Finding Balance with Stress

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Tools to help create a balance for sustainable well-being

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When I chat with clients, I can never stress to people enough the importance in being equipped with a variety of tools and options in your life to create sustainable well-being. What I mean by “sustainable well-being” is bringing calm from within rather than outside. This ensures that in almost any condition you can find calm, and this calm lasts/builds on the last moment, and only has positive or neutral consequences.

If your go-to response to being in or approaching a state of distress is to use alcohol, tobacco, food, marijuana, caffeine, harder drugs or other negative coping mechanisms (such as verbal abuse/conflict with coworkers, friends or family…) as the primary form of coping mechanism, then you are setting yourself up for failure and the tendency to repeat actions and thought processes that actually increase your distress. Not to mention, falling into a regular pattern of abuse of most of the items I just mentioned can lead to addiction which comes with a full set of problems on its own.

man s hand in shallow focus and grayscale photographyOften, when you begin internal work with the efforts to develop sustainable well-being in your life, you are also doing yourself a favor by building the tools to help prevent unnecessary instances of distress. The list that I have researched and complied is not exhaustive of the positive methods you could use. These are just some that I have found extremely helpful both personally and while working in my practice with clients.

Tools for Mental & Physical Well-being:

I have linked very helpful, reputable sources that provide step-by-step guides or videos for continued exploration, for each of the following tools/tips which you will see underlined in the list.

  • Progressive muscle relaxation: This is a simple technique that you can use almost anytime and anywhere to help reduce stress, tension and anxiety. You simply tense one muscle group at a time for 5-10 seconds, then exhale your breath as you release the tension in that muscle group. In addition to helping reduce physical and mental stress, it can help with instances of insomnia!
  • Autogenic training: While Autogenic training is usually done with a counselor or other practicioner guiding you through a relaxing, visual meditation, you can also do it by yourself by listening to a guided audio file. In the link provided, you will find an audio file as well as more information on this form of meditation. The University of Melbourne describes Autogenic Training as “a method for influencing one’s autonomic nervous system. Autogenic Training restores the balance between the activity of the sympathetic (flight or fight) and the parasympathetic (rest and digest) branches of the autonomic nervous system.” woman girl animal dog
  • Deep breathing: Whether you practice 4-square breathing, exhaling longer than the inhale, or sitting/laying with your hands on your belly to feel and recenter your breath and thought, intentional breathing does wonders for both your body and your mind. It helps to regulate emotion, heart rate, and blood pressure.
  • Mindfulness and grounding techniques: These two are pretty closely related. Mindfulness is being aware of your environment (in your mind, and your physical environment around you) without placing judgement on it or dwelling on a thought. Grounding is a technique that helps to recenter your mental state by grounding your thoughts back to the present moment- this can be useful when you are feeling upset or anxious. Both of the links provided have interactive videos that help you understand and practice these concepts.
  • Exercise; Hiking, swimming, and seated exercises are all wonderful low impact ways to get exercise. If traditional “exercise” isn’t your thing, you can incorporate physical activity in everyday activities such as gardening, cleaning and playing a team game/sport. Walking is always a good go-to, and is extremely underrated considering the huge amounts of benefits that it provides. Just 20 minutes of walking a day can help you lead a healthier lifestyle, by improving circulation, weight management, emotional regulation and so much more.
    Photo by Lukas Rychvalsky on Pexels.com
    Photo by Vlad Cheu021ban on Pexels.com
    Photo by Godisable Jacob on Pexels.com
  • Tap into your creativity: Writing, drawing, adult coloring pages, poems, music, dancing, singing are all great ways to re-fresh your mind.
  • Work on your sleep hygiene. The amount and quality of sleep you get plays an extremely important role in your mood and mental state, which effects how you respond to stressors.
  • Stretching helps improve your circulation, which is linked to improved mental clarity and decrease in feelings of anger, sadness and confusion that can be caused by extreme stress. This is because as stretching improves your circulation, your blood flow increases and your heart rate decreases.
  • Talking with a trusted friend or family member can help you release feelings that have started to build up from continuous stressors. Sometimes, you might even get insight from hearing a different perspective on your situation, or coming to a solution that you hadn’t thought of. Regardless, having someone to vent your frustrations to once in a while can be enough and allows you to let out the feelings you may have been keeping bottled up inside.
  • Having a pet to take care of can increase feelings of well-being and decrease loneliness, which is a major contributor to stress for many as we continue to navigate the pandemic.
  • Spiritual or religious practices can give meaning. This does not have to mean organized religion, just the sense of a higher power can give others meaning. This could also be developing a deeper connection to nature.
  • Getting outside can do wonders for your mind and body and increase your feelings of well-being. This is similar to the above mention of using nature to increase your sense of meaning in life, which increases your resiliency. 
  • Decrease drug, alcohol, tobacco and processed food use as these all interfere with mental well-being.
    • With the exception of tobacco and hard/dangerous drugs, some things are okay in moderation. The important thing here is to note your limit (what can trigger you into a downhill spiral of abuse) and to keep it in light MODERATION.
  • Create loose structure in your life; build a routine (you can refer to Caitlyn’s stream and blog post on building a quarantine routine that we posted near the beginning of the pandemic in March)
  • Give yourself affirmations. Affirmations such as “I am strong. I am capable. I am alive” and so on give your life a greater sense of positivity and confidence. One of my favorite guided affirmations is the Loving-Kindness script.

I hope that these tips and resources are helpful to you in your journey towards sustainable well-being in your life! Remember to be gentle with yourself. Change does not occur overnight. Not even for the most motivated individual. What is important is that you are doing at least one thing each day that will help you get to the place where you want to be in life. Who and where you want to be in life is up to you- the most important thing is that you live a life fully of joy, personal stregnth and resilience.

As always, please reach out to myself or Caitlyn Clock to assist you- whether that is creating a quit plan, gaining accountability and support with maintaining your tobacco-free life, and/or anything in-between as it relates to your tobacco reduction goals! Take care.

Amber Jager, CTTS in the Detroit Area: (269)350-3826

Caitlyn Clock, TTS in the Ypsilanti/Jackson Area: (734)961-1077

Building Your Own Quit Kit

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If you’re currently a client in Unified’s tobacco program, or if you’ve ever discussed the tobacco program with another UHHB provider, you might know that one of the services we offer through our program are quit kits. Our quit kits include a variety of items and resources including fidget toys, journals/puzzles/coloring pages, gum/candies, tea bags, outside resources like information for the Michigan Quit Line, and cough drops. However, it should be noted that this is not all a quit kit can contain, and there are multiple ways to add to your quit kit (if you’ve received one from UHHB or another service) or to build your own quit kit.

What is a quit kit?

A quit kit is a compilation of items, strategies, and resources to support someone who is looking to quit or reduce their own tobacco use. A good way to think about quit kits is that they are essentially a toolkit for quitting smoking. Oftentimes, we might think of the quit kit as something that is specifically for an individual’s quit day or only the first week or so of being quit. However, the true purpose of a quit kit is to be there to support you on your quit journey, whether that be your first day tobacco-free or your thirtieth. While this might predominantly be in times of frustration or when an individual is trying to cope with a particularly challenging craving, quit kits can also be there for moments of celebration as people begin to meet their quit goals.

Why is quitting so challenging?

Celebrating quit milestones is more important than people realize, and that’s because quitting is difficult. In our most recent Tobacco Talk Tuesday livestream, we discussed the dual nature of tobacco addiction and how that dual nature is what makes quitting so challenging for most, if not all, of those who are trying to quit smoking. The first part of this is an individual’s physical dependence on/addiction to nicotine. When someone uses tobacco products, the nicotine moves into the brain and activates a receptor that leads to the release of dopamine (a chemical that boosts your mood, motivation, and attention). This process happens within seconds and leaves people feeling great, so when the effects wear off they’re often left feeling stressed, anxious, or tense, which is the result of the body craving the next dose of nicotine. Over time, an individual will build up a tolerance to nicotine, and will therefore need to consume a greater amount in order for them to get the pleasurable effects from smoking. 

The nicotine addiction cycle.
Image from ResearchGate

The second part of this dual nature has to do with how an individual’s tobacco use has infiltrated their daily life. Someone looking to quit smoking must also address the patterns and habits that have become closely associated with their smoking. These might include: their cup of coffee in the morning, meals or snacks, driving, working out, smoke breaks at work, stress, specific places and people, as well as other various situations in which they might reach for a cigarette either before, during, or after it occurring. In order to find success in quitting, people often need to work to change these routines, which on it’s own can be challenging. 

It’s because of this dual nature that we suggest a two-sided strategy and response when it comes to quitting. This is done through a combination of pharmacotherapy (nicotine replacement therapies, Chantix, or Wellbutrin) with some form of behavioral intervention (individual counseling, support groups, or quitlines). 

Planning for your quit kit

Prior to starting your quit kit you might want to consider a few things:

  1. Have you already created a quit plan?
  2. Do you have a quit day (or a practice quit day!)?
  3. What does a typical day look like for you with smoking?
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If you’ve already created a quit plan you might have already considered and likely answered the second and third questions above. If you’ve created a quit plan, your quit kit should include items and resources that will support that plan. If you haven’t worked on creating a quit plan, tracking your smoking habits prior to creating a plan and building your kit may be beneficial. We often suggest individual’s track their habits over two days (a weekday and weekend) and write down what time they smoked, where they were/what they were doing, and how they were feeling at that time. Tracking your smoking habits will allow you to gain an understanding of what changes you might need to make in your daily life. Making sure your quit kit is ready (or at least partially ready) to go prior to your quit day is also important, and it might be useful to test out your quit kit on a practice quit day to see what was helpful and what was not. 

What goes in a quit kit?

When it comes to building your own quit kit, there are very few rules about what you can add to it. The most important thing to remember is that your quit kit should support you and your own quit efforts, and therefore items or resources that will help you cope with cravings or manage specific triggers should be included. The following list of items and resources isn’t a mandatory or even complete list by any means. Rather, it’s here to give ideas and be a starting point for anyone looking to put together their own quit kit.

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  • Fidget toys – bendy straws, stress balls, fidget cubes, putty, pipe cleaners, yarn loops, rubber bands
  • Colored pencils and coloring pages or books
  • Crosswords, Sudoku, or other puzzles
  • Journal and pens
  • Tea bags
  • Gum, mints, hard candies, lollipops
  • Plain or mint toothpicks
  • Cough drops
  • List of smoking triggers (and something you can do instead of smoking in that moment)
  • List of motivations to quit
  • Bubbles
  • List of snacks to replace smoking – carrots, celery, pickles, frozen grapes
  • A picture of something you’d like to buy with the money saved 
  • A planner or calendar 
  • A list of support or people you can call during a tough moment 
  • A book
  • Chosen quit medication(s)
  • Supplies for hobbies 
  • Quit smoking apps like quitStart (iOS, Android), Smoke Free (iOS, Android), and Kwit (iOS, Android)
  • Rewards for quit milestones
  • Recipes you want to try

Maybe some of these ideas have helped you on past quit attempts, or maybe a few will help you on a future quit attempt. Regardless of the items you choose to add to your quit kit, the most important thing is that the contents of your kit are there to support your quitting efforts.

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Have additional questions about quit kits 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 

Understanding E-cigarettes and Vaping

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“Would switching to an e-cigarette be helpful?” is not an uncommon question to hear working in tobacco treatment, even with the nationwide panic over vaping occurring just under a year ago. Since their introduction into the U.S. market in 2007, e-cigarettes have been seen as a way to potentially aid in tobacco reduction/cessation by many, but most specifically the industry’s marketing teams. Additionally they’ve been marketed towards teenagers and young adults through social media and youth-oriented flavors, and as result we’ve seen major growth in use over the last five to ten years. Because of this, it continues to be important to consider the health risks and concerns that come along with e-cigarette use. 

Background

E-cigarettes are a type of electronic nicotine delivery systems (ENDS), and are also commonly referred to as vapes or vape pens, as well as various brand names (example: JUUL). The devices work by producing an aerosol from a liquid that’s heated within the device by a metal coil, which the user then inhales. “E-liquids” are made up of nicotine, glycerin or propylene glycol, flavorings, and various chemicals. The aerosols that are inhaled may also contain  ultrafine particles and heavy metals like nickel, tin, and lead. 

When they were initially introduced to the market, e-cigarettes looked very similar to combustible cigarettes and were a disposable product. Since then, we’ve seen major changes to both the appearance and functional capabilities of these devices – and not necessarily for the better. E-cigarettes and vapes no longer have one design, instead they now might look like pens, lighters, highlighters, USB devices, or even inhalers. In addition to modern generations being refillable and/or reusable, users can modify what is being put into their e-cigarette which leads to the ability to use marijuana and other substances with these devices. 

Growth, Marketing, and Current Use

The first time I saw an e-cigarette was at least 10 years ago in a kiosk in the local mall (those who frequented Briarwood mall in the 2007-2010 might have memories of this as well), and what I remember specifically is that they were primarily being marketed as a way help adults who smoked quit cigarettes. At some point the kiosk was changed, and I didn’t really think about e-cigarettes or other ENDS products for many years. During this time, e-cigarette and vaping companies began to make major strides within the market, with focus shifting from current tobacco users looking to quit smoking to youth and young adults .

E-cigarettes are currently the most commonly used tobacco product among youth in the United States, with over 5 million middle and high school students reporting use within the last 30 days in 2019. Specifically between 2011 and 2015 we saw a 900% increase in use within this demographic. Some (and likely most) of this growth can be attributed to the youth-oriented marketing that has been present in the last 5-10 years. Examples of this marketing include brightly colored ads (like the one below), social media use (including hashtags like JUUL’s #vaporized), promotion through celebrities and “influencers”, and youth-targeted flavors (fruit, candy, and mint). These efforts have succeeded in reaching U.S. youth, with more than 5 in 10 (over 14 million) middle school and high school students reporting seeing e-cigarette advertising in 2018. 

People use e-cigarettes and vapes for numerous reasons. For adults these include: to aid in quitting combustible cigarettes, to get around smoke-free laws/regulations in public spaces, and that they view them as a “safer” or “healthier” option. Youth also often believe e-cigarettes and vapes to be less harmful than combustible cigarettes (many are also unaware that these products contain nicotine) and have cited novelty and flavors as additional reasons for use.

Health Risks

Being a “safer” alternative to smoking is a commonly cited reason for using an e-cigarette, as well as being a belief many have seen used to promote these products by companies and other pro-vaping organizations and groups. Something that is seen far less in these promotions is that “safer” does not mean SAFE. There are still health risks and concerns when it comes to e-cigarette and vaping product use, with more research on long term health impacts still needed. These risks include:

  • Nicotine/nicotine addiction – particularly a concern for those under the age of 25 and pregnant individuals as nicotine is associated with issues with attention, learning, mood, and impulse control within the developing brain
  • Harmful chemicals – including cancer causing chemicals and chemicals like diacetyl (chemical flavoring) which is linked with serious lung disease
  • Inhalation of ultrafine particles and heavy metals such as nickel, tin, and lead
  • Increased likelihood for dual use and increased likelihood for using combustible tobacco products later in life 
  • Unintentional injuries – such as explosions and/or fires caused by defective batteries or poisoning caused by swallowing, breathing, or absorbing e-cigarette liquid through the skin or eyes
  • Secondhand exposure to chemicals via aerosol 
  • E-cigarette or Vaping product use Associated Lung Injury (EVALI) – has been linked with vitamin E acetate and THC containing products, and research continues to look into other causes and risks

You can find more information on health risks and resources for discussing e-cigarettes (particularly with youth) on the CDC, Michigan Department of Health and Human Services, and Surgeon General webpages for e-cigarettes and vaping. 

Regulations 

E-cigarettes are currently regulated at the federal level by the FDA, which implemented regulations for sales and manufacturers, and some regulations to ban flavored (non-menthol) cartridges. Additionally, the FDA began recognizing ENDS as a tobacco product in 2016. In Michigan, we have two laws that currently regulate e-cigarette use and sales which:

  • Define “liquid nicotine” and “liquid nicotine container”, as well as establish minimum safety standards for these containers
  • Define e-cigarettes and vaping products separately from tobacco products
  • Requires these products to be stored in a locked case or behind the counter in vape and smoke shops
  • Prohibits sale to minors 
  • Prohibits use/possession by minors

Like the FDA, Michigan and other states across the country have attempted flavor bans or other regulations of flavored e-liquids. Overall there have been issues with these attempts not being strong enough. Menthol and mint flavors are often not being targeted by these bans, and some brands are able to avoid them through device design, allowing for flavors popular with youth to remain on the market. 

It should be noted that due to some of these efforts and restrictions at the federal and state level, there has been a shift in marketing tactics. Specifically JUUL, the largest e-cigarette and vaping company in the U.S., has removed their candy flavored “pods”, cleared out their social media, and given their website a sleeker and more mature look. With these changes, it appears they (along with other companies like IQOS) are now focusing their marketing on adults who currently smoke or adults who are looking to quit smoking. 

Use in Tobacco Cessation 

One of the most commonly asked questions when it comes to e-cigarettes and vaping products, and the question I decided to start this blog off with, is whether or not these devices are useful in quitting combustible cigarettes and other tobacco products. In a world that loves clear-cut answers, this one will certainly be unsatisfactory, and it is: we don’t know. Like long-term health impacts, there is still a need for more research on this topic moving forward. However, it should be noted by all who are considering using any form of these products that there currently is no evidence to support their usefulness in tobacco cessation. There is also concern that dual-use (i.e. use of an e-cigarette/vape and use of combustible cigarettes/tobacco products at the same time) may occur in those who try to use e-cigarettes to quit smoking. Additionally, e-cigarettes have not been approved by the FDA as an aid for quitting smoking, but there are currently seven approved quit medications that you can learn more about on our most recent tobacco blog.

The bottom line is that while these devices may be safer in some aspects, safer does not mean safe. Specifically, e-cigarettes and vapes are not safe for youth, people who are pregnant, and people who do not currently use tobacco products. There are numerous cessation aids and strategies that have been shown to be successful for people looking to quit their tobacco use, all of which should be considered first and foremost.

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Have additional questions about a blog topic 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 

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 

 

Building Your Quarantine Routine

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It’s fair to say that our lives feel completely different than they did a month ago, with COVID-19 and stay at home orders turning our world upside down. This ever-changing new normal results in the loss of our daily routines and increased uncertainty about what the future may hold. Many of us are experiencing increased feelings of stress, frustration, boredom, anxiety, and depression. As such, it’s important to find a way to establish a sense of normalcy in our daily lives.

COVID-19 and Tobacco Use

For people who currently smoke, there are additional health concerns when it comes to dealing with the COVID-19 pandemic (as discussed in the most recent tobacco blog). COVID-19 is a lung infection, and therefore people who currently use tobacco are at a higher risk of developing more severe and/or prolonged symptoms if they do contract the virus. In addition to physical health, COVID- 19 can contribute to emotional triggers that may lead to an increased want or need to smoke. This can have a negative impact on your goals to reduce or quit your use, or even just increase your tobacco use overall. 

Why bother with a routine?

Having a daily or even a weekly routine can help support your physical and mental health, and help prevent an increased reliance on tobacco products. For some individuals who smoke, their tobacco use may be seen as one of the only things in their life they have full control of, and a global pandemic will likely only contribute to that. Having a routine may help provide structure to your day and give you a sense of control over your daily life during this time. 

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What should my daily routine look like?

It’s important to remember that your routine doesn’t need to look exactly like anyone else’s, have every minute of every day scheduled, or completely deviate from your current (or non-pandemic) routine. Your routine also doesn’t have to incorporate all of the following components, but rather use them as ideas to start structuring your life during the COVID-19 pandemic. 

  • Maintain a sleep schedule – keeping a consistent sleep schedule is important for your health in general, but during quarantine especially. Waking up and going to bed at similar times each day helps keep your days structured and promotes healthier sleep. 
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  • Get dressed for the day – when you don’t have anywhere to go it can be very tempting to remain in your pajamas all day. But getting dressed (or at least changing into something other than what you slept in) keeps your mornings consistent and allows for predictability in your life during an unpredictable time. 
  • Socialize while social distancing – perhaps one of the biggest changes as a result of the stay at home order is our new inability to spend time with other people in person (or at least other people who we don’t live with!). Even for those who often prefer to spend time alone, forced isolation can have a huge negative impact on mental and physical health. Fortunately, we live in a very tech-savvy time and physical presence isn’t always required for socializing with loved ones. Make plans with friends or family to have regular calls, text conversations, or video chat sessions. Or plan to read or watch the same books and movies together (Detroit and Ypsilanti public libraries have options for e-book downloads). 
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  • Get moving –  for most people, increased time at home means less daily physical activity with most of the time we spend walking to or into different places being replaced by more time sitting or lying down. Finding ways to increase your movement throughout the week is important for your overall health, and can help you manage cravings. Take walks, have dance breaks, stretch/do yoga, go up and down stairs, or anything else that may get you moving.  
  • Don’t forget about meal times – eating meals as normal provides structure to your day. Try and eat around the same time each day and try to move to a new location to eat if you find yourself in one spot for most of the day. 
  • Do activities you enjoy – this is NOT going to be a blog that tells you you should be mastering your second, third, or fourth language by now. But, it is a good idea to try and incorporate activities you enjoy throughout your weekly schedule. Planning out time during the week to read, cook, watch favorite movies, knit, play games, etc. is a good way to boost your mood and keep your mind off smoking. This could be something you do for everyday, or for a few times throughout the week. 
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If you’ve read my previous blog, or if you’ve worked with me in the last few months to develop your tobacco reduction/quit plan, you probably know that I often encourage making small changes and building on those to create a larger, positive change. We’ve been dealing with a major change over the last month, and it’s been overwhelming to say the least. Remember the goal with creating a “quarantine routine” is to help deal with that change, support your physical and mental health, and hopefully keep you on track with your tobacco reduction/cessation goals (even if that goal is to just maintain the amount you’re currently smoking!). Pick one or two of the above ideas and see if they help to start, and go from there. Lastly, remember there are some days where routines will just go out the window, that’s normal and it’s okay to need those days!

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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 

An Open Letter to the Trans Communities of Southeast Michigan during COVID-19

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To the trans communities of Southeastern Michigan,

My name is Jack. I am a white trans man who transitioned 7 years ago while living in Northwestern Ohio. I have been involved with community organizing and direct support services for LGBT+ communities since 2011. Currently, I am a medical case manager at UNIFIED – HIV Health and Beyond in Ypsilanti, Michigan.

I feel it is important to write a letter addressed to trans communities during the COVID-19 global pandemic. I know firsthand how isolating being trans can make one feel, both as individuals and within one’s own communities. Now, with social distancing and quarantine mandates, these feelings of isolation are ever-present. For many of us these are scary and uncertain times.

Throughout history, trans people have struggled to live as our authentic selves. Trans communities continue to exist under persecution from powerful institutions that enforce transphobia and transmisogyny. The stress of these oppressions is further exacerbated for Black trans women, as well as other trans people of color. Prisons, medical and social gate-keeping, and policing are just a few examples of these powerful institutions working to keep all of us from truly being free.

At the same time, trans people have been resilient in our battles against oppression. For as long as there have been powers attempting to strip away our dignity and strength, there have also been trans people fighting back. Trans woman scholar and historian, Susan Stryker, says it well: “when people struggling against an injustice have no hope that anything will ever change, they use their strength to survive; when they think that their actions matter, that same strength becomes a force for positive change.” During this time of regional, national, and global unrest, we must remember these words to be true. Our strength has always been within ourselves and each other. The strength trans people hold can and will carry us through to the “other side” of COVID-19.

Many trans people are aware of the disproportionately high rates of suicide, HIV, and violence that our communities face. I know I am not just speaking for myself when I say that these numbers terrify me. Whether I am concerned for my own safety or someone else’s, I try my best to coax my feelings of fear and concern into care for myself and others. My hope for trans communities enduring the stress induced by COVID-19 is that we take care of ourselves and we take care of each other. Somewhat surprisingly, these are the same hopes I had in the pre-COVID-19 world. Often times trans people are not afforded the care and community we deserve solely based on cisgender people’s assumptions and biases of transness. Therefore, it is crucial that we offer care to each other. We should care about our communities at all times and especially now when physical gatherings is not an option.

I feel the current moment will affect each of us in different ways. It may also prompt some tough questions about how we move forward in a world where social distancing and quarantining are temporary new normals.

How do I take care of myself during times of enormous stress?

What are actions I can take to keep myself and people I come in contact with safe?

Do I have the capacity and resources to help people struggling in my communities?

Though these questions may be difficult to ask, let alone answer it serves us to do our best, whatever our best may look like at this moment. I want you to know that we are in this struggle together. Now more than ever is the time to stay connected to our communities.

Please keep yourself safe!

In solidarity,

Jack A. (he/him/his)

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“We All Belong Here” by Micah Bazant

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

Time Management and Tobacco Reduction: Tips to Get Started

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What is Time Management?

In our first tobacco workshop of the year, clients discussed the idea of looking at time management in two different ways:

  1. Having too many tasks, appointments, etc. and feeling as if there isn’t enough time to get them all done.
  2. Having too much free time and not knowing how to fill it.

Both of these situations can be overwhelming, and both can lead to an increase in feelings of stress, anxiety, frustration, and loneliness/depression. Which can result in an increased want or need to use tobacco products. Stress, in particular, is a commonly cited barrier for people attempting to quit their tobacco use, and often plays a role in slips and relapses during quit attempts. 

So how can one start to utilize time management skills in their daily life? Something I noticed when exploring ideas for this month’s blog is that most articles and blog posts offering time management tips revolve primarily around productivity and efficiency in the workplace. While productivity-based skills can be incredibly useful in many settings, they often don’t prioritize an individual’s overall wellbeing. The following list includes my top time management tips.

  • Start Small. It’s important to remember not to overwhelm yourself with major changes, even when they may benefit you in the long run. Scheduling every minute of every day is unnecessary and likely to increase negative feelings if you’re unable to meet those detailed time frames. Start with marking down important appointments and deadlines, and see what else would be helpful from there. 
  • Use a Planner or Calendar. While it seems obvious, using a calendar or planner can help you keep track of appointments, events, and other commitments. Keeping track of these will allow you to make appointments as needed while also helping to prevent you from double or overbooking yourself. Having these things planned out will also allow you to prepare for them.
  • Become a List Maker. Using lists can be incredibly helpful when you feel like you’re just not getting things done that you need to. Not only can they serve as a reminder for what needs to be done today (or tomorrow, or this week, etc), crossing off tasks as you complete them will provide you with a visual of how much you’ve accomplished.
  • Break Up Your Big Tasks. Oftentimes major tasks can seem intimidating and we can end up putting them off to avoid feelings of failure and anxiety. By breaking these big tasks up into multiple smaller ones, you can gain confidence in getting through your to-do list without trying to put them off. 
    • For example: You were sick in bed for a week and missed multiple appointments with your doctor, your case manager, your tobacco treatment specialist, your therapist, and a class. Rather than trying to reschedule everything in one sitting, space the calls (and the appointments) out with breaks in between. 
  • Prioritize! Though time management skills can certainly be helpful, they can’t change the fact that we only have 24 hours in the day and seven days in the week. Take time to determine which tasks are the most important, and which one(s) can wait until you have more time available.
  • Make Time for Yourself. While making it to your appointments and other commitments is important, remember that it’s equally important to set aside time for yourself to do things you enjoy whether that’s reading, taking walks, spending time with loved ones, or watching movies. 
  • It’s Okay to Say No Way. These tips and skills are supposed to help reduce stress, anxiety, and frustration in your daily life. Recognize that it’s okay to let people know when you have enough on your plate for that week and need to schedule for a better time in the future. 
  • Celebrate! With any change in your life, it’s important to remember to recognize your accomplishments even if they seem small. Made it on time to an appointment you’d missed and rescheduled a few times? Have a small treat! Completed a major task that’s been looming over your head for weeks? Give yourself a night where you can focus on relaxing and doing activities you enjoy.

As you begin to plan ways to put some of these tips to the test, remember that different things work for different people. Maybe most of these will work for you, or maybe only one will. Don’t be afraid to adapt these tips to benefit YOU and your time management needs. Ultimately, the goal is to find ways to help manage feelings of stress, anxiety, frustration, depression, and boredom that might lead to an increase in your tobacco use. 

Interested in finding out more about Unified’s Tobacco Reduction services? Contact your office’s 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.

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  • 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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agility balance beautiful girl dancer

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)

adult athlete body exercise

 

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.

woman in black sleeveless crop top and white leggings using a butterfly machine in front of a mirror

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.

women having exercise using dumbbells

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.

woman girl silhouette jogger

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.