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Medical Edge Newspaper Column from Mayo Clinic

HELPING YOUNG PEOPLE STOP SMOKING

DEAR MAYO CLINIC: Smoking causes so many health problems that usually occur later in life. But because this habit is most often formed early in life, it’s clear that targeting adolescents and young adults is the way to go. Are any cessation methods particularly effective for these groups?

ANSWER: You are correct that people tend to start smoking when they’re young. About 90 percent of smokers acquire the habit before age 21 — most before age 18. And they are rapidly hooked; among adolescents, nicotine addiction can begin within days or weeks of smoking their first cigarette.

The nicotine in tobacco keeps them smoking because it increases the release of a “feel-good” brain chemical called dopamine. Getting that dopamine boost is part of the addiction process, and nicotine can be as addictive as cocaine. Thus, a very important part of smoking cessation, regardless of age, is the use of medications that will either replace the nicotine or ease withdrawal symptoms.

Nicotine-replacement products are available over the counter in the form of skin patches (brand names include Nicoderm CQ, Nicotrol and Habitrol), gum (Nicorette) and lozenges (Commit); and by prescription as a nasal spray or inhaler. Biologically, their effects are similar, so choice depends on the specific needs of the individual. But for younger people, especially adolescents, experience has shown that the patch, applied once a day, is the most practical delivery system because keeping track of doses during the day is not necessary.

Another option is to use medication to reduce withdrawal symptoms. The leading choice is the antidepressant medication bupropion (Zyban), which increases the level of dopamine in the brain, thereby reducing the severity of cravings that plague the recent nonsmoker.

Use of nicotine-replacement products or bupropion doubles the smoking-cessation success rate, compared to simply going cold turkey. But it’s important, especially with young people, to work with a health-care professional when using any of these medications. Acting on their own, individuals will not necessarily be able to choose the best forms of delivery or determine appropriate dosages.

Actually, the combination of medication and counseling is the standard of care for people of all ages. Whether this counseling — the “cognitive/behavioral approach” (its aim is to change one’s thinking and behavior) — comes from a physician, psychologist or another trained professional is less important than the quality and consistency of support for the patient.

Ideally, the individual should be counseled for at least eight sessions, each lasting at least 10 minutes. Experience has shown that the total time in smoking-cessation counseling should range from 90 to 300 minutes.
These sessions include three basic elements: recognizing high-risk situations, developing coping skills and understanding basic information.

It is important that the individual recognizes situations — such as drinking alcohol, being around other smokers or feeling rushed — that increase the possibility of relapse. Coping skills give people ways of dealing with such situations or avoiding them in the first place. The idea is to substitute other kinds of pleasure for the pleasure previously derived from smoking.

Finally, knowledge of basic information is critical. It’s useful to be aware, for example, of withdrawal symptoms, and to realize that their intensity will begin to subside after one to three weeks. It’s also nice to know, especially when the going gets rough, that half of all people who’ve ever smoked have successfully quit.
In addition, counselors may encourage patients to establish a smoke-free home, solicit the cooperation of co-workers and participate in support groups.

Complementing all of this, particularly for a young person, should be a caring parent, other relative or friend who shows interest in a nonjudgmental way and can provide support when needed.

— Steven C. Ames, Ph.D., Nicotine Dependence Center, Mayo Clinic, Jacksonville, Fla.

Additional Resources:
Treatment for Nicotine Dependency
Appointment Information
More Information

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.