Although there has been 1 million smokers fewer in France in 2017, cigarettes remain the leading cause of preventable death with 73,000 deaths per year. “This is the equivalent of an airliner crash per day with 200 passengers on board”, illustrates the doctor Marion Adler, tobacco specialist at the Antoine Béclère de Clamart Hospital (AP-HP), in the service of addictology.
Smoking is a real addiction, it is a chronic disease of which addicted smokers are victims and not guilty. In fact, tobacco can be likened toheroin in terms of dependency. “95% of addicted smokers must smoke every day. By comparison, this figure is 20% for the‘alcohol “, explains Dr. Adler. According to his figures, 70% of regular smokers have tried to quit, but the dependency process is a hindrance to the success of this process.
Is willpower enough to quit smoking?
First and foremost, it is important to understand the mechanism of action of nicotine, responsible for addiction. This molecule acts in a few seconds and increases alertness (norepinephrine), the feeling of pleasure (serotonin) and satisfaction (dopamine). “In a smoker, the brain no longer knows how to produce these endorphins on its own, so it must relearn how to secrete them naturally without immediate stimulation by cigarettes “, explains the tobacco specialist.
Also, getting up one morning and telling yourself that you will never touch a cigarette again is possible but very complicated. Indeed, overnight, the body will be “in need” of nicotine. The urge to smoke will be very strong and to resist will become difficult. Mood disorders, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, weight gain, depression… await aspiring non-smokers. Logically, many end up picking up. “When the patient relapses, I call it ‘delayed success’, you always have to be optimistic. The person has to relearn how to live without tobacco, without suffering from it.” In short, giving the body what it “needs” to do away with the physical symptoms of withdrawal. Nicotine substitutes can then greatly help.
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Combine the patches with the oral forms
Nicotine replacement therapy (TNS) has existed since 1992 in various forms: patches and oral forms (gums, sprays, patches, tablets, inhalers).
The patches make it possible to manage the lack continuously throughout the day and the oral forms, called emergencies, make it possible to relieve a sudden urge to smoke. Contrary to stereotypes, it is strongly recommended to use both. “You can also smoke even if you have a patch. In absolute terms, you will be overdosed on nicotine, like when you smoke too much in the evening. This results in palpitations, headaches, a ‘mushy’ mouth feeling, diarrhea. , nausea … “, explains Doctor Marion Adler. Note that a pregnant woman can, of course, use nicotine substitutes. “The most important thing is that she get out of the
cigarette during pregnancy. ”For advice on NRT, a pharmacist, doctor, tobacco specialist, or even a midwife can help.
Read also: Stop smoking: watch out for patch changes
Adapt nicotine substitutes and medications to each person
The prescription of TNS, now reimbursed, is done according to the patient’s consumption, the objective being that he is weaned. If he smokes a pack a day, he will start with a patch. For two packages, it is therefore 2 patches that he will have to put. “That the patient smokes” lights “does not change anything. They are as toxic as normal cigarettes and the person generally aspires harder in order to have the same dose of nicotine delivered”, specifies the tobacco specialist. The dose of nicotine will then be slowly diminished. “I will start to reduce the patches after 1 month without a cigarette and if the patient agrees. In some, I start for example with a pre-weaning by reducing the number of cigarettes and by combining with oral nicotine substitutes before d ‘arrive at the use of the patch “.
In 2nd intention, it is also possible to prescribe drug treatments (bupropion, Varenicline, or cytisine) which will act either on nicotinic receptors or on the production of endorphins. She places great emphasis on tailoring the treatment to each patient. She equates stopping smoking with a broken leg: “You are not going to treat your leg with the only force of your will. You need a cast and crutches for your size”.
Read also: Smoking cessation: behavioral therapies associated with drugs would be the most effective
The electronic cigarette, an ally of choice
Marion Adler also uses E-cigarette as a tool, even if it is not considered a treatment. “The goal is that the taste is pleasant and that the quantity of nicotine is sufficient for the patient”. Studies show that electronic cigarette smoke contains 95% less harmful substances. In fact, liquids are composed in particular of propylene glycol, a substance which makes it possible to make smoke as in the theater or at fairgrounds, of glycerin, water and food flavorings. Unlike cigarettes, the smoke from vapers does not contain any mutagen, that is to say it does not modify the DNA of cells and therefore does not promote the development of cancer. Only shadow on the board, some aromas would lead to the creation of molecules more toxic than others such as diacetyl, acetoin and acetyl propionyl. Diacetyl is known to cause obliterating bronchiolitis in popcorn factory workers, where it was used to impart that buttery taste, as explained MedicineNet.com. In France, the AFNOR standard already prohibits the addition of diacetyl in e-liquids.
Like the oral nicotine substitutes available in pharmacies, the aim of the electronic cigarette is to deliver nicotine as quickly as a conventional cigarette and also to offer the user a similar experience in terms of taste, gesture and smell. Liquids contain different levels of nicotine from 18 mg / ml to 0 mg / ml, it is then possible to gradually reduce the dose of nicotine until reaching 0. Thus, according to the figures of the 2016 health barometer (health public French), 41% of electronic cigarette users are ex-smokers who have found an effective alternative to traditional cigarettes.
Read also: What would happen if all smokers switched to electronic cigarettes?
What about heated tobacco?
All of the 4,000 toxic compounds that we breathe in when we light our cigarettes come from the combustion of tobacco. The tobacco industry has therefore implemented a new technology at the crossroads between the electronic cigarette and the cigarette, where the tobacco is no longer burned, but heated to very high temperatures (around 300 degrees against 800 usually). According to their studies, the vapor created by this device would be similar to that of electronic cigarettes by producing 90% to 95% less toxic substances. For the moment, only the device of Philippe Morris, IQuos for “I quit Ordinary Smoking”, is available in France. It should be followed by “Glo”, the product of the Bristish American Tabacco.
“It is an invention of the tobacco industry which must find the future product which will replace cigarettes, by making people believe that they are quitting smoking”, protested the doctor. “There is a resistance which produces combustion at low temperature, like pyrolysis. There is identical burning of tobacco, and therefore the same toxic substances, but undoubtedly just a little less dosed”. Indeed, researchers from the University of Lausanne found levels of harmful substances higher than the figures announced: the equivalent of 82% of acrolein (very toxic and irritating substance) of a normal cigarette, 74% of formaldehyde and 50% of benzaldehyde. The smoke also contained 3 times more acenaphthelene (a tar), polycyclic aromatic hydrocarbons (PAHs) and also carbon monoxide (CO). This device is therefore absolutely not recommended for anyone who would like to quit smoking.
Read also: Passive smoking: children still too exposed
Hypnosis, acupuncture…. What should we think ?
Regarding “parallel” techniques, “hypnosis or acupuncture do not act on the physical lack. In addition, no scientific evidence has advanced the fact that these disciplines help to quit smoking, “adds Dr. Marion Adler. However, they can be useful for people who do not really want to stop smoking. ‘quit but who are aware of the value of weaning.
Thus, just as each person is different, each will be able to find help, support, from health professionals and all the mechanisms that exist in order to strengthen their chances of success.
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