Changes to Celebrate When Quitting Tobacco

Clients involved in our tobacco use reduction program generally have the same goal– becoming tobacco free. When you quit tobacco, your body and brain experience physical changes as they adapt to the lack of nicotine and tobacco. Quitting tobacco also involves starting new habits and changing your overall lifestyle. The process of quitting tobacco can feel overwhelming and frustrating, especially when you haven’t achieved your end goal yet.

However, it is important to give yourself credit for everything you’ve achieved so far. Even if you are still in the process of becoming tobacco free, your health has likely benefited from the changes in your routine and mindset. Recognizing and giving yourself credit for these accomplishments is important and can help you stay motivated in your journey. So what changes can you expect to see when quitting tobacco?

You’re developing healthier coping skills

Smoking can become an automatic response to stress, anger, and other unpleasant emotions. Between tobacco’s addictive nature and the way it easily becomes a habit, it is not uncommon for smoking to become an unhealthy coping mechanism. When quitting tobacco, it is important to identify situations where you are using tobacco as a coping skill. The next step is replacing the habit of smoking with other healthier behaviors. Discovering and implementing healthy coping skills is a huge victory when quitting tobacco. Not only can these skills help with reducing smoking, but they also help with stress management and living an overall healthier lifestyle.

You can go longer without smoking your first cigarette

One of the ways nicotine dependence is measured is by how soon after waking up you have your first cigarette. Since you are not using tobacco while you sleep, your body tends to go into withdrawal overnight. This is the reason people tend to crave a cigarette as soon as they wake up. Being able to go longer without your first cigarette of the day is a sign that you are becoming less dependent on nicotine. Even being able to go a few minutes longer without reaching for a cigarette is worth celebrating.

You know when to walk away from triggering situations

Learning to accept and cope with difficult situations is important, but there is also value in knowing when to walk away. Quitting tobacco might involve saying no to or leaving situations where you’ll have to urge to smoke. For example, the smell or sight of a cigarette is a common trigger. Learning to remove yourself from these situations can not only help you with tobacco cessation, but it can also teach you how to better manage situations that could damage your general health. The way you manage your triggers may also change over time. You might initially need to walk away from a situation, but with time you might learn how to better manage said trigger.

You can prevent slips from becoming relapses

When discussing quitting tobacco, a ‘slip’ refers to a singular incident of smoking whereas a ‘relapse’ refers to going back to your previous habits . Slips are very common, but they don’t always have to lead to relapsing. Instead of beating yourself up over a slip, focus on what you can learn from it. Reflecting on your slip– where were you, what were you doing, and how were you feeling– can help you better understand your triggers along with what is and isn’t a helpful strategy to manage them.

You’re able to accept yourself and your life as they are

Accepting what you can and can not control is key to making lifestyle changes, such as quitting tobacco. Triggering situations may be out of your control, and life may not go as expected even when we feel in control. Radical acceptance is a term that refers to accepting yourself and your life as they are rather than dwelling on what could be different. Learning acceptance takes practice, but feeling unable to accept reality can increase the pain in distressing situations. On the other hand, radical acceptance also involves giving yourself credit and accepting positive situations. It may be difficult to accept that you haven’t been able to completely quit tobacco, but there is also value in accepting the progress that you’ve made.

Becoming tobacco free can feel overwhelming as the process takes time and patience. Breaking it down into smaller steps and learning to recognize the small victories can make cessation feel more achievable. Realizing what you’re gaining from quitting smoking can help you stay motivated. If you’re feeling stuck in your cessation efforts, UNIFIED’s tobacco reduction program can help you create a plan to keep moving forward.

If you would like to learn more about tobacco reduction and cessation, please contact our team:

Caitlyn Clock (313)-316-7561

Exploring the Environmental Impact of the Tobacco Industry

^{Bird feeding a cigarette butt to its chick. Photo: Karen Mason / Audubon}

What do you think is the most littered item: plastic bottles? Possibly straws?

The number one most littered item is actually cigarette butts. Contrary to popular belief, cigarette filters are not biodegradable, and as the cellulose acetate they contain breaks down, tiny pieces of plastic are spread into the environment. Microplastics have been found in every stage of the food chain, our drinking water, even the air we breathe. In fact, it is estimated that, on average, we could be eating as much as a credit card worth of plastic each week.¹ How many cigarette butts do you think you’ve eaten?

Cigarette butt pollution is a very visible indicator of the damage the tobacco industry has on the environment, and it is only a small part of a large, global problem. The World Health Organization released a report this year on the environmental damage the tobacco industry causes through deforestation, depletion of resources, chemical waste, and carbon emissions. This report, along with other recent publications, illustrate the ways the tobacco industry poses a serious threat to the health of our planet through the manner in which commercial tobacco products are grown, manufactured, and discarded.²

A Growing Problem

The topic of climate change seems to get hotter every year, much like the average temperature of the planet. As fossil fuel use adds excessive greenhouse gases into the atmosphere and deforestation removes the natural processes that offset these gases, the ability of the earth to release heat into space diminishes.³ The tobacco industry is a major contributor to deforestation. Forests are clear cut to create farmable land for commercial tobacco production. Combined with the trees used in the curing process, a total of approximately 200,000 hectares of forest is lost each year. For context, that would be a forest the size of Yellowstone National Park leveled in less than 5 years. It is estimated that 5% of total annual deforestation is related to the tobacco industry.

The soil in which tobacco is grown can become unsuitable for other crops, which compounds issues of food scarcity in the lower income countries where these farms are mainly located. Nicotine exposure is difficult for farmers to avoid, and studies show that people working on these farms are exposed to the equivalent of 50 cigarettes per day. Symptoms of “green leaf sickness”, a common name for nicotine poisoning, are prevalent. Tragically, many of those who work on these farms are children.⁴

^{Young child binding tobacco leaves by hand.} ^{Photo: Marcus Bleasdale/Human Rights Watch Quote: British American Tobacco / Report}

As mentioned above, the curing process requires significant deforestation. These trees are burned, releasing chemicals into the atmosphere. Once cured, the tobacco is transported to manufacturing facilities then on to distribution centers and consumers, generating significant carbon emissions. Chemical waste made during the manufacturing process often makes its way into water systems where it disrupts ecosystems. E-cigarette manufacturing is more difficult to describe in terms of environmental impact due to limited data, but it is speculated that these products require even more environmentally taxing processes.⁵

Only You Can Prevent Dumpster Fires

E-cigarette components present a new, unique concern for the planet compared to the aforementioned cigarette butt. Plastic, metals, nicotine, filler compounds, flavor additives, batteries, and the other materials that comprise the 460+ brands⁶ of e-cigarettes are improperly discarded with increasing frequency. Littered e-cigarettes are a complicated problem, but disposing of these devices responsibly is also difficult. Liquid nicotine is legally classified as a hazardous waste, and many types of e-cigarette must be disposed of at specialized facilities. Due to lack of information, consumers often throw e-cigarettes directly into their regular trash or recycling. There are increasing incidents of garbage truck and dumpster fires related to the lithium ion batteries found in e-cigarettes.

Fraction of environmental impact of tobacco industry by stage. ⁷

The above graph published in Environmental Science & Technology shows that tobacco farming (medium blue), curing (yellow), and manufacturing (light blue) have the most impact on the environment. Tobacco companies attempt to shift the emphasis on the consumer when it comes to environmental responsibility. They use greenwashing strategies to improve their appearance and send an “only you” message concerning the prevention of tobacco waste.

Greenwashing refers to an entity, namely a company, cultivating an image of eco-friendliness to distract from their harmful environmental impact. Tobacco companies publicly donate to events such as clean ups and run campaigns on the importance of proper cigarette butt disposal. Additional emphasis is placed on “green” business operations, such as the use of electric vehicles or reduction in office waste. As the graph clearly shows, however, the majority of the environmental impact occurs far from corporate offices and before the consumer is sold the product. In the big picture, clean ups and donations are performative marketing.

Natural American Spirit greenwashing ad that ran in magazines such as *Vogue* and *Rolling Stone* promoting “cleanup challenges” for Earth Day. Photo: Trinkets and Trash

The More You Know

The World Health Organization, among others, is working to bring to light the damage that the tobacco industry is causing and the strategies these companies use to shift responsibility onto the consumer. Governments worldwide are beginning to put more pressure on these companies to take responsibility and to move toward more sustainable practices. In the meantime, consumers can educate themselves on how to dispose of their waste. The FDA provides information on how to properly dispose of e-cigarettes. There is a county directory of Michigan recycling and hazardous waste contacts that can also be a good place to start.

The relationship between the environment and the tobacco industry is a complex, evolving subject. For further reading, check out the 2022 WHO publication Tobacco: Poisoning Our Planet. The Truth Initiative is also a reliable resource for information on topics like e-cigarette waste. Tobacco Tactics has well researched articles on subjects such as greenwashing. Finally, the infographic below provides a visual summary of the facts discussed above and other interesting, eye-opening pieces of data.

If you would like to learn more about tobacco reduction and cessation, please contact our team:

Melissa Small – Ypsilanti/Jackson Tobacco Treatment Specialist

(734) 329-9223

Monica Allen – Detroit Tobacco Treatment Specialist

(313) 949-2938

References:

Kala Senathirajah, Simon Attwood, Geetika Bhagwat, Maddison Carbery, Scott Wilson, Thava Palanisami, Estimation of the mass of microplastics ingested – A pivotal first step towards human health risk assessment, Journal of Hazardous Materials, Volume 404, Part B, 2021,124004, ISSN 0304-3894, https://doi.org/10.1016/j.jhazmat.2020.124004. (https://www.sciencedirect.com/science/article/pii/S0304389420319944)
Tobacco: poisoning our planet, World Health Organization, 2022, ISBN 978-92-4-005128-7
Dean, Annika, Deforestation and climate change, August 21, 2019, https://www.climatecouncil.org.au/deforestation/#:~:text=Burning%20fossil%20fuels%2C%20in%20combination,carbon%20sinks%20such%20as%20forests.
Larson, Nina, Big tobacco’s environmental impact is ‘devastating’: WHO, May 31, 2022, https://phys.org/news/2022-05-big-tobacco-environmental-impact-devastating.html
Tobacco and the Environment, Tobacco Tactics, updated 30 May 2022, accessed 01 August 2022. https://tobaccotactics.org/wiki/tobacco-and-the-environment/
NIDA. 2020, January 8. Vaping Devices (Electronic Cigarettes) DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/vaping-devices-electronic-cigarettes on 2022, August 2
Cigarette Smoking: An Assessment of Tobacco’s Global Environmental Footprint Across Its Entire Supply Chain, Maria Zafeiridou, Nicholas S Hopkinson, and Nikolaos Voulvoulis, Environmental Science & Technology 2018 52 (15), 8087-8094, DOI: 10.1021/acs.est.8b01533

5 Tips for Setting Boundaries While Quitting

In my personal and professional life, it is not uncommon to hear about tension between those trying to quit tobacco and others in their lives. Friends and family can serve as a great support system, but they can also unintentionally become a barrier to quitting. It can be difficult to navigate your reduction journey when those around you continue to smoke or be unsupportive. Common advice, such as ‘get new friends’ or ‘just avoid smokers’, tends falls flat for folks who have deeper relationships with people who are unable to support them on their quit journey. So how do you balance quitting tobacco while maintaining relationships with others?

Having and learning to set boundaries allows you to keep a healthy connection with friends and family. The term ‘boundary’ has become a buzz word recently, but what exactly does it mean? A boundary refers to that imaginary line between you and others; it separates your physical and emotional needs, feelings, and responsibilities from others. Boundaries exist in every aspect of our lives, whether it is needing privacy from roommates, being uncomfortable with certain sexual activities, or refusing to do certain tasks at work. Everyone has boundaries, but it takes time and practice to learn what yours are and how to express them.

Boundaries are a powerful tool for those attempting to reduce or quit tobacco. Your boundaries might look like refusing to buy cigarettes for others, being able to walk away from people who are smoking, or any other limits you have to maintain your quit. Setting boundaries is easier said than done, but with practice they are a great way to protect your needs and your relationships with others. So how do you actually use boundaries in real life?

1. Focus on what you can control

Setting boundaries allows you to express what you need from others. However, you can not control others’ behavior. When setting boundaries, it is important to focus on what you can control: yourself and your actions. Boundaries are a reflection of your own needs, values, and comfort. Though it can be difficult at first, it is up to you to learn what your boundaries are, how to communicate them to others, and how you can respond to them being crossed.

2. Set boundaries before they are crossed

Once you’ve realized the boundaries you need to set, it can be helpful to communicate them to others before they get crossed. Communicating what you need before you’re in a tough situation can allow you to express yourself with a clear mind and avoid resentment in your relationships. For example, you might consider letting friends know you’re working towards quitting and are currently uncomfortable being around others while they smoke. Communicating ahead of time can help you avoid triggering situations, whether that means your friends going outside to smoke or them knowing why you may need to walk away when they smoke.

3. Don’t assume others’ intentions

When others are unable to respect our boundaries, it is natural to feel frustrated and hurt. Boundaries exist to keep us emotionally and physically safe, and it is important to build relationships where you can respect each other’s boundaries. However, we also don’t know others’ intentions when they can’t respect our boundaries. Someone who continues to offer you cigarettes, doubt your ability to quit, or be unsupportive in other ways may be unaware of how hurtful their actions are. Their behavior is more likely a reflection of their beliefs and values; they may view smoking as a way to connect or might not understand how important quitting is. This does not excuse their actions, but being able to take a step back and avoid assumptions can help us avoid resentment.

4. Boundaries help save relationships

At first, having boundaries can seem like a wall between you and others. Setting boundaries can be uncomfortable and may change the dynamics of your personal relationships. However, everyone has personal boundaries and expressing them can actually strengthen relationships. Having relationships where you both can comfortably express what you need from one another can help create safety and respect between each other.

5. Learn how to respond when boundaries are crossed

After setting a boundary, it is your responsibility to stand firm in what you need and learn how to set consequences when others can’t respect that. Boundaries are an opportunity to teach others how to treat you. If someone continues to cross your boundaries, it is time to determine how to distance yourself from harmful situations. This might look like walking away from or refusing to be in situations where your boundaries to be crossed, but it can also be a chance to create spaces where your boundaries will be honored.

If you would like to learn more about tobacco reduction and cessation, please contact our team:

Melissa Small – Ypsilanti/Jackson Tobacco Treatment Specialist

(734) 329-9223

Monica Allen – Detroit Tobacco Treatment Specialist

(313) 949-2938

The True “Cost” of Tobacco

At least two things about cigarettes are popularly understood: 1. They are extremely harmful to your health. 2. They are expensive. But “expensive” is a subjective term. What is the personal cost of smoking? And what is the more broad economic impact of the tobacco industry? While there is no simple answer to these questions, there is much to explore regarding the financial, medical, and environmental burden of commercial tobacco use.

Individual Cost, Communal Bill

The average cost for a pack of cigarettes in Michigan today is $8.27.¹ To put that into perspective, the average Michigan smoker of median income would spend roughly 7% of their earnings on cigarettes.^{2 3} There are other direct and indirect costs of tobacco use. Smokers can pay as much as 50% higher on health insurance premiums⁴, and copays for medications and frequent office or hospital visits add up quickly. There is also opportunity cost, or the loss of potential gains from using funds for tobacco and tobacco related illness rather than investing into other aspects of life. One study estimated the total lifetime cost of smoking for an individual in Michigan was $2,193,645.⁵ Smoking, and the use of other tobacco products, is a heavy expense for the individual, but it also places a heavy financial burden on society.

Direct and Indirect Cost

The CDC reported that the U.S. spends $226.7 billion in one year on public and private health care costs related to tobacco use. Over half of this figure is tax funded. For perspective, that averages to each household paying $1,223 in taxes yearly just for tobacco related health care expenses. The CDC report states there is an additional $6.99 billion in health care costs related to secondhand smoke.⁶ Tobacco related illnesses also demand medical resources, and delays in care can increase the severity – and cost of treating – other patients.

Exploring the Environmental Cost

The treatment of tobacco related illness requires significant energy use and creates a massive amount of medical waste. This, along with the environmental damage related to production and consumption of tobacco products, contributes to a growing economic and existential problem. The White House recently released a report which claimed that by 2100 extreme weather events related to climate change could cost the country $2 trillion each year.⁷ It is difficult to estimate the economic impact of something as nebulous as the tobacco industry, which requires significant deforestation, water consumption, and carbon emissions to operate. One study found that the cost to simply address pollution caused by cigarette butts in the 30 largest U.S. cities was $264.5 million each year.⁸ Concern has been raised about even greater danger posed by electronic cigarette pollution.

Liability, Lies, Limits

The cost to address these problems must be borne by someone, and the tobacco industry is spending a fortune to deflect that responsibility onto the individual, with society ultimately left to pick up the bill. It’s a tough battle for anti-tobacco activists. In 2020, tobacco companies spent $28.2 million lobbying Congress alone.⁶ Accountability is a hard sell when tobacco companies are able to legally pay politicians, spend $23 million a day on marketing, and sponsor their own “research”. Perhaps, though, the fact that tobacco companies need to spend so much to survive is a positive sign. As our society continues to gain better understanding of personal wellbeing, the broad implications of public health, and the danger of climate change, the facts will be too loud to hush. The simple conclusion is that the true cost of tobacco will always be too much.

Further reading:

This Smokefree.gov calculator shows how much money is saved over time after quitting cigarettes.
ASH (Action on Smoke and Health) provides a wealth of information on the effects of the tobacco industry and what legal/policy measures can be taken to eventually end tobacco related deaths.
Tobacco Free Funds provides information on funds that invest in tobacco manufacturers or entertainment agencies that promote tobacco use.

If you would like to learn more about tobacco reduction and cessation, please contact our team:

Melissa Small – Ypsilanti/Jackson Tobacco Treatment Specialist

(734) 329-9223

Monica Allen – Detroit Tobacco Treatment Specialist

(313) 949-2938

References

1: “Cigarette Prices by State 2022” World Population Review. Retrieved from: https://worldpopulationreview.com/state-rankings/cigarette-prices-by-state
2 & 3: Calculated using (average cost x average consumption) divided by median income.
2: “US Households Number of Cigarettes Smoked on an Average Day 2020” Statista. July 2021 Retrieved from: https://www.statista.com/statistics/275993/us-households-number-of-cigarettes-smoked-on-an-average-day/
3: “Median Individual Income in Michigan” Data Commons. Retrieved from:
https://datacommons.org/place/geoId/26?utm_medium=explore&mprop=income&popt=Person&cpv=age%2CYears15Onwards&hl=en
4: “Marketplace Premiums Rise Faster For Tobacco Users Because Of Subsidy Design.” HealthAffairs. September 2020. Retrieved from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00015
5: “The Financial Cost of Smoking by State” WalletHub. January 2022. Retrieved from: https://wallethub.com/edu/the-financial-cost-of-smoking-by-state/9520
6: “The Toll of Tobacco in the United States” Tobacco Free Kids. November 2021. Retrieved from: https://www.tobaccofreekids.org/problem/toll-us
7: “The Future Cost of Climate Inaction 2 Trillion a Year Says the Government” NPR. May 2022. Retrieved from: https://www.npr.org/2022/04/07/1091258821/the-future-cost-of-climate-inaction-2-trillion-a-year-says-the-government
8: Schneider, J. E., Scheibling, C. M., Peterson, N. A., Granados, P. S., Fulton, L., & Novotny, T. E. (2020). “Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities.” International journal of environmental research and public health, 17(13), 4705. https://doi.org/10.3390/ijerph17134705

FDA Proposed Menthol Ban

In April of 2022, the U.S. Food and Drug Administration proposed a ban on the manufacturing and sale of menthol cigarettes and cigars. The FDA hopes this ban will “help prevent children from becoming the next generation of smokers and help adult smokers quit” along with reducing health disparities. Previous legislation has banned flavors, with the exclusion of tobacco and menthol, in cigarettes and e-cigarettes. It is important to note that the ban would target those making and selling menthol cigarettes, but it would not punish those who possess menthol cigarettes. This distinction allows Big Tobacco to experience consequences without penalizing those struggling with addiction.

Menthol may be one of the most popular flavors for tobacco products, but people may not be familiar with what it actually is. A chemical naturally found in peppermint, menthol can be described as minty and cooling. This flavoring may make smoking feel less harsh and seem healthier, but menthol can actually make it easier to start smoking and make it more difficult to quit. Studies have found that those who smoke menthol are less likely to quit when compared to those who smoke non-menthols.

Not only are menthol cigarettes designed to be more addictive, but they have also historically targeted African Americans through their marketing tactics. Mentholated brands, such as KOOL and Newport, have been advertised in Black publications and other media. Big tobacco also has a history of sponsoring Black events and organizations. For example, Philip Morris (owner of Marlboro, Virginia Slims, and other brands) has sponsored the National Association for the Advancement of Colored People, the Urban League, and the United Negro College Fund. There are countless examples of Big Tobacco targeting African Americans and other minorities. Bans and regulations surrounding tobacco may prevent future generations from being impacted by the tobacco industry’s marketing, but decades of targeting have already damaged many individuals and communities.

By banning menthol, the FDA can work towards making tobacco less appealing and accessible. Not only could it prevent younger generations from using tobacco, but banning menthol could also act as an incentive to help those who currently smoke quit. As tobacco becomes more regulated and restricted, the tobacco industry loses its ability to influence more people to smoke. For more information on the proposed ban, you can check out the FDA’s official Press Announcement.

If you’re interested in learning more about tobacco reduction and cessation, please contact our team:

Monica Allen, Detroit Tobacco Treatment Specialist

(313)-949-2938

Melissa Small, Ypsilanti/Jackson Tobacco Treatment Specialist

(734)-329-9223

Unpacking Tobacco Use in the LGBT+ Community

The decline of tobacco consumption throughout the previous decades is worth celebrating. Increased tobacco cessation programs, awareness surrounding the health effects of tobacco, and legislation to limit consumption have worked together to create an environment where more people can either quit tobacco or not start smoking at all. However, this decline has not affected all people and communities equally. Rates of tobacco use among the LGBT+ community have remained disproportionately higher than in the general population.

National data from 2016 shows that the rate of tobacco use among lesbian, gay, and bisexual adults is 20.5% compared to 15.3% in heterosexual adults. There are even larger disparities for transgender adults as 32.6% of transgender adults currently use tobacco compared to 23.6% of cisgender adults. For transgender youth, the rate of smoking cigarettes is nearly 4x compared to cisgender youth. These disproportionately high rates remain consistent among all tobacco products, and more information on how tobacco use compares within the LGBT+ community can be found here.

Big Tobacco and the LGBT+ Community

When we discuss differing rates of tobacco use, it is important to examine why these disparities exist. Big tobacco has strategically marketed to the LGBT+ community through LGBT+ publications and events. In particular, R. J. Reynolds (the parent company of Newport, Camel, Pall Mall, and Doral) launched Project SCUM (Subculture Urban Marketing) in the 1990’s. This campaign targeted the LGBT+ and homeless populations in hopes of increasing their tobacco use. R.J. Reynolds is not the only company to market cigarettes as a normal and exciting part of LGBT+ life. Other companies within big tobacco have exploited the community through targeted advertisements, sponsoring pride events, and funding LGBT+ and HIV/AIDS organizations. These marketing tactics may no longer exist today, but their impact on the health of the community remains.

How Health Inequities Impact Smoking Cessation

Beyond the history of what led more folks within the LGBT+ community to start using tobacco, there are also barriers that make quitting more difficult as well. LGBT+ individuals are more likely to experience discrimination or have negative experiences with healthcare providers. Providers may be ignorant or have preconceived notions regarding LGBT+ health issues, which can lead to inadequate care or a lack of care altogether. One study found that 18% of LGBT+ individuals reported avoiding seeking out healthcare due to fears of discrimination. When discrimination around one’s identity is combined with the stigma surrounding tobacco use, it can be challenging to find a provider who is empathetic and committed to addressing everyone’s unique needs.

LGBT+ folks are also more likely to experience financial barriers when seeking out healthcare. The Affordable Care Act and legalization of same-sex marriage have helped to provide health insurance to the LGBT+ community, but healthcare still remains unaffordable for many. Though data on LGBT+ health is limited, it is suggested that LGB adults are more likely to avoid necessary care due to cost. Transgender adults experience the same inequity when it comes to the cost of care, and they are also less likely to have insurance compared to cisgender adults. These inequities can make it more difficult for LGBT+ folks to receive nicotine replacement therapy, counseling, and other cessation support.

Tobacco Reduction and Cessation Resources

Learning about health disparities can be discouraging, but more people are taking the time to educate themselves on these inequities and work to change them in their personal and professional life. Southeast Michigan has various organizations that provide physical and behavioral healthcare to the LGBT+ community.

Here at UHHB we provide inclusive care and resources to people living with HIV in the Detroit, Ypsilanti, and Jackson areas. This includes our tobacco reduction program that offers counseling, support groups, and other resources to individuals looking to reduce their tobacco use.
Ruth Ellis Center in Detroit has a variety of services for LGBT+ youth and young adults, including a Health and Wellness Center with behavioral health services.
The Corner Health Center in Ypsilanti offers physical and behavioral health services to LGBT+ youth, including support with tobacco reduction.
Ozone House provides shelter and support for at-risk youth. Some of their programs include LGBT+ support groups, counseling, and substance use support.
LGBT Detroit supports the Detroit LGBT+ community through advocacy and education. They offer various programs to provide a safe space and increase the wellbeing of Detroit’s community.

Building Your Own Quit Kit

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:

Have you already created a quit plan?
Do you have a quit day (or a practice quit day!)?
What does a typical day look like for you with smoking?

This image has an empty alt attribute; its file name is screenshot-3.png

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.

This image has an empty alt attribute; its file name is usethisjournalimagecait.jpg

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.

–
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

“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

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).

happy man funny sticking tongue out

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.

beach woman sunrise silhouette

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

black ball point pen with brown spiral notebook

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

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.

Characters of people holding time management concept illustration

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.

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).

Characters of people and their social network illustration

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!

–

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

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

You’re developing healthier coping skills

You can go longer without smoking your first cigarette

You know when to walk away from triggering situations

You can prevent slips from becoming relapses

You’re able to accept yourself and your life as they are

Share this:

Like this:

A Growing Problem

Only You Can Prevent Dumpster Fires

The More You Know

Share this:

Like this:

Share this:

Like this:

Individual Cost, Communal Bill

Direct and Indirect Cost

Exploring the Environmental Cost

Liability, Lies, Limits

References

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Your Guide to Pharmacotherapy for Reducing or Quitting Tobacco Use

Nicotine Replacement Therapy (NRT)

Quit Smoking Medications

Additional Notes

Share this:

Like this:

Share this:

Like this: