts to build up this mucous in our sinuses and makes us more susceptible to colds and allergies. This can even eventually lead to cancer of the throat and lungs over time.

upper and lower respiratory

Also worth noting, is the fact that cigarette smoking suppresses your immune system by damaging important organs in your body.  This causes your organs to have to work harder and less efficiently than if they were not damaged, in order to carry out normal functioning within your body such as breathing, hormone regulation, and the ability to fight off infections.

What you need to know about COVID-19 if you smoke

Given the facts that smoking causes significant damage to your lungs and other airways, as well as suppresses your immune system there is validity in being concerned about COVID-19 if you smoke and you should be more cautious during this time.

In an article by the American Lung Association, Dr. Albert Rizzo states “COVID-19 is a lung infection that aggressively attacks the lungs and even leaves lung cells and tissue dead,” Dr. Rizzo said. “While it’s important to prevent getting COVID-19 in the first place, it’s also essential that we do all we can to keep our lungs healthy to avoid the worst affects of the disease.”

single cigaretteThe bottom line: If you do get COVID-19, you are at an increased risk for developing more severe symptoms as well as having symptoms for a longer period of time due to tobacco use decreasing the body’s ability to heal itself efficiently. You can read more about COVID-19 here

 

What you can do to protect yourself

The important thing to know and remind yourself in the midst of this pandemic is knowing that there’s hope. If you smoke, you can begin to take your health into your own hands by making the decision to quit smoking. This task is difficult, though definitely not impossible. Here are some tips to help you get started:

  • Think about your “why.” What are some reasons today that you would want to quit smoking? Give this some thought and create a list of all of your reasons. Go a step further, and hang that list in a visible spot so that you can see it every day.
  • Keep track of your triggers and plan ahead. One of the most important parts of planning to quit smoking is identifying the moments when you are the most likely to smoke or want to smoke. Do you always seem to smoke after a big meal? Do you get a craving every time you feel worried about something? Take a day or two, before you quit smoking, to keep a journal on you and log each time that you smoke. Before you light up, record what time it is, what you are doing (or just did) and how you feel. Once you’re aware of your smoking triggers, create a plan for alternatives to smoking when these situations arise. For example, common alternatives people direct themselves to after eating instead of smoking are to go for a walk, chew gum, have a mint or brush their teeth.    QuitSmoking613_2
  • Set a quit date. Once you feel comfortable with an alternative for your smoking triggers, it’s time to set a date within the next month of when you will smoke your last cigarette. Be mindful to set your quit date for a time when you have no foreseeable stress, as well as big celebrations, in order to set yourself up for success.
  • Maximize your social support. Tell the people in your life that you are quitting and ask them to help keep you accountable. If you don’t have support from your friends or family, look for support in the form of a quit smoking group. Here are some free online communities with the common goal of becoming and remaining tobacco-free:

QUITLINE

  • Call the Michigan Quitline at 1-800-784-8669 or enroll in their online program to see if you qualify for free Nicotine Replacement Therapy to assist you with quitting. NRT can help significantly ease the feeling of withdrawal symptoms and ween you off of nicotine.
  • Practice mini quits! Pick one day or a few days where you won’t smoke, and take note of how that felt, what you needed to get by, etc. It’s a less intimidating way to get a feel for a tobacco-free life as you prepare for your quit date. This article details more about the benefits of practice quits. 

 

Things you can do right now

In addition to following the recommendations from the CDC (hand-washing, social distancing) wherever you are in your quit smoking journey,  here are some tips to help you stay healthy and build your immune system:

  • Focus on your sleep hygiene. Set a consistent time to go to sleep and wake up each day. This not only helps keep your body physically healthy, but it will help eliminate stress and mild depressive symptoms as well as the anxious feeling of being on quarantine. person wearing black low top sneakers and black jeans
  • Move! From walking to jumping, or doing at home workouts in your living room, any form of moderate exercise is beneficial for your immune system as well as your mental health.
  • Stay hydrated. Drinking water throughout the day won’t only keep you feeling awake and replenish hydration throughout your organs. Drinking fluids also helps flush out bacteria and viruses that could be lingering in your body.  variety of vegetables
  • Eat your vitamins. Literally. While it’s important to incorporate a daily multivitamin to make up for gaps in nutrition, the best way for your body to absorb vitamins and other micro-nutrients is by eating nutrient rich foods such as vegetables and fruit. Organ meat also has a high amount of vitamins, so if you’re feeling adventurous try my personal favorite: liver and onions!
  • Warm your body up by drinking hot tea and honey. Honey is proven to help rid the body of bacteria. Another added bonus- honey helps to break down mucous build up! Many herbal teas also have beneficial affects on the immune system.
  • Laughter is good for the soul (and immune system). Last but never least… LAUGH! During stressful times and when you’re undergoing changes within your routine (such as reducing or quitting smoking), it never hurts to make time for a good laugh- whether that means joking with friends and family, watching stand up comedy, a feel good sitcom, or finding something else to make you giggle a little. It is scientifically proven that laughter is good for your mental and physical health. Read this article by the Mayo Clinic that details all of the long-term and short-term health benefits of laughter.

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As we continue to navigate these confusing and uncertain times, please continue to refer to the CDC for information on how to navigate the changing status of the pandemic in your community.

 

Interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit: 
Amber Jager – (313) 446-9800 
ajager@miunified.org

Ypsilanti/Jackson: 
Caitlyn Clock – (734) 961-1077
cclock@miunified.org

Quit Smoking Tip of The Week: Keep the weight off! Part 3

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So far we have covered nutrition and exercise as tools for a healthy weight and lifestyle. Now, third but definitely still just as important as the former two, is sleep! We often disregard or forget about this oh so important factor altogether, in the go-go-go lifestyle that comes along with our society. Sleep is one of the most crucial ingredients for health and well-being. Sleep is what regulates your hormones, repairs your body, promotes a healthy mental state, and so much more.

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If weight loss is your goal and you’re eating healthy foods and working out but not seeing much progress, it is time to evaluate your sleep. Not only will your “gains” from working out be lost if you are deprived of sleep, but your body will crave more food to help fuel your body as it goes into “overtime,” and usually the foods we crave are not the foods we need for proper nutrition. Let’s dig a little deeper, here, and see what else is effected by sleep and HOW to get the most out of your sleep!

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In addition to getting enough sleep (a recommended 6-8 hours for adults), the timing of your sleep is also crucial. Research shows that your body starts to release melatonin in the evening as it starts to get dark out, then begins to release cortisol as the sun begins to rise. Melatonin is the sleep hormone responsible for putting your body at rest and cortisol is the sleep hormone responsible for waking your body up. An optimal sleep schedule is to sleep from 10pm to 6am (8 hours), as 10pm-2am is the time in which your body reaches its peak hormone balance to promote optimal restoration for your cells. When you stay up too late, or sleep in too late, your body is thrown off by hormone dysregulation. This can explain why you may still feel tired even after getting a solid 7-8 hours of sleep, because getting 8 hours of sleep from 12am-8am, is not the same as a 10pm-6am schedule. When you go to sleep at 12am you have already missed the first two hours of REM sleep. Dr. Oz has a great article going deeper into the science behind the 10pm-2am cycle of restorative sleep here if you’re interested in learning more.

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What happens to your body when you get a good night’s sleep? A ton of great things, such as:

  • Blood sugar regulation, important for preventing type 2 diabetes
  • Your muscles rebuild themselves, utilizing essential amino acids that you have digested throughout the day (making your workout actually worth it!)
  • Your body repairs itself from internal and external stressors (inflammation reduces, mood regulates, free-radicals that cause disease are removed, all thanks to the antioxidant properties of melatonin)
  • Long-term memory is reinforced, helping you perform cognitive tasks more efficiently

All of the above (expect for the last point, which should still be an important factor for people) aid in weight loss. When you don’t get a quality amount of sleep, the above either will not happen or will occur at a much less efficient rate.

So, get those ZZZ’s because they’re a lot more important than you think!

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Setting a routine for better sleep

Now, let’s address HOW to get this restorative, restful sleep, because as we all know, insomnia can be a withdrawal for many smokers who begin their quit journey.

family of three lying on bed showing feet while covered with yellow blanket

  • Only use your bed for sleep and sex. When you do other activities in your bed (such as reading, watching tv or eating) your brain does not associate your bed with sleep as strongly, and your bed should only be associated with relaxation.
  • When you can’t fall asleep, get out of bed. This might sound like bad advice, but it goes along with the first tip. If it is taking you up to an hour to try to fall asleep, get out of bed and read on the couch or stretch until you feel sleepy, then hop back in bed. When you can’t sleep and stay in bed, feeling anxious or upset that you can’t fall asleep, you are unintentionally associating your bed with negative emotions.

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  • Exercise early in the day, if possible. It is proven that moderate exercise (try for 30 minutes a day, even if it’s just walking) will help adults get a better night’s sleep. Even further, if you exercise before 3pm you will be getting the most from this benefit as it is also proven that exercising after 3pm can cause your sleep hormone production (melatonin and cortisol) to get post-poned, potentially making it harder to initially fall asleep.
  • Consistency is key. Try to go to sleep at the same time each night, and wake up around the same time each morning. Building a consistent routine around your sleep schedule helps keep your hormones in check and makes it easier to fall asleep (and stay asleep) at night.

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  • Unplug! This one is so important in our busy, always accessible society. At least an hour before going to bed, stay away from your cell phone, computer, tv, or any other electronic device. Read a book, stretch or find another relaxing activity that you can participate in each night as part of your routine to help your body unwind and relax. This will help you rid yourself of your racing thoughts, as well as give your brain a rest by intentionally reducing the blue-light that you are exposed to. Blue-light interferes with our internal clock, which controls our sleep hormone (melatonin), causing hormone imbalance, anxiety and stress.
  • Ditch the late night snacks (or meals). Eating later in the evening and at night is tough on our digestive system. Historically speaking, when the sun goes down, so does our body. And with it, our bodily systems, such as digestion. Remember earlier when I said that our body repairs itself when we sleep? Well, when you eat a meal less than three hours before going to sleep, your digestive system is still doing a lot of work while your body is trying to rest! This might be why you wake up multiple times in the night to pee, can’t seem to get a deep sleep, or even have trouble falling asleep. Do yourself and your digestive system a favor and try to abstain from eating at least three hours before sleeping, four if you’re able to eat dinner earlier.
  • Dim your lights. Our sleep hormone, melatonin, is produced by our pineal gland which gets triggered to release or not release melatonin based on the light we receive. Similar to the idea of unplugging from technology, you should try to reduce the overall amount of light received as soon as the sun starts to set. In this way, you are mimicking the way nature intended and helping produce melatonin naturally in order to induce a restful sleep by 10pm.

espresso machine dispensing on two mugs

  • Reduce or eliminate your caffeine intake altogether. Caffeine is a stimulant and it has been proven that even having caffeine in the morning can effect your sleep at night. Try cutting down from 2 cups of coffee to 1, or switch to decaf if you really enjoy the taste. Be aware that a lot of teas have a ton of caffeine in them, so opt for the de-caffinated ones or something light like a white tea.

white bed comforter

Coming from someone who has personally had a bad relationship with sleep from my adolescence through my early 20’s, if you try all of these tips, you will be successful in helping to reset your sleep pattern. I never thought that I would have a “normal” sleep schedule, but the fact is most American’s are not getting a restful sleep due to the rise in technology and just lack of knowledge about how our sleep hormones are regulated and what environmental cues can throw them way off. Give it a try for a week, and be amazed that you will not need a sleep aid or other substances to help you sleep anymore! If you suffer from racing thoughts at night, as a lot of us do, and stretching or meditating is not working for you, you can try getting a magnesium supplement to help relax your mind (it also relieves muscle cramps!) or look into ashwaganda root to take mid-afternoon and in the evening for stress relief and relaxation. Always ask your doctor before adding any supplements to your daily regimen as some can interfere with medications.

Quit Smoking Tip of The Week: Keep the weight off! Part 2

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Last time we discussed the basics of weight loss and maintaining a healthy and active lifestyle. This week, I want to go a little deeper into exercise.

As mentioned before, doing cardio is good for your body as well as getting a jump start on weight loss. The real key to fat loss though, is to build lean muscle. I’m not talking body builder muscle, but a decent amount of muscle that is strong and appropriate for your body type to support your metabolism as well as your daily activities. Muscle is what promotes a faster resting metabolism (meaning, it helps you burn calories even while you are not doing any physical activity). So… how do we build muscle? There are a few different ways to build muscle that I am going to cover.

man in red and black shorts

First, there are body resistance training exercises. These are my favorite, because they require essentially no workout equipment due to you using your body to build upon itself.

Body resistance training 101:

  • Push-ups (Click here for a guide with different push-up variations)
  • Squats (Click here for a guide with different squat variations)
  • Ab sets (Click here for a beginners guide)
  • Lunges (Click here for a guide with different lunge variations)
  • Pull-ups (Click here for a step-by-step guide)

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Secondly, there are machine resistance training exercises. The amount of equipment required can vary here. From using resistance bands, to exercise machines that hyper-isolate one muscle group and build on contractions (pushing your muscles out, then stretching, and back again). Here is a guide that shows you variations with resistance bands.

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And lastly, another one of my favorite, are the free weight exercises. These are basically resistance training but I like to include them in their own category because they do such a great job at helping improve stability and target certain muscle groups while helping tone other areas of your body through stabilization. Here is a beginners guide for utilizing weight machines as well as free-weights.

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I recognize that a lot of people who might be reading this may be thinking at this point, “but what if I can’t do any of these exercises due to an injury, or general immobility?” Don’t worry, you can still build muscle! It may take a little longer, but there are some great ways to modify workouts so that anyone can participate.

My guide for limited mobility:

Items Needed:

  • 2-5lb (or heavier) Dumbbells *can substitute for 16oz water bottles or any similarly heavy set of objects
  • Medicine Ball *can substitute for a sturdy medium sized ball, such as a basketball or soccer ball
  • Resistance Bands *optional
  • Chair
  • Paper plates *or socks that allow for easy sliding

Instructions: It is advised that adults get approx. 30 minutes of exercise each day. Find which exercises below work best for you or are the most enjoyable and rotate between them as needed for 30 minute intervals. Be sure to include at least one rest day in your routine if you are new to exercise.

 

Legs: Seated Slides Back and Fourth

Sit tall and place paper plates under each foot. Push onto the right plate and slide the foot forward.  Slide the foot back, pressing onto the plate to activate the hamstrings while sliding the left foot forward.  Continue alternating for 16 reps (one rep includes both right and left slides).

 

Legs: Seated Outer Thigh

Sit tall in the chair and tie a band around the mid-thighs.  Step the right foot out to the side, touch lightly and then bring it back in, focusing on the outer thigh.  Repeat, stepping out with the left foot and repeat for a total of 16 reps (one rep includes both the right and left taps).

 

Leg Extensions

Sit tall with feet flat on the floor and knees together.  Squeeze the quads (upper thigh) to straighten the right leg, foot flexed. Bend the knee to lower the foot, lightly touching the floor. Repeat for 20 reps and switch sides. Add ankle weights for more intensity if desired.

 

Legs: Seated Ball Taps

Place a medicine ball (or a medium sized ball of choice) in front of you and sit tall with the abs engaged. Lift the right foot and tap the toes on top of the medicine ball. Take it back down and tap with the left foot. Continue tapping the ball, alternating feet, as fast as you can repeating for 16-20 reps.

 

Legs: Inner Thigh Squeeze

While seated with tall posture, place a ball between your knees. Squeeze the ball by contracting (pulling in) the inner thighs and release slightly–don’t release all the way–and repeat for 16 reps.

 

Arms: Seated Lateral Pull With Band

While sitting tall, hold a medium-tension band in both hands up above and slightly in front of your head. The distance between your hands will determine the intensity of the exercise (closer together is harder, further apart is easier). Contract the back and pull the right elbow down toward the ribcage.  Release and repeat for 16 reps before switching sides.

 

Upper Body: Chest Squeeze With Medicine Ball

Sit on a chair, back straight and abs in. Hold a medicine ball (or any other type of medium sized ball) at chest level and squeeze the ball to contract the chest. While continuing to squeeze the ball, slowly push the ball out in front of you at chest level until elbows are almost straight. Continuing the pressure with your hands, bend the elbows and pull the ball back to chest. Repeat for 16 reps.

 

Upper Body: Seated Lateral Raise

Sit with a tall posture holding 2-5lb dumbbells (or 16oz water bottles) at your sides. Keeping the elbows slightly bent and wrists straight, lift the arms up to shoulder level (palms face the floor). Lower back down and repeat for 16 reps.

 

Upper Body, Shoulders: Overhead Press

Sit with tall posture holding 2-5lb dumbbells (or 16oz water bottles) in both hands. Begin the move with arms bent to 90 degrees, weights next to the ears (arms should look like a goal post). Press the weights overhead and lower back down, repeating for 16 reps.

 

Arms: Biceps Curls

Sit and hold 2-5lb dumbbells (or 16oz water bottles). Curl the weight up toward your shoulder and release. Avoid swinging the weights and keep the abs engaged. Repeat for 16 reps.

 

Core: Seated Rotation for Abs

Sit tall, holding a 5-8lb dumbbell (or an equally heavy object) in front of your chest. Keeping the abs contracted, rotate the torso to the right while keeping the hips and legs facing forward. Contract abs to bring the weight back to center and then rotate to the left. Repeat for 12 reps.

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Hopefully after reading this, you have been able to think of a few ways that you will be able to implement strength training into your daily routine. Play around with these guides and even create your own fun way to get active, while building muscle, by exploring different sports or activities such as hiking. The most important part of exercise, is that you are enjoying it and doing it to better your body and mind rather than seeing as a chore because you “need” to lose weight. Rethinking physical activity is the start to a healthier, happier life.

Quit Smoking Tip of The Week: Keep The Weight Off! Part 1

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Post cessation weight gain can cause a lot of stress for most people. You don’t want to put on 10-15 extra pounds, especially if that will put you in the overweight or obese category. That’s completely understandable, and there are small changes you can make in order to achieve and maintain a healthy weight but most importantly a healthy and active lifestyle.

First, I do want to address the fear of gaining weight while quitting smoking. If you are concerned about the health implications of gaining weight, know that putting on a temporary 10-15 pounds is far healthier than continuing to smoke or use tobacco. This is something I touch on with my clients who bring up weight as a major concern or trigger in their reduction/quit journey. I also like to let clients know that the upside to quitting is that even when you do gain a few pounds, your body is continuing to detox and rebuild its cellular processes post smoking cessation. This means that you will be able to more efficiently burn fat and put on healthy amounts of muscle because you are no longer doing continuous damage to your organs (which must function optimally to lose the RIGHT kind of weight).

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With my background in nutrition and weight loss coaching, I understand that this can feel like an uphill battle oftentimes, but rest assured that all you need is patience and dedication and there is no reason that you won’t be able to prevent or remedy weight gain after quitting. The best thing you are doing for your physical health and appearance is quitting smoking. Let’s face it, it’s hard to be fit and also a smoker- something to keep in mind.

Okay, so HOW exactly do you manage your weight?

Now let’s get into the details: how do you lose weight or even prevent the weight gain altogether? This is going to be a multi-part blog series, because there is no one magic secret that is going to do the trick. Tons of things factor into weight and how you gain and lose it, and it takes a long time for both to happen. In America especially, we get so caught up in the “immediate results, immediate gratification” mindset that we don’t step back and take a look at the whole picture.

Two Major Components: Exercise and Nutrition

These are the most well-known components to a healthy weight and lifestyle, yet most people are still not eating the right types of foods and either not exercising enough or exercising too much.

vegetables and tomatoes on cutting board

A healthy diet includes a diet consisting of healthy fats, proteins and vegetables and a moderate amount of complex carbohydrates, such as the Mediterranean diet. The Mayo Clinic offers a great, easy to follow guide here.  One of the most important things that you can do for yourself regarding weight loss or maintaining a healthy weight is to eliminate as much processed food from your diet as possible. This includes chips, donuts, cereal, etc. This doesn’t mean that you can never eat these types of foods, but it’s encouraged to limit these to a “once in a blue moon” snack and not a daily (or even weekly) item to have.

bodybuilding close up dumbbells equipment

Now it’s time to touch on physical activity. You should strive to get 20-30 minutes of exercise each day at minimum. These guidelines are from the American Heart Association. This includes walking, so don’t let yourself get discouraged if you don’t have time (or the strength) to hit the weights every day. If you work, try to get up every hour or so to do a lap around your building. Take the long way to the restroom. Even park farther away (or, if you utilize public transportation and live in a safe area, try walking to your destinations as much as possible). Walking and more intense forms of cardio can be wonderful for jump starting a weight loss journey. But if you stick to JUST cardio, it will be just that and only that: weight loss. Not fat loss. Excessive cardio eats away your muscle, so you want to be careful to not overdo it. Muscle is what you want to keep, and build, in order to actually loose fat. The more muscle you have on your body, the higher your resting metabolism. It’s important to mix up your routine if you’re looking to lose fat rather than maintain your weight. Work on building strength, and the weight will come off (as long as you stick to a healthy diet—trust me, I have personal experience from years of learning that you can never out train a bad diet! Fat loss starts in the kitchen). Next week, we will go a little deeper in proper exercise and nutrition as well as touch on another important, but often neglected factor in healthy weight and lifestyle.

The Connection – Smoking and Anxiety

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Many people are under the false assumption that smoking helps relieve anxiety OR they know intellectually that it doesn’t help, but they don’t actually know why or how the brain tricks you into still craving that cigarette as the “only” thing that will take away the panic, the racing thoughts, etc. The association between cigarettes and anxiety can be confusing when you don’t know the whole story of how they affect each other.

close up photo of cigarette

Clients with anxiety, depression, or who have beat other addictions are the ones who will benefit the most from quitting! Most of the time, one drug has a learned association with another that is being used. Think about coffee. If you’re a coffee drinker and a smoker, you probably associate the two together. Same with alcohol and other drugs. So staying abstinent from all drugs, including nicotine, is a good way to stick to your sobriety.

It is backed by science and many studies that quitting smoking only has a positive effect on mental health and to continue to smoke is to continue to agitate the symptoms of anxiety as well as speed up the progression to HIV stage 3 (AIDS).

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How smoking increases anxiety and why your brain still tricks you into thinking that smoking helps relieve anxiety and stress

Nicotine is a stimulant. When it enters the bloodstream and makes its way to the brain (within 7-10 seconds) it increases the heart rate, increasing your cortisol, as well as your alertness. These are symptoms of physical stress, and for people with anxiety or a predisposition for anxiety, these stress catalysts can make anxiety even worse.

Persons with a predisposition to anxiety also may experience more anxious thoughts as they enter nicotine withdrawal, which happens many times during the day for cigarette smokers. On the graph below, you can see that after the first cigarette, throughout the rest of the day there are continues spikes going up and down. The spike up is the initial pleasure response (release of dopamine) from smoking. The down spikes are the withdrawal cues that tell your brain to smoke again- manifesting themselves in excessive worry, irritability, tiredness, etc. This cycle of smoking to relieve withdrawal symptoms is very taxing on the body and can cause unnecessary stress on the body’s nervous system as you are constantly trying to find equilibrium yet being stuck in a cat and mouse game of highs and lows from nicotine.

nictotine withdrawal graph

Acute tolerance is what tricks the body into thinking that smoking that cigarette is the magic stress reliever/ anxiety killer. But, acute tolerance is actually your body trying to protect itself from the effects of smoking. What happens is, as soon as you light up your cigarette when you’re feeling anxious, your body knows that your heart rate will increase rapidly, and you will get a short burst of energy. To defend against this, your body slows its heart rate down before you inhale. The cigarette did not relieve your stress or anxiety symptoms. Your body did (right before you smoked) as a response to what it knew was going to happen. Once you light up and smoke that cigarette, your body gets a wave of anxiety-causing symptoms again from the increased heart rate and raised alertness, yet thanks to acute tolerance, you would never even know!

One of the best things that you can do for your mental health is to reduce or quit your tobacco use and trade in your cigarettes for healthier, effective coping strategies for anxiety and stress. Reach out to a tobacco treatment specialist (TTS) at UNIFIED- HIV Health and Beyond now to see how we can work with you to reduce your stress and anxiety without cigarettes! To contact the TTS at our Detroit office, call (313)446-9817 to speak with Amber Jager, and for our Ypsilanti/Jackson area office, call (734)572-9355 to speak with Erin Suprunuk.

Tobacco Reduction Program Services

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new year

Happy New Year, everyone! As we enter 2019, most of us have goals of renewing ourselves and refocusing on our health- whether that’s mental or physical. Along with those goals may be a big one: quitting tobacco or continuing to reduce your tobacco use as we enter the New Year. Whether you have never quit before, or have been quitting for the past year, the Tobacco Treatment Specialists at UNIFIED want to help you quit and stay tobacco free- whatever that looks like in your life!

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You may be wondering “Do I qualify for these FREE services, and if so, what exactly do these services provide?” To qualify for the Tobacco Reduction Program at UNIFIED you need to be an individual living with HIV/AIDS, qualify as low-income and live in either the Detroit, Ypsilanti or Jackson area. If you have never received case management services with UNIFIED before but fit the above qualifications, you still qualify for these FREE tobacco cessation services!

So what does a tobacco reduction counseling session consist of, anyways? The short of it, is that it is different for everyone and up to you what you want your reduction and quit plan looks like. We, as tobacco cessation counselors, are here to offer proven-strategies, non-judgmental support and accurate information to help guide your journey to a successful smoke-free life.

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When I meet with my clients, I think of it as them driving the car and me simply navigating the route for them. Most smokers know what they need to do to quit, but need a little guidance to create an individual and effective game plan to get there. That’s where Tobacco Treatment Specialists come in!

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Not ready to quit or reduce, but a little concerned about the health, social or personal implications of tobacco use? Come talk to a cessation counselor! We respect the boundaries of our clients and don’t push when an individual is not ready to make this big change. What we will do is offer information when appropriate, have open conversations about the pros and cons of smoking, and help you decide if it is the right time in your life to quit and give real feedback on what tools (mental coping strategies) you will need when you decide you’re ready to work towards reducing or setting a quit date. There’s nothing to lose by speaking with a tobacco cessation counselor, except maybe a pack of cigarettes or two!

Give us a call today! For our Detroit location, reach Amber Jager at (313)446-9817 and for our Ypsilanti and Jackson location, reach Erin Suprunuk at (734)572-9355.

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Quit Smoking Tip of The Week: Fight Post-Cessation Depression!

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Quitting smoking can momentarily bring on a more depressed mood as your body adjusts its hormone balance and the nicotine receptors slowly start to decrease back to a normal level. Think of it this way- when you smoke a cigarette, nicotine attaches to naturally occurring receptors in your brain. When this happens, you get a flood of dopamine (the feel good hormone). As time goes on and your smoking becomes a habit, your brain develops even more receptors allowing more nicotine to bind to receptors, resulting in a huge flood of dopamine. Well, your brain is not used to having this much dopamine readily available and down regulates this amount. Think of it as you listening to uncomfortably loud music and putting earplugs in to lessen what you can hear (Sleight, VJ. (2016, September 18) A craving is just your brain screaming, “WHERE’S MY NICOTINE?” Retrieved from https://www.linkedin.com/pulse/craving-just-your-brain-screaming-wheres-my-nicotine-vj/). This is what your brain does with dopamine.

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Once you stop smoking, your brain will take a while (a few weeks usually) to adjust to the lessened amount of dopamine that is being produced. Your brain is still down regulating the amount of dopamine being produced, leading to even less dopamine being processed in your brain than before you started smoking. So, you’ve turned the music down but you haven’t taken the earplugs out yet (Sleight, VJ.). The time it takes is different for everyone’s brain to adjust to the normal hormone levels now being produced (some only days, some up to a few weeks) and this could by why some people experience depressed symptoms after quitting tobacco use and some do not. It could also be the reason for increased agitation and feelings of anxiety as part of the withdrawals.

Also, as we dive into the winter season in Michigan we need to be aware that seasonal depression is among us. Up to 10% of adults will experience SAD, Seasonal Affective Disorder (Mental Health America, http://www.mentalhealthamerica.net/conditions/sad).

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Here are a few things that you can do consistently throughout the week to help fight the onset of depression or to just increase your happiness in general: 

  • Keep a Gratitude Journal
  • Savor the moment. This could be any moment- having dinner with a friend, talking with a loved one, walking outside, etc. Savor it by being completely present in this moment- no thoughts of the past or future, electronics put away, thoughts on what you feel, see and hear in that moment.
  • Be kind to someone. This could be someone that you know, or a complete stranger. But the idea is to act with kindness without expecting anything in return. Open the door for someone, smile at a stranger, give someone a compliment.
  • Spend less money on things and more on experiences (but free experiences are an added bonus). We get used to and bored with things. Experiences are encoded as memories that we can cherish forever, and they foster personal growth.
  • Make a new social connection or strengthen a friendship that you currently have. Say hi to a stranger, call a friend that you haven’t spoken to in a while, check-in on your neighbor.

These are just a few! I encourage you to do some of your own research, try out new things and see what works for you to lessen the seasonal blues. I strongly believe in taking care of your mental health and reaching the highest potential as possible regarding your happiness– we all deserve it! If you would like to work on more specific coping mechanisms with a smoking cessation counselor one on one to develop an individualized approach with tangible resources to help you quit with less distress, reach out to Amber Jager at (313)446-9817 for persons living in the Detroit area, and Erin Suprunk at (734)961-1077 for persons living in the Ypsilanti and Jackson area to see if you qualify for FREE smoking cessation services!

Please take into consideration that the combination of these activities are meant to be a part of lifestyle changes in order to help increase general happiness and fight off mild feelings of depression, but are in no means meant to treat Major Depressive Disorder or other extreme conditions that need to be treated by a physician. If you are experiencing suicidal thoughts or experiencing extreme or worsening depression, call the National Suicide Prevention Hotline at 1-800-273-8255. The Lifeline provides 24/7, free and confidential support for people in distress, and prevention and crisis resources for you or your loved ones.

National Suicide Lifeline

Quit Smoking Tip of the Week: Stay prepared with supplies!

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Find a place (your backpack, purse, home, car, etc.) where you can easily access a supply of gum, mints, toothpicks, fidget toys, and whatever else can keep your hands and mouth busy to distract you from the urge to smoke as well as fulfill the hand-to-mouth routine that your body has become used to from months to years of smoking. If you are interested in quitting or reducing your tobacco use, call (313)446-9817 to schedule an appointment with Amber Jager, Tobacco Treatment Reduction Program Specialist at the Detroit location, or (734)961-1077 to schedule an appointment with Erin Suprunuk, Tobacco Treatment Reduction Program Specialist at the Ypsilanti office. During your visit you can create a quit plan that includes individual tobacco counseling sessions with one of our specialists, or you can just stop by to pick up a quit kit that includes a variety of the above supplies listed to help you reduce and cope with smoking cravings! Below I have outlined a few more helpful things to keep with you for withdrawal symptoms and the quit-smoking-journey.

Your Quitting Tool-Kit

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The Power of Cinnamon Sticks: You can purchase whole cinnamon sticks and literally replace them with your cigarettes. Of course you won’t light these up, but you can use cinnamon sticks to mimic the motion of how you use a cigarette: inhale with the cinnamon stick when you feel a craving, until this feeling subsides. This helps by adding the deep breathing that your body gets when smoking a cigarette and the motion can even help trick your body into thinking that you are smoking and calm the urge a bit. This does not work for everyone, but is worth a shot. An added bonus is that even just using cinnamon mints or cinnamon containing gums, oils, etc. help to drastically reduce sugar cravings! So if you’re concerned about weight gain and the craving for unhealthy food, try some cinnamon to combat this.

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Journal The Process: Keeping a journal on you can be very beneficial for you in order to understand your habits and help prevent relapse in the future. It can also be helpful to prevent boredom when used as a creative outlet. Something that I have most of my clients do, depending on their stage in the quitting process, is fill out a Pack Wrap. A Pack Wrap is where you record the feelings/triggers/actions that are occurring during the times when you smoke. The goal is for you and myself to understand what the most triggering situations/feelings are, and create an individualized and successful quit plan with the help of this information. How you do it: this is to be done before you actually quit smoking. Over the course of a few days to a week (I encourage recording a couple days during the week and one day on the weekend to get a full view of your habits) keep your journal on you throughout the entire day. Right before you smoke a cigarette, record the time of day, what you just did/are about to do, and what feelings you have. Even as adults, it can be hard to identify what exactly you are feeling, and this list of 57 different emotions can come in handy to give a name to what you feel.

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Stay Hydrated: The first 3-4 days are the most important when it comes to helping your body detox from nicotine and the many other substances that your body has absorbed from smoking. Try to drink half your body weight in ounces each days (if you weigh 150lbs, then you should be drinking about 75 ounces of water daily). Keeping a water bottle handy at all times, though, will help you with hunger cravings (a lot of the time we think we are hungry when we are just dehydrated), tiredness, headaches and coughing that all can occur at increased rates during the withdrawal stage.