UC HEALTH LINE: In Troubled Times, Help Available for Smokers

CINCINNATI—Find yourself reaching for a cigarette as the stock market tumbles?

While smoking is a common response to stress, and it might be tempting to puff away the anxiety, there’s no reason to add health problems to financial misery. Plenty of smoking-cessation help is available, often at a modest price. And stop-smoking efforts get a boost with the Nov. 20 Great American Smokeout, which urges smokers to quit for at least one day.

“It wouldn’t surprise me to see more smoking in these stressful economic times,” says University of Cincinnati (UC) researcher Robert Anthenelli, MD, a professor in the psychiatry department with an appointment at the Cincinnati Department of Veterans Affairs Medical Center.

Anthenelli, director of the Tristate Tobacco and Alcohol Research Center (Tri-TARC), also notes that with companies shedding jobs, fewer people have access to health insurance—and that affects their ability to obtain prescribed medicines.

At least one effort to stimulate the economy had an adverse effect on smoking-cessation efforts: Ohio lawmakers in May abolished the Ohio Tobacco Prevention Foundation effective June 30 and authorized the state treasurer to liquidate its remaining funds of $270 million, with $230 million going to a new state jobs fund. The remaining $40 million went to the foundation’s obligations, which were taken over by the state health department.

Still, there are low-cost services available to help smokers quit, Anthenelli says, including the American Cancer Society’s Quitline at (800) 227-2345. The toll-free telephone number links callers with trained counselors.

While some smokers are able to quit on the spot, Anthenelli is a firm believer in combining counseling with an approved smoking-cessation medicine.

“Your likelihood of succeeding ‘cold turkey’ is probably about 1 in 20,” he says, “and those aren’t very good odds. You can dramatically improve those odds by using a combination of a medication and counseling.”

The U.S. Food and Drug Administration has approved seven medicines for smoking cessation—five nicotine replacement therapies (NRTs) and two non-nicotine pills, varenicline (trade name Chantix) and bupropion (Zyban). Varencline has been found to be the most effective smoking cessation medication, followed by bupropion and the NRTs, but smokers wishing to quit should consider their medical history and discuss their choice of medication with a health care provider.

Varenicline works on specific nicotine receptor sites in the brain and also blocks any rewarding feelings of smoking. Bupropion, originally developed as an antidepressant, helps reduce the craving for cigarettes. Non-nicotine pills are usually started about a week before the quit date, with a treatment period of 12 weeks after the quit date.

NRTs work by replacing some of the nicotine lost when a smoker quits and reducing withdrawal symptoms. They include the nicotine gum, patch and lozenge, all of which are available over the counter, and the nasal spray and inhaler, which are available by prescription only. The usual length of treatment is about eight weeks.

“The medicines work best if combined with counseling,” Anthenelli stresses. “The more counseling you can get in combination with the medication, the greater your likelihood of quitting.”