How to add ten years to your patient's life : help him/her quit smoking

Abstract

WHAT IS SMOKING? • PSYCHO SOCIAL HABIT 20 cigarettes a day mean 200 hand-to-mouth movements and puffs a day; 6,000 a month; 72,000 a year; or more than 2,000,000 for a 45-year-old smoker who started at 15. • PHARMACOLOGICAL DEPENDENCE Nicotine reaches the brain within 7 seconds of inhaling tobacco smoke, twice as fast as if it were injected intravenously. Due to the short half-life nicotine has in the body, craving occurs with in minutes of finishing a cigarette. Habitual cigarette smoking fits the WHO criteria for addiction: • The compulsion to take a drug (nicotine) 'on a continuous basis (200 shots a day) • in order to experience its effects (small doses stimulate, large doses sedate), 'or to avoid the discomfort of its absence (anxiety, irritability, tremor, loss of concentration, memory impairment, insomnia, constipation, weight gain, craving). (WHO definition of addiction as adapted by Dr Chris Steele). THE PATHOPHYSIOLOGY OF SMOKING Smokers smoke for the effects of nicotine, but suffer the morbid and mortal effects of carbon monoxide and smoke condensate (tar), the latter containing 4,000 different chemicals, including 300 known carcinogens.