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.

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. 
Group of people reading and borrowing books

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!

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

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.

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  • 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.

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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 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.

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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.

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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.

Tobacco Reduction Program Services

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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

From Day One to Today: Becoming a PLHIV

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 By: Jonathon Arntson

Hello there. I’m Jonathon. I work at UNIFIED –  HIV Health and Beyond as the Health Education Coordinator. Three plus years ago I became HIV+. Since then I’ve experienced my ups and downs, but I keep myself getting through it with support from friends and family, helping others where I can, and maintaining a sense of humor no matter what. One way in which I am doing that is to share my experiences (adventures?) as a person living with HIV (PLHIV) who also works in the field. You can look forward to me sharing those with you a couple times a month. It’s my hope that my writings will prompt us to engage in progressive discussions about the state of HIV today. I also hope that anyone reading will be inspired to share their own stories. I shared my first day story on thebody.com. You can view it here and you will see snippets peppered into my ongoing posts. 

After I tested positive, I received the “first day” welcome kit of a blood draw, pamphlets, referrals, and you-must-use-condoms-now finger-waggings . Then, I arrived home to begin coping. I felt like I was beginning the same transition you witness in old vampire and werewolf films.

I noticed little changes here and there. After a while, the changes felt deeper like every bug bite or blood cell had mutated into weird little monsters. After a while, I didn’t even realize I had a fever until it began dissipating. I fell asleep and woke up a few hours later. But instead of waking up with powers or sharper teeth or fur all over, I felt exactly the same. And the fever had been a result of emotions. My blood felt the same inside me, and I would soon learn it looks the same. I was beginning the (still ongoing) grieving process.

Although I was still reeling from the werewolf episode, the day after my confirmatory result was also my first day back at work. At the time, I was working at a housewares store–the brand at which I had worked for five intermittent years. When I started that night’s shift, I’d mostly forgotten about my transition into a mutant. As happened too often at this job, I cut my finger on something. Getting cut is inevitable at this home store. Between glass, cardboard, splintered wood, and unloading trucks, getting cut is inevitable at this homestore; I endured hands covered in bandages on the weekly. I did not see it coming but this first day as a new creature gave me a crash-course in accepting myself as-is.

As soon as I cut my finger on a broken vase that a customer left sitting on a shelf, I was transported to a Tarantino film.

Blood sprayed from my hand, and then from my fingertips. Each blink changed my surroundings between neon colors like I was in an early iPod commercial-turned-horror film. I rushed to the restroom, locked myself in, grabbed a wad of paper towel, and crouched into a vertical version of the fetal position. I stayed in the restroom for half an hour as I worried about what I should do. I knew I needed to rinse off my hand but I was afraid to get blood on the faucet handles.

I finally overcame my dread and turned on the water. Instead of sticking my now mostly dried, bloody hand into the water, I plunged my face into the cascade and washed away the irrationality. I cleaned my hands, cleaned the minimal blood off the sink, and left the restroom to dress the wound as though nothing was out of the ordinary. To this day, I still have a small panicked feeling when I see my blood. This feeling diminishes the more I learn about HIV and how being undetectable equals untransmittable.

Speaking of undetectable, I will be sharing many posts grappling with the drama and trauma of being a patient and a case worker/educator.

Months after testing reactive, I volunteered at UNIFIED (formerly AIDS Partnership Michigan). I didn’t know how to talk about HIV or what I was going through. It was easier to say I was “fine” and gulp than to own up to my not knowing what the hell to do or say.

But I showed up, answered calls on the Michigan HIV/STD Hotline (800-872-2437), and covered the front desk. My time volunteering allowed me to hone my communication skills while building confidence in the facts surrounding HIV and how I engaged with them.

I then gained knowledge and confidence working on and off with CARES of SW Michigan and Mr. Friendly to co-facilitate weekend camps for positive men. We learned about disclosure, healthy relationships, and the ongoing science behind HIV. This involvement put me right in the middle of being a person with HIV as well as a counselor for my peers.

I spent my first year employed with UNIFIED as a Linkage to Care Specialist. I worked with newly diagnosed individuals, those who had fallen out of care, and those who had recently relocated to Metro-Detroit. I went through Linkage to Care as a client and when I had the opportunity to switch sides and become the specialist, I was anxious and excited. I had never had a “real job”  before. Taking that opportunity lead me to an even better one, and two months ago I became the Health Education Coordinator at UNIFIED. This position has me in charge of support and education groups, building and maintaining partnerships with peer AIDS service organizations (ASOs), medical clinics, and community agencies offering services to address needs well beyond HIV care.

Beside working at UNIFIED, I participate in panels and discussions as a PLHIV, work on the draft of an autobiography, and write letters to my legislators imploring them to support drastic augmentation to the Michigan HIV Disclosure Law. Lastly, I am working on a website that will offer a space for PLHIV and their loved ones to share their stories. This project has many logistics and barriers to deal with and I am moving very slowly. If you are inclined to help, I would never decline.

Thank you for reading and I look forward to offering you more insights and anecdotes about how I got to being more than just “fine.” Whew. It was really nice to write about myself without it being on a dating app.

Love, Jonathon

social media:

Facebook: jonathon.arntson

Instagram: @themanwiththemichigantattoo

Twitter: @monkeyboydet