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More Than a Bad Habit

Nicotine dependence should be treated as a chronic condition, according to the authors, and requires ongoing medical and behavioral treatment.
May 1, 2015

OPINION -- Tobacco use related illness is the single greatest cause of preventable disease and death, taking a huge toll in lives and dollars. Tobacco use kills about half a million Americans each year—more than all other drugs, car crashes and gun deaths combined.1 While tobacco use rates for the general population have continued to decline, this is not the case for people with substance use or behavioral health disorders. About half of the cigarettes smoked in the U.S. are smoked by people with a substance use or behavioral health disorder. As a result, they are more likely to suffer from tobacco-related disease and disability, and die 25 years earlier than the general population.2

Tobacco use is more than a bad habit, and establishing a tobacco-free life takes more than willpower. The nicotine in cigarettes actually changes the chemistry of the brain, causing a powerful physical dependence that is reinforced by learned habits. In fact, nicotine addiction is one of the most difficult to interrupt. As with other addictions, nicotine works in a very diabolical way to keep people hooked—raising the levels of a neurotransmitter called dopamine in areas of the brain that produce feelings of pleasure and reward. Tobacco companies have capitalized on nicotine’s addictiveness, using chemical additives, flavors, and product design to increase the impact of nicotine and the likelihood of dependence. The same holds true for e-cigarettes, which are currently unregulated and have been found to contain varying levels of nicotine, flavorings and toxic chemicals.

The good news is that nicotine dependence is treatable and a tobacco-free lifestyle can be established with appropriate treatment. Sure some people are able to quit cold turkey, but quitting cold turkey can be a difficult process that often leads to relapse and fear of future attempts. The physical symptoms caused by withdrawal from nicotine—including irritability, attention difficulties, sleep problems, and cravings—can last a few days to a few weeks. For most people, the

ritual of smoking or using chew tobacco creates a strong mental or emotional dependence that can lead to relapse even years later. It is for this reason that the Clinical Practice Guidelines for Treating Tobacco Use and Dependence recommends that nicotine dependence be treated as a chronic condition—one that requires ongoing medical and behavioral treatment.

Adapt has taken steps to address the challenge of tobacco use among people with substance use and behavioral health disorders by integrating evidence-based tobacco cessation treatment into its clinical standard of care. All of Adapt’s counselors complete training and clinical service hours in addiction prevention, intervention, and treatment as part of their professional credentialing. Over the past year, five clinical team members received advanced Tobacco Treatment Specialist training and certification from the Mayo Clinic—an opportunity made possible in part by Douglas County Public Health. And, in cooperation with the Umpqua Health Alliance and Western Oregon Advanced Health, these behavioral health professionals are integrated in primary care clinics in Coos and Douglas counties to help meet patients’ behavioral health care needs, including treatment for tobacco dependence. Beginning in 2016, Adapt will expand its tobacco cessation services to the general public—offering a Mayo Clinic program that is designed to help participants increase their motivation to develop a tobacco-free life.

Although tobacco use rates are significantly higher among people with substance abuse and behavioral health disorders, research has found that they want to quit and, more importantly, can quit with effective treatment. Adapt has conducted National Institutes of Health sponsored clinical research that demonstrates that those who successfully address their nicotine dependence also have higher rates of recovery from other drug dependencies. While there is no simple solution to the problem of tobacco use, we know what works to prevent young people from starting and to help people quit. We all have a role to play in the success and sustainability of efforts that systematically address tobacco use, especially among those who have the least information about the health risks of tobacco use, the fewest resources, and least access to cessation services. Visit Adapt at to learn how you can create a tobacco-free clinic or workplace and help connect people to the tobacco cessation services they need.

John Gardin II, Ph.D., FACAPP, ACS is the director of integration, training and research for ADAPT/SouthRiver Community Health Center, and Marilyn Carter, Ph.D. is the Policy & Systems Change Grant Director for Adapt. They can be reached at 541-672-2691.