By Denver Brown, PA-C
Winona Health Family Medicine

“I’m ready,” he says with a sense of resolve. I feel excitement as a patient gives me the invitation to help him quit smoking. I know that without quitting, my patient’s chances of dying from a tobacco related disease is 2 out of 3.  Deciding to quit is a difficult place to come to and, for many, it is one of the most difficult things they will ever try. Statistically speaking, 70 percent of smokers want to quit. In the past year, 50 percent have attempted to quit, but only about 3 to 5 percent are successful long term if trying to quit without the help of counseling or medications.

Four years ago, I went through the Mayo Tobacco Treatment Specialist program and have been thankful to be better able to help my patients here at Winona Health quit smoking. Nicotine is very likely the most addictive substance known. I have had many patients tell me that they have been addicted to but were able to quit alcohol, meth, opioids, cocaine, marijuana and, for those coffee lovers, even caffeine! Yet I consistently hear that trying to quit smoking is the one thing they have struggled with most.

Recurrent nicotine use causes the brain change and the “want” for more and more nicotine. Not giving the brain the nicotine it wants leads to the symptoms of nicotine withdrawal: irritability, anxiety, cravings. Often, patients smoke to avoid withdrawal more than because they like the feeling that comes with smoking.

Here are statements reflecting misconceptions about tobacco and quitting followed by the facts:

  1. I switched to chewing tobacco because it is safer. Chewing tobacco is still very dangerous. It just changes the location of the cancer: instead of lung cancer, using chew puts you at high risk for throat and mouth cancer.
  2. I do not want to use gum or patches. I am already addicted to nicotine, why would I use more nicotine? This is a common question patients have. The patch, for example, delivers a slow steady release of nicotine throughout the day at much lower levels than are reached by smoking a cigarette. This helps give the brain a small amount of nicotine, enough to help control withdrawal and urges, but not enough to be addictive the same way smoking cigarettes is addictive.
  3. The nicotine gum and lozenges do not work. This is a common misunderstanding. Some people chew nicotine gum just like any other gum. However, the nicotine is absorbed through the mouth lining, not through the stomach. So, in order to get the benefit from nicotine gum or lozenges they should be “parked” under the lip similar to chewing tobacco. Again, these work by giving a smaller, slower dose of nicotine to ease withdrawal and urges to smoke. If you’ve tried the gum in the past and it did not work for you, I would recommend giving it another try.
  4. I switched to e-cigarettes to help me quit or as a safe alternative. E-cigarettes have not been around long enough to thoroughly study their long-term effects or safety and they currently have not proven to be effective for helping quitting.

My suggestion to those who want to quit is to try treatments that are proven safe and effective, such as quit lines, counseling, and medications like those available by prescription or the nicotine replacement products like patches or gum. Using these tools can increase your chances of quitting by 2 to 4 times compared to trying on your own.

My hope is that you are encouraged and inspired to give yourself and your loved ones the gift of being tobacco free. If you’d like help getting started, schedule an appointment with your healthcare provider to learn about upcoming programs.

Denver Brown, PA-C

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