ABC News' Dr. Tim Answers Questions About Smoking
Nov. 30, 2005 — -- Question: Given what we know about what smoking does to people's health, why do people start smoking?
-- E. Figueroa, Houston,TX
Answer: People begin smoking for a variety of reasons. The main reason for trying a first time is curiosity, related to observing smoking among family or in the media, and believing that they may obtain or express certain social images or achieve a better reputation among their peers by smoking. Youth are sometimes informed by their peers that if they keep trying out cigarettes, they will learn how to smoke correctly (get past the sick feelings). Those that keep trying to smoke may come to enjoy the effects of nicotine (on their mesolimbic dopaminergic neurotransmission system, for example). They may experience pleasure or a temporary lowering of feelings of sadness or anxiety. By no longer feeling sick they are also now showing signs of addiction. Within 6 months to 2 years, people will become addicted to nicotine. Many teens do try to quit and find that they can't due to being addicted.
Source: Division of Health Promotion, Keck School of Medicine of USC
Question: My college-age son is a heavy smoker, and one of his reasons for putting off quitting is that he is prone to severe migraines, the kind that cause severe nausea, photophobia, and knock him out for 8 to 12 hours or more. Caffeine withdrawal provokes these headaches, and he has had a couple when he has not been able to smoke for a day or so. Is this a known correlation, or just "in his head"? Aside from the patch, do you have any suggestions for dealing with this side effect of withdrawal?
-- Lisa Kohn, Chicago, IL
Answer: Withdrawal from nicotine typically results in irritability and difficulty concentrating, and may result in headaches -- in your son's case severe migraines. Still, the headaches will go away if he stays off nicotine long enough. There are medications for migraines, but your son probably is aware of these already. He could try the patch or inhaler, etc. but it also is possible that he should not be using any nicotine-containing product to reduce the probability of onset of migraines (avoid the withdrawal effects). Thus, it is advisable for him to arrange a three-week period when he can minimize responsibilities and take the big step and quit. It takes a sacrifice.
Source: Division of Health Promotion, Keck School of Medicine of USC
Question: I have been trying my best to quit smoking cold turkey and just when a month or two has passed and I think that I officially made it, I get the craving for a smoke and I usually start all over again. I tried the Nicotrol patch and it worked for a couple of days, then my heart started to beat fast. Is there another way I could use a patch without this effect?
-- Michelle Borden, Brooklyn, N.Y.
Answer: Using a nicotine patch to quit is a good idea, because people who use the patch (or other nicotine replacement products) double their chance of success. A rapid heart rate could mean that you are getting too much nicotine from the patch and should use a lower-strength patch. Read the patch instructions for proper dosage according to the number of cigarettes you smoke per day and your body weight. For example, a pack-a-day smoker using the Nicotrol patch usually starts with a 15 mg. patch. However, a rapid heart rate could mean that you should use a lower dose patch, such as a 10 mg patch. Another approach would be to use another form of nicotine replacement, such as nicotine gum or lozenges. Both of these can be bought without a prescription in a pharmacy and they give the person using them more control over the amount of nicotine that enters the body. There is also a nicotine inhaler that a doctor can prescribe for you that also gives you more control.
Another reason for a fast heart rate is caffeine. You might want to decrease your caffeine intake when you are quitting. A third reason would be that if you smoked a cigarette while wearing a patch, that could gives you too much nicotine and could cause your heart to beat rapidly. Good luck, and keep trying. Remember, it often takes several tries before a smoker quits successfully.
Source: Tobacco Research and Treatment Center, Massachusetts General Hospital
Question: Do you think when a person quits smoking that transitional cells from the change can turn to cancer cells, or is it just a coincidence that so many people are diagnosed with it within ten years after quitting? Also, do you think spiral CT can cause cells to turn cancerous? I had a CT five years ago but had a relapse for several months and wonder how often a person can have a CT safely.
-- Maureen Westerman, Worcester, Ma
Answer: Neither quitting smoking nor having a spiral CT scan can cause cells to turn into cancer. Even having more than a spiral CT every year does not expose a person to enough radiation to cause harm. However, whether smokers should get routine spiral CT scans is a controversial question that is the subject of a large national research study now underway. We don't have the answer yet about whether current or former smokers should get these tests routinely when they have no symptoms and this is not currently recommended as a way to reduce the risk of lung cancer.
The reason why many people develop lung cancer or other cancers after they quit smoking is that, unfortunately, the risk of getting cancer doesn't suddenly fall to zero the moment a smoker quits. A person's previous smoking may have started the process that ends up as cancer even after he or she has quit. However, don't let that discourage you. The risk of cancer from smoking falls progressively after quitting and after 10 years the risk of lung cancer is only half of what it was before quitting. The risk of cancer continues to fall as each year passes and is much less than it would have been if the person had kept smoking.
Source: Tobacco Research and Treatment Center, Massachusetts General Hospital
Question: I'm a smoker of 16 years. I take Premarin and my doctor said that I can't take anything like the patch to help me quit smoking. What can I use along with the Premarin to help me quit?
-- Dottie Pridgett, Newport NC
Answer: We don't know your full medical history, so we can't second-guess your own doctor. However, let's explain the concern about smoking and estrogen. We know that smokers who take birth control pills have a much higher risk of serious complications (heart attacks, strokes, and clots in the lungs) than nonsmokers who take birth control pills because both estrogen and smoking increases the risk of clotting. The extra risk caused by smoking increases with age and that is why doctors generally do not prescribe birth control pills to smokers over the age of 35. However, the amount of estrogen in Premarin is much less than the amount of estrogen in birth control pills and therefore taking Premarin is much less risky for a smoker than taking birth control pills is. It is not unusual for a smoker to use Premarin, especially at a low dose. If you are already smoking and taking Premarin, using the nicotine patch will not be any riskier than what you are already doing. Using the patch temporarily to quit sounds like a good idea and many doctors would prescribe it in this situation.
Source: Tobacco Research and Treatment Center, Massachusetts General Hospital
Question: I smoked for 30 years. I quit smoking March 2004. What is my risk of lung cancer? How long does it take from the time one stops smoking to know if one will develop lung cancer?
-- JB, Victorville, CA
Answer: Your risk of cancer from smoking depends on three factors: how many years you smoked, how heavily you smoked (number of cigarettes per day) and how long it has been since you quit. Thirty years of smoking is a long time, but the good news is that you have now been smoke-free for 20 months. (Congratulations!) In that time your risk of cancer has already fallen.
The risk of lung cancer falls progressively as time passes. After 10 years the risk of lung cancer is only half of what it was before quitting, and after 20 years the risk of lung cancer is almost as low as that of a person who never smoked. Unfortunately, lung cancer can develop many years after quitting, but with each passing year, that risk is less. Don't forget that quitting smoking has also reduced your risk of many other diseases, including heart attacks, strokes, other cancers and emphysema.
Source: Tobacco Research and Treatment Center, Massachusetts General Hospital
Question: Hi … in my area, the new treatment being offered is laser treatments to make you quit smoking. The treatments are $295 and up and they are saying the rate of people who quit immediately and never smoke again is incredibly positive.
My question is: How does this treatment work on the body to make you never crave another cigarette? I currently take Zyban and it is working on my cravings for cigarettes (and food, surprisingly! - lost 26 lbs!!) and has helped me cut my habit down to one-third of what I used to smoke a day. I did not have total success in quitting altogether, obviously. The Laser center says I can stay on the Zyban (Wellbutrin) while I take the laser treatment(s).
I'd also like your input on if there are any "Rapid Detox" options for nicotine addiction like there are for narcotics at an inpatient center for a weekend or so?? There's one here in Chicago as well -- for narcotics.
-- Mary, Chicago, IL
Answer: Nothing -- including laser treatments -- can "make" you quit! If you read the laser literature carefully, long term success rates are not quoted. It works on the same pressure points as acupuncture so I am sure for some there is a resulting decrease in cravings but it certainly is not a guarantee that quitting will be achieved with laser treatments.
Rapid detox is not appropriate for tobacco cessation. Nicotine is water soluble -- meaning it is eliminated from the body very quickly. If you go cold turkey, do not use NRT products, there is no measurable nicotine in the system after only 2 to 3 days, which is why the worst of the withdrawal symptoms are initially during that time. That is also why NRT products are so helpful; using NRT products allows for a gradual reduction in the amount of nicotine so that the phsyical withdrawal from nicotine is nonexistant or very minimal.
It is excellent that you have been able to cut down. Do not wait too long to set that quit date to stop letting smoking be an option! You do not need to be in a coma -- you need to work at getting through your day without a cigarette no matter what so that eventually it becomes "normal" not to smoke no matter how badly you crave.
Source: Northwestern Memorial Hospital Wellness Institute
Question: Hello Dr. Tim, I am a 17-year-old student studying at ASU, I have been smoking heavily since I was 10-years-old. I smoke Marlboro Reds which is one of the strongest cigarettes out there. I have heard that there's some sort of operation to "refresh" your lungs or something to that effect where it can take the blackness away and all the nicotine and make your lungs as good as new. Is that true and will that reduce my chances of getting any diseases if I keep on smoking after it? Thank you and I appreciate it.
Answer: I certainly have not heard of such an operation and even if there was, even one cigarette would offset the results. Your best bet is to quit -- that is the only true way to start the healing process. The good news is that your body will recover upon quitting and you are young enough that you will make a real difference in the quantity and quality of your life if you can quit now.
Source: Northwestern Memorial Hospital Wellness Institute
Question: My mother has been smoking for many years and was watching the series on ABC, and thought she heard you say that a person could use the patch and supplement one of the other replacement therapies when they had a really bad urge to smoke. Meaning they could take a few puffs off the nostril puffer while wearing the patch. Did she hear you correctly and would this be safe to do for those really bad urges?
Answer: It is absolutely safe to use any and all of the NRT products in any and all combinations. Despite what some of the labels may say, it is medically sanctioned to use combination products. The idea is to get as much nicotine through these products as was obtained via the cigarettes to eliminate or decrease the physical withdrawal symptoms. That way the person can concenctrate on the hardest parts of quitting, which are psychological and behavioral.
Source: Northwestern Memorial Hospital Wellness Institute
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