Treating Tobacco Dependence As a Chronic Disease

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Smoking wreaks havoc on the entire body. Each year, many people try to quit but are unsuccessful. Suzanne Harris, co-director and nurse administrator at the UCSF Fontana Tobacco Treatment Center, discusses treating patients with tobacco dependence as a chronic disease characterized by relapse and, therefore, needing symptomatic treatment over adequate periods of time. Suzanne shares real-life success stories of patients who overcame their battle with addiction while immensely improving their quality of life.

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So joining us now is Suzanne Harris, who is a nurse.  She's co?director and nurse administrator of the Fontana Tobacco Treatment Center at UCSF Medical Center at Mount Zion.  Suzanne, it really is tough, but it's possible to quit, isn't it? 

I often compare it to the process that we all went through learning how to walk as children, that there was a lot of falling down, there was a lot of tipping over, and every time that happens nobody was saying, Oh, my god, you're failing at learning how to walk, you're going to have to sit down for the rest of your life.  We could see that each of those efforts, they were all training small muscle control and various skills that were necessary in ultimately being able to walk.  And the same is true of learning how to stop smoking. 

And with stopping smoking the way that we currently use medications is in a similar way, that if you're having urges to smoke, even if you have been smoke?free for six months, we will support you in continuing whatever your medications are or going back on them and using them as the barrier to picking up a cigarette. 

Andrew Schorr:

You have gum.  Maybe there are other approaches as well that you could mention, but the point is it's not just a one?time thing.  It sounds like a tool that you may use at various times so that you don't smoke. 

So for example someone might use a patch, which is seen as a long?acting nicotine because it delivers a steady dose of nicotine over 24 hours, and then in addition to that a shorter?acting kind of nicotine like a gum or a lozenge or one of the prescription nicotine delivery devices so that when you're in a situation where you'd get what we call a breakthrough urge you can use a shorter?acting nicotine to get you through that particular episode. 

And the same is true with some of the combinations with the pills.  There's a bupropion, which is a pill form of medication that was actually initially used as an antidepressant and then discovered to have an effect on people's desire to smoke.  So a typical combination would be bupropion plus a patch.  The two together can be very effective in helping somebody manage the withdrawal symptoms so that you can learn the new behaviors, so you have enough support medicinally to be able to focus on learning new ways of thinking and behaving so that they support you from going back to cigarettes.  

So we encourage people to continue using the medications as long as they need to to feel secure not smoking.  And even so some people will use them for a week or two, and they'll be so surprised at the ease with which they're being able to not smoke that they take that as a sign of, oh, I've got this licked.  I can just stop the medications, and then within a short period of time they've relapsed.  So we encourage people to give themselves a good stretch of time.  Most of us smoked for many years, and we need to relearn how to live our lives without doing that, and that doesn't happen in two weeks or a month. 

So she was expecting a lot of judgment, and what she got was a nonjudgmental environment and a lot of support and compassion.  And in that environment she was able to stop smoking.  And the process so moved her and she felt it was so important that they wanted other people to be able to have access to that quality of treatment and when she did die she left us $2.3 million in order to be able to continue having the program and making it available to not only patients at UCSF but anybody who wants to come. 

So he came to the class, and he found himself interested in some of the information that we were sharing.  We try to just share more things that people won't already know about and are not punitive, and he did make an attempt to stop.  And he found himself being really uncomfortable with withdrawals, and his life just didn't feel normal anymore because it had been built up around smoking and now where were his cigarettes? 

So at one point in a group where he was complaining about how miserable he was it was suggested that he might find a way to have some fun with this instead of have it be making him so unhappy.  And somehow that suggestion took root.  And he lives down by the ocean beach and had always wanted to go for walks, had been saying, I'm going to walk the beach, but in all the years he'd live there he never had.  So he decided to go give that a try, and within a week he was walking all the way down to Pacifica and back, which was unheard of for him.  And he became, if you will, addicted to physical activity.  Walking, it made him tired enough that when he came home he just wanted to go to bed.  And he decided that he was seeing so many beautiful places by his walking to get a camera, and he began taking pictures.  And within a couple of years he had thousands of pictures.  He had climbed Mount Tam and other mountains and just had a completely different quality of life from having put down the cigarettes and picked up his camera and found the photography and the hiking to be far more satisfying and life enhancing than cigarettes had ever been. 

I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of UCSF Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on May 9, 2014