Sunday, March 11, 2012

Chronic Conditions Require Ongoing Treatment

Some people have suggested that the way to help more smokers quit is to offer treatment for a longer period--say from 6 to 8 months, as opposed to 6 to 8 weeks.  Will that work?

What happens when you begin treating someone for hypothyroidism and then have them stop taking levothyroxine? Their symptoms return with a vengeance.

But what if you slowly wean them off levothyroxine? Their symptoms return, bur at a slower pace. Then, when treatment stops altogether, the symptoms return with a vengeance.  Hypothyroidism is a chronic condition that requires ongoing treatment.

Many people who smoke are self-medicating chronic underlying conditions. The scientific literature shows that people with chronic depression, attention deficits, memory problems, and those who are being treated for schizophrenia have much lower rates of cessation than the rest of the population. Let’s think for a moment about why that is true.

The scientific literature also shows that nicotine helps to improve mood, concentration, and attention and also helps to alleviate side-effects of anti-psychotic medications. It stands to reason that those who have a chronic condition that is helped by nicotine will be impaired when they give up nicotine.

It doesn’t matter whether the nicotine-dependent person tapers down for 6 to 8 weeks or for 6 to 8 months. When nicotine intake stops, relapse follows. Sometimes relapse begins even earlier, when the process of tapering down triggers relapse because symptoms are not being controlled adequately.

The Institute of Medicine’s 2001 report, “Clearing the Smoke,” stated, “Indeed, it has been predicted that even with the most intensive application of the most effective programs for abstinence and cessation, at least 10 percent to 15 percent of adults in the United States would continue to smoke.” That's not 10 to 15 percent of smokers--that's 10 to 15 percent of the entire adult population, representing between 33 and 45 million people.

The 2007 report by the Tobacco Advisory Group of the Royal College of Physicians, “Harm reduction in nicotine addiction: Helping people who can't quit” pointed out that some people will never be able to give up all use of nicotine. The authors went on to say, “If nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.”

Pharmaceutical nicotine products are a start, but they are often ineffective as a cigarette substitute. The FDA has purposely kept the nicotine dosage low in these products, in the belief that this will prevent new addictions. Millions of people have escaped from smoking by switching to a smoke-free alternative such as low-nitrosamine snus (a type of moist snuff), dissolvable tobacco products, or smoke-free electronic ‘cigarettes’.

“Clearing the Smoke,” had another important message: “… the best way for those who already smoke to minimize their health risks is to quit promptly.” This makes sense because the faster you can help smokers to stop inhaling smoke, the less irreversible damage will be done to their bodies. Encouraging inveterate smokers to switch to a much less hazardous alternative would be a life-saving course of action.

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