‘It always makes sense to quit, no matter how old you are’

What is the status of smoking in the Netherlands?

“Since the 1970s, the number of people who smoke has fallen sharply. But still more than a quarter of adults, about 3.5 million people, smoke. An incredible number. Especially when you consider that a cigarette contains a thousand toxic substances that cause damage to cells and tissues everywhere in your body. About 20,000 Dutch people die every year from the effects of smoking, or 55 per day. A quarter of smokers do not reach their pension.”

Not everyone who smokes gets sick from that, right?

“A lot. More women die from lung cancer than from breast cancer. One in three smokers develop cardiovascular disease. More than 20 percent develop the lung disease COPD. A quarter of all dementia is caused by smoking. The list of miseries is almost endless.”

You have become a figurehead for smoking cessation over the past fifteen years. Why do you care so much about the fate of smokers?

“Because they are still often seen as spineless weaklings. Completely wrong. Tobacco addiction is comparable in intensity to an addiction to some hard drugs, such as heroin. Not everyone who drinks has an alcohol addiction. But almost everyone who smokes is addicted to tobacco. That says enough.”

Why is quitting so hard?

“How addictive a substance is depends, among other things, on how quickly and for how long it works. Inhalation is the most effective way to take drugs. Within seven to ten seconds, the nicotine reaches your brain. That is faster than hard drugs that you inject through the bloodstream. The body breaks down nicotine quickly, so you quickly feel the need for a new cigarette. And cigarettes are also available on every street corner.

People over 50 who have been smoking for a long time may think: there is no point in quitting anymore.

“It always makes sense to quit, no matter how old you are. Already after three days you get more oxygen. After a month your taste and smell will improve, after six weeks your skin will have good blood circulation again. Your fitness will also improve by leaps and bounds. On average, the risk of cardiovascular disease returns to its previous level within five years. And while the risk of lung cancer will never be the same as that of someone who has never smoked, it certainly goes down drastically if you stop.”

And a 75-year-old smoker who says, ‘It will take my time’?

“It is of course a personal decision. But there are also other advantages. If you stop four weeks before surgery, for example, you have a 50 percent less chance of complications. Furthermore, quitters suffer considerably less from depression and anxiety disorders after six to twelve weeks than before. And perhaps just as important: you set a good example for your (grand)children.”

What can you do to increase the chance of a successful quit attempt?

“People often need several attempts before they succeed in stopping permanently. You have the greatest chance of success if you combine nicotine replacements and/or other medicines with professional guidance from a healthcare provider, for example a practice nurse from the general practitioner. The treatment guideline states that this is the best approach when someone smokes more than ten cigarettes a day. This applies to almost all smokers. Unfortunately, only a small part of the wish-stoppers still manage to find their way to help.”

Which medicines can help?

“There are two types: nicotine replacements, usually in the form of patches, and certain (prescription) drugs that reduce nicotine cravings, such as Zyban, Nortrilen and Champix. When the craving for a cigarette and the withdrawal symptoms decrease, it creates space to learn new behavior and new habits. That’s not easy either, by the way. Hence the emphatic advice to do this with the help of a professional.”

What do you think of the e-cigarette?

“I have mixed feelings about that. Because there is no tobacco in it, it is less harmful than a regular cigarette. But the nicotine addiction remains. Moreover, we do not yet know whether the vapors from an e-cigarette are also harmful in the long run. Incidentally, one of the major tobacco manufacturers launched the iQOS Heatstick in 2017. This is a variant of the e-cigarette, but with tobacco. So that brings you back to square one.”

What has changed in the care of quitters in recent decades?

“When I started working in addiction care in 2000, smoking was not seen as a serious addiction there. Many doctors also had no idea how bad smoking really is, and how best to help patients get rid of it. We have made a lot of progress in that regard. There is more awareness about the dangers of smoking throughout society. The help in primary care, at general practices, is now well organized. Also, more and more addiction clinics have gradually started to offer the treatment of tobacco addiction.”

Which smokers would do well to be referred to addiction care?

“People who smoke more than two packs a day, or who are unable to quit with other help. It is also important that smokers who report another addiction, for example to alcohol or sedative drugs, also receive support in quitting smoking at the same time. Nicotine increases the chance of relapse when you recover from other addictions.”

Why is that?

“Almost all people with another addiction started smoking first. In doing so, they have, as it were, ‘ripened’ their brains for addictions. When you try to get rid of another substance and you continue to smoke in the meantime, you continue to activate the addiction center in the brain. This makes the risk of relapse even greater. In short: to successfully kick the habit, it is important to break through all the addictive behavior.”

CV

Trudi TrompBeelen (69) was a general practitioner in Alkmaar and Amsterdam for 25 years. In 2000 she stopped her practice and focused entirely on addiction care. Until 2016 she worked as an addiction doctor at the Jellinek Kliniek in Amsterdam, where she focused on the treatment of smoking. She was involved in developing the Tobacco Addiction Treatment Guideline. She also gave hundreds of health care professionals refresher courses about smoking (cessation). Although she is officially retired, she still teaches this continuing education.

This article originally appeared in Plus Magazine January 2018. Not yet a Plus Magazine subscriber? Becoming a subscriber is done in no time!