Dr. Jacqueline Gerhart: Should My Son Discontinue Nicotine Patch?

UW Health Family Medicine physician Dr. Jacqueline GerhartMadison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.


Dear Dr. Gerhart: My son is 25 and has been using a nicotine patch and smoking for the last year. He smokes three fewer cigarettes than before. Would he be better off just quitting the patch? Is he getting more nicotine from the patch than the three cigarettes he gave up?


Dear Reader: It's great that you are talking to your son about quitting. Smoking is the largest source of preventable death in our country. By quitting he will decrease his cancer risk and have improved circulation, blood pressure, breathing, and improved senses of taste and smell. Chances are he'll also save some money.


However, there are some drawbacks to quitting. Irritability, anxiety, hunger, weight gain and depression are common side effects. According to the American Cancer Society, 70 to 90 percent of smokers say cravings and withdrawal symptoms are the main reasons they are not successful quitting. This is due to being physically dependent on nicotine.


Treatments such as nicotine patches provide the same dose of nicotine as that in cigarettes, but without all the other toxic chemicals in cigarette tobacco. The idea is to slowly transition to lower and lower doses of the patches, and eventually become nicotine-free.


The patch is one form of "nicotine replacement." Other forms include gum, lozenges and inhalers. Nicotine replacement treatments are meant to be used once the last cigarette is thrown away, and not at the same time with cigarettes. This is because they truly replace the nicotine from the cigarettes.


So if a person smokes and uses the nicotine patch, they may actually be getting more nicotine than before trying to quit. If throwing away cigarettes brings anxiety, a person should talk to their physician. There may be other medications - pills, not nicotine replacements - such as bupropion (Zyban) or varenicline (Chantix) that could be used.


While medications can help a smoker ease off the physical addiction to nicotine, there also is a mental and emotional addiction to smoking. As of 2009, all 50 states have telephone-based smoking cessation programs that link callers to counselors. Group sessions from public health departments, hospitals, clinics or employers also can keep you on track. Also, your health care provider can counsel you through quitting.


In my office, one way I do this is through creating SMART goals with my patients: specific, measurable, attainable, relevant and timely. An example might be, "I will decrease my smoking by one cigarette each day for the next week." Or, "I will not smoke when inside my house for the next month." Or, if using nicotine replacement, "I plan to have my last cigarette on Saturday and start the nicotine patch that day."


I then assess how motivated and confident the individual is about attaining these goals by asking them to rate their motivation and confidence from 0 to 10. If motivation is at a 10 (extremely motivated), but confidence is at a 5 (neutral), we try to determine what barriers or obstacles are in the way, and how to overcome them.


In summary, assessing motivation and confidence, creating SMART goals and using nicotine replacement or medication has been successful for many of my patients. I encourage your son to seek out his health care provider for help with quitting smoking. It can be very tough, and we're here to help!


This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.

Date Published: 05/08/2012

News tag(s):  jacqueline l gerhart

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