Find help quitting smoking
Call the Ohio Quit Line at 1-800-784-8669 for counseling over the phone and incentives for quitting.
Visit online at www. ohio.quit.logix.org.
Check with your insurer to see if they have incentive programs to stop. The five Medicaids in Ohio (CareSource, Buckeye, United Health Care, Molina and Paramount) offer incentives.
Nicotine addiction brings more veterans to the Cincinnati VA Medical Center for treatment and counseling than depression and post-traumatic stress disorder.
About 17 percent — 7,200 — of the 43,000 patients who visit the Cincinnati VA each year are treated for tobacco use disorder, using a handful of evidence-based therapies, said Dr. Shannon Miller, acting director of addiction services.
“Of all the addictions treated, tobacco is the most likely to kill (the patient),” Miller said.
But veterans aren’t the only ones affected by nicotine addiction. Nationally, half of all hospital beds occupied are for tobacco-related diseases that kill 488,000 people per year. It’s the No. 1 preventable death, but still kills more than suicide, fires, drugs and crashes combined, according to Miller.
“When you look at all the medical problems that come from tobacco, the scope is so wide,” Miller said, including cardiovascular disease, lung cancer, diabetes, asthma and infection.
Tobacco costs the U.S. more than $300 billion annually, including $170 billion in direct medical care for adults and $156 billion in lost productivity, according to the Centers for Disease Control and Prevention. Roughly $5.6 billion of that total is due to second-hand smoke exposure.
Dr. Clifford Cabansag, addiction medicine physician and tobacco treatment specialist at Lindner Center of HOPE in Mason, said tobacco is such a large problem for several reasons, including it’s legal, can be purchased most anywhere and is conveniently placed right behind the cashier at gas stations.
The tobacco industry spends more than $9 billion a year on cigarette advertising and promotion. In 2014, 264 billion cigarettes were sold in the U.S. — down from 273 billion in 2013, according to CDC.
Cabansag said Joe Camel is as recognizable to children as Mickey Mouse.
“It’s insidious,” he said.
While the rate of smokers continues to decline, it’s still tough to quit once you’ve started. It takes a smoker between four and eight attempts at quitting before sustained success, according to local addiction experts.
Local smoking cessation efforts include three programs by Butler County, including those targeted to expectant mothers and middle school and high school students. The Lindner Center of HOPE is also participating in a ground-breaking study looking at the use of electromagnetic energy to reduce cravings.
Vietnam War veteran Mark Klaene, 65, who lives in Hamilton County, receives smoking cessation assistance through the Cincinnati VA. He attends a weekly support group at a VA clinic in Dearborn County, Ind.
After 40 years of smoking, and several unsuccessful attempts, Klaene has now been smoke free since May 17, 2014.
“I consider it an ongoing challenge,” Klaene said, who first started as a teenager.
Klaene said the Cincinnati VA also helped him establish a plan for quitting, set a reasonable quit date and set him up with nicotine replacement therapy.
“I set a realistic quit date and started preparing; a lot of it is mental,” Klaene said. “Most smokers would like to quit. It’s hard work.”
In fact, Dr. Miller said about 85 percent of smokers have reported trying to quit. At least one-third of smokers attempt to quit each year, with about 3-7 percent having success long term.
Miller said the success rate is so low because many attempts are “unaided.” He added that for smokers who try to quit on their own, eight out of 10 will relapse within one month.
“We provide both therapies and medications, individual and group approaches,” Miller said, through a staff of over 50 specifically trained for addiction work.
Other programs at the VA include nicotine replacement therapy for detoxification; technology-based therapies such as a tobacco-specific text messaging service and video telemedicine; and relapse-reduction medications such as Chantix (varenicline) used in combination with talk therapy.
Klaene said the support group is helpful because of the added accountability and not wanting to let the group down.
“I wish I had (quit) a long time ago,” Klaene said. “It’s difficult but worth the effort.”
Klaene, who smoked over a pack of Salem Lights a day, said he’d previously made several attempts to quit, some lasting a week and one time making it almost a year. He said the most success he had was when his nicotine patches were paired with Wellbutrin, a medication that reduces anxiety and aids in quitting smoking.
“I fell off the wagon for emotional and physical reasons,” Klaene said, including anxiety at work.
Klaene said it was a mix of health and financial reasons leading up to retirement that got him to quit smoking. He’s since saved $2,000 that would have otherwise gone to cigarettes.
“I started looking at my budget more closely and I would rather spend that money on something else,” Klaene said, who can now afford to go golfing. “I’ve used that as an aid to help me.”
Klaene said he “tries all the little tricks” to stay smoke free, including having his quit date posted on his bedroom mirror. He said it also helps that his wife Susan of 40 years has never been a smoker.
“The effects of it kind of sneak up on you,” Klaene said, who had trouble breathing and would wake up coughing. “My breathing has definitely improved; the ability to breathe deep. My taste and smell have improved.”
Klaene said it’s a positive trend that the rate of smokers in America continues to decline. In 1955, half of all adults were smokers. Awareness has helped to bring that rate down to below 20 percent.
In 2014, CVS/pharmacy announced it would stop selling cigarettes and all tobacco products at its more than 7,600 stores nationwide.
Dr. Cabansag said the number of opioid overdose deaths is 44,000 per year in the U.S. The rate of smoking-related deaths is more than 10 times that at 488,000 per year “but we as a society tolerate it.”
“Tobacco is the only commercial product that when used as intended kills 50 percent of the people who use it,” Cabansag said.
The number of smokers in Ohio is higher than the national rate, at about 25 percent of adults — or 1.8 million Ohioans. There were over 18,000 smoking deaths in 2010 in Ohio, according to Ohio Department of Health.
Science of nicotine addiction
Dr. Miller said the average age of first use is only 15 years old when the brain is still developing. With as little as one puff on a cigarette, a third of the brain’s receptors are occupied.
Dr. Cabansag added that the cigarette as a nicotine delivery system is highly effective because it hits the brain in just seconds.
“It turns on circuits in the brain that relate to pleasure,” Miller said. “The brain feels irritable and not right if you stop smoking. It turns from smoking for pleasure to smoking to relieve displeasure.”
Cabansag said there are three drugs approved by the Food and Drug Administration to help those quit. He said they give the person a 50 percent higher success rate by helping with the physical withdrawal. Other items such as nicotine gums, patches and lozenges play a role too.
Smoking cessation trial
The Lindner Center of HOPE is one of over 15 sites in the U.S., Israel and Europe participating in a pilot study to determine the effectiveness of transcranial magnetic stimulation (TMS) technology in helping smokers quit, said Dr. John Hawkins, chief medical officer and deputy chief research officer at Lindner.
“We’re frequently comparing the power of nicotine and the power of opioids,” Hawkins said. “The subtleties of the drug make it stand out; you don’t even notice it (the addiction). It’s a seductive drug.”
The TMS technology by Brainsway was FDA-approved in 2008 to treat depression, and for the last year is being tested for smoking cessation and whether it helps to reduce cravings and use of cigarettes.
The trial includes a total of 18 TMS treatments that each last 18 minutes. During that time, 1,800 pulses of electromagnetic energy go to two parts of the brain. But Hawkins assures it’s nothing like shock therapy and the only reported sensation is the feeling of a rubber band tapping on the forehead in rapid succession.
The electromagnetic energy is “more targeted and better tolerated,” Hawkins said.
The addiction and mental health center is actively recruiting participants through the end of 2015. There are some stipulations though — you must commit for six weeks and want to quit smoking; have smoked at least 10 cigarettes a day for the last year; be a nicotine-only user; not have any head trauma issues or mental illness; and be between the ages of 22 and 70, according to Hawkins.
Participants will also write a diary of the number of cigarettes used and their level of cravings. Nicotine levels are also tracked by urine analysis.
If you meet those requirements, call 513-536-0721 to start the telephone screening process.
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