Tag Archives: cessation

E-Cigs

March 25, 2013 by
Photography by Bill Sitzmann

With the implementation of Omaha’s indoor smoking ban in 2006, electronic cigarettes (e-cigs) have become a popular option for many patrons in local bars and businesses. Kiosks in the mall have started selling the so-called “better for you” cigarettes, and even Jake’s Cigars and Spirits in Benson and House of Loom in Downtown Omaha now sell and allow customers to smoke e-cigs.

Each bar has its own rules about e-cigs; it’s up to the owner’s discretion whether e-cig smoking in their establishment is allowed. Bar owner Tim Addison of Addy’s Bar and Grill in Millard says smoking e-cigs in his business is permissible, though he prefers those with e-cigs go outside “like everyone else.” Addy’s is a family-friendly place, he says, and he feels smoking e-cigs indoors just looks bad. Addison cites a regular customer who comes in often for lunch: “He smokes electronic cigarettes, but he still goes outside out of routine.”

The occasionally disposable but usually rechargeable e-cigs are a battery-powered nicotine delivery system that simulates the act of smoking a traditional cigarette. E-cigs use a mixture of vapor, flavoring, and nicotine to create a smoking affect, and some even have a light at the end that glows when inhaled, mimicking a real cigarette. The controversy surrounding e-cigs, however, is this: while makers claim they help some people quit smoking, they are still not considered a safe alternative to smoking by many health professionals. According to WebMD, e-cigs have different levels of nicotine, so in theory they can be used to lessen one’s addiction to cigarettes, or even help them quit. Unlike Chantix or the Nicotine patch, however, e-cigs are not FDA-approved as smoking cessation aids.

Marketers of e-cigs appeal to the smoking masses with brands like Njoy, Vapor4Life, and Blu Cigs (which is endorsed by actor Stephen Dorff). Blu Cigs offers flavored versions as well, like Magnificent Menth, Vivid Vanilla, and Pina Colada. Njoy even has a disposable version called One Joy. Despite their popularity, the jury is still out on the safety of e-cigs. But as Joy Fortuna from Pcmag.com writes, “E-cigs may help you decrease your dependence on nicotine…It is conceivable that a self-managed program of nicotine step-down might lead to a drug-free lifestyle.”

As far as bar owner Tim Addison is concerned, he plans to use e-cigs to help him kick his own smoking habit “real soon.”

Smoking Cessation Aids

Photography by Bill Sitzmann

The old saying “third time’s the charm” didn’t work so well for Laura Adams when it came to quitting smoking.

“Every time I quit, I’d be good for about six months,” she says. “Then I’d get stressed about something and decide to have just one. Well, once you start up again, it’s all over. It’s an all-or-nothing thing.”

Adams is not in the minority. Most smokers will try quitting multiple times before they are successful. There’s a lot more to smoking than meets the eye, say local smoking cessation experts. “There’s an addiction to nicotine, the actual habit, and the emotional dependence that all need to be addressed,” says Laura Krajicek, a smoking cessation coordinator for Nebraska Methodist Health System.

A smoker for more than 20 years, smoking had become a crutch for Adams. “It helped me deal with daily stresses,” she explains. “When I had a cigarette, that was my relaxation time, my ‘me time.’ Coffee, cigarettes, and break time all went together. It was hard to have one without the other.”

Adams knew that it wasn’t a “pretty habit,” nor one she was proud of. With a campus-wide no smoking policy at her place of employment, Alegent Creighton Health Immanuel Medical Center, Adams would have to “sneak” to an off-site parking lot to smoke. To mask the nasty smoke odor, she would slip on a different coat, pull her hair back in a ponytail, wash her hands, and coat herself with body spray before returning to the office. “It was an embarrassing addiction,” she recalls.

“When I had a cigarette, that was my relaxation time, my ‘me time.’” – Laura Adams, former smoker

When Adams learned about Alegent Creighton Health’s smoking cessation program, Tobacco Free U, she decided this might be the extra push she needed to help her quit for good. The program focuses on the use of group or individual counseling in combination with a smoking cessation aid such as nicotine patches, nicotine gum, or medications.

According to the Cochrane Review, an internationally recognized reviewer of health care and research, combining counseling and medication improves quit rates by as much as 70 to 100 percent compared to minimal intervention or no treatment.

“Success rates rise drastically when you combine the two,” says Lisa Fuchs, a certified tobacco treatment specialist at Alegent Creighton Health. The counseling portion helps people tackle the behavioral addiction, and the smoking cessation aids help with the nicotine addiction.

Which smoking cessation aid is recommended depends on how heavy a smoker, health conditions, as well as what seems to be the best fit for that person’s lifestyle, notes Fuchs. These aids are most successful in individuals who have been counseled on how to use them appropriately. The most common aids include:

Nicotine patch – The patch is a long-acting therapy that delivers a steady dose of nicotine over a 24-hour period and is designed to curb a person’s cravings for nicotine. This may be appropriate for very heavy smokers. The dosage is gradually lowered to wean a person off the nicotine habit.

Nicotine gum or lozenges – Gum and lozenges are short-acting therapies that deliver smaller doses of nicotine and can be taken as needed to curb the nicotine urge. Tom Klingemann, certified tobacco treatment specialist at The Nebraska Medical Center, recommends that smokers schedule the doses so that they maintain a steady state of nicotine in the body to avoid the nicotine cravings and temptation to smoke. In general, he is opposed to short-acting nicotine replacement therapies because “they keep people looking for a chemical fix even though they may not be smoking anymore.” They are also very expensive, and most people trying to quit can’t afford the $40 a week price tag they would cost if used appropriately.

e-cigarettes – These work by heating up a liquid nicotine substance that is inhaled as vapor. The product is not regulated by the Food and Drug Administration (FDA) and many still have a lot of chemicals that may not be any healthier than actual smoking, notes Klingemann. “These are not intended to help people quit but keep them addicted to nicotine,” he says.

Medications – The two primary prescription medications used for smoking cessation include Zyban and Chantix, with Chantix being the preferred of the two, says Fuchs. “Zyban is an anti-depressant and may be recommended for a person with mild depression to help with moodiness as well as decreasing cravings and withdrawals,” notes Fuchs. It is believed to work by enhancing your mood and decreasing agitation related to trying to quit.

Chantix is a newer drug and works by binding to nicotine receptors in the brain and blocking them so that nicotine can no longer activate those receptors, causing a person to get less satisfaction from smoking. At the same time, it also triggers a small release of dopamine, the reward neurotransmitter in the brain. It appears to be safe and quite effective, notes Klingemann. Krijicek says that her clients have seen the most success with this aid.

“Success rates rise drastically when you combine [counseling and medication].” – Lisa Fuchs, certified tobacco treatment specialist at Alegent Creighton Health

Adams used Chantix, which she said helped curb her nicotine urges. But what helped the most, she says, was to change the habits that she associated with smoking. For instance, instead of coffee and cigarettes in the morning, she reached for coffee and orange juice. Because she normally smoked while driving, she changed the route she drove to work. She also replaced the time she would have spent smoking with more positive habits like walking her dogs, running, bicycling, and swimming.

“Once I quit, I started making healthier decisions in other parts of my life as well,” she says. “I started eating better, drinking less caffeine, and exercising more. I feel better now.”

“For 90 percent of smokers, the addiction is behavioral,” notes Klingemann. “It’s all of the other stuff that drives the smoking addiction. Until you start changing your behaviors and routines, it’s really hard to quit.”