Are doctors taught about nicotine recovery?

Sometimes the response people get from their doctors upon finding out that they had quit smoking is less than enthusiastic, often expressing great skeptisism that the people will be able to sustain their quits over the long-term. The former smokers are often left discouraged and at times begin to question their own ability to stay off. Video explains why physicians are often pessimistic of people’s ability to quit smoking and stay smoke free over the long term.

Related videos:

“Whatever you do, don’t quit cold turkey”
When you may really need to talk to your doctor about quitting smoking
Talk to your doctor about quitting smoking
New video to pass along to your physicians, dentists and other allied health professionals
How to help your patients quit smoking
How did the people you know quit smoking?
Am I doomed to fail if I don’t get professional help
Who should you believe?Is cold turkey the only way to quit?
A smoking cessation expert?
The surgeon general says…

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“What ever you do don’t quit cold turkey!”
So how did most successful ex-smokers actually quit?
“40 years of progress?”
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“I would rather be a little overweight and not smoking than underweight and dead.”
Resources for doctors to help their patients

A study of smoking and smoking cessation
on the curricula of UK medical schools.
Tobacco Control 2004 March ;13(1):74-77.
Roddy E, Rubin P, Britton J.Division of Respiratory Medicine, School of Medical and Surgical  Sciences, University of Nottingham, Nottingham, UK. Faculty of Medicine and Health Sciences, University of Nottingham. Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham.OBJECTIVES: To identify current practice in teaching on smoking and smoking cessation in UK medical schools, and establish whether newly qualified UK doctors feel prepared to deliver smoking cessation interventions.
DESIGN: Search of published curricula from all UK medical schools; questionnaire surveys of all UK medical school deans and UK qualified pre-registration house officers (PRHOs).
PARTICIPANTS: Deans or nominated representatives from all 24 UK medical schools with current undergraduates, and all UK qualified PRHOs.
MAIN OUTCOME MEASURES: Inclusion and organisation in curriculum of 15 predefined core topics related to smoking (deans); perceived readiness to deliver smoking cessation interventions (PRHOs).
RESULTS: There was no mention of smoking or smoking cessation in the published curriculum material of 10 (42%) medical schools. Deans reported compulsory teaching on a mean (SD) of 9.5 (2.8) core topics, while PRHOs recalled compulsory teaching in only 6.6 (3.2). Training in clinical aspects of smoking cessation was particularly neglected, with 60% of PRHOs reporting that they graduated unable to deliver smoking cessation interventions in accordance with national guidelines. Only 17% of PRHOs felt well prepared to deliver advice on using nicotine replacement therapy, and 5% on bupropion.

CONCLUSIONS: Teaching on smoking cessation in UK medical schools is inadequate.

PMID: 14985601 [PubMed – as supplied by publisher]


WhyQuit’s Patient Resources
Joel’s Library as a .PDF Book
Sadly, the odds are that your physician’s nicotine dependency recovery understanding is primarily comprised of what the NRT pharmaceutical industry want him to know. Even then it’s only what the industry wants them to know.
How many know that when all over-the-counter patch and gum studies are combined and averaged that only 7% of study participants are not smoking at six months?[1] How many physicians actually know that two different studies have now shown that the six-month smoking cessation rate for second time and subsequent nicotine patch users drops to almost 0%?[2][3] How many know that 36.6% of all nicotine gum users are chronic long term users?[4]
Imagine the number of minds and lives that could be touched if your physician’s nicotine dependency understanding matched yours. There was always only one rule, no nicotine today, Never Take Another Puff!
1. Hughes JR, Shiffman S. et al, A meta-analysis of the efficacy of over-the-counter nicotine replacement, Tobacco Control 2003 March;12(1):21 -7. Full text link – http://tc.bmjjournals.com/cgi/content/f … o5/Oz4yutI
2. Tonnesen P, et al., Recycling with nicotine patches in smoking cessation. Addiction. 1993 Apr;88(4):533-9. Abstract – http://www.ncbi.nlm.nih.gov/entrez/quer … t=Abstract
3. Gourlay, S.G., et al., Double blind trail of repeated treatment with transdermal nicotine for relapsed smokers, BMJ 1995;311:363-366 (5 August) http://bmj.bmjjournals.com/cgi/content/ … 1/7001/363
4. Shiffman S, Hughes JR, et al., Persistent use of nicotine replacement therapy: an analysis of actual purchase patterns in a population based sample, Tobacco Control 2003 November; 12: 310-316. Abstract – http://tc.bmjjournals.com/cgi/content/abstract/12/3/310
Other related commentary:

I’ve had a few discussions recently with people who have encountered doctors who were encouraging members of their families or their friends to consider taking NRTs to help deal with occasional smoking thoughts even though the people were totally off smoking and nicotine for very significant time periods. Again, some of these people assumed the doctors understood something because they were trained medical professionals. As this article discusses, training in smoking cessation for medical professionals is usually inadequate to almost non-existant.

All of our members and lurkers have an opportunity to help their doctors to be better able to help their patients. It is not even by just referring them to Freedom, or WhyQuit.com or to any online support. It is by helping them see that for you what made quitting possible was simply getting nicotine out of your system and the one thing that is making this quit stick is the fact that you recognize that you cannot put nicotine back into your system ever again.

If physicians, dentists and other health care professionals see and hear this enough they will start to recognize what message they can give to really help their other patients break free from nicotine. The message is oh so simple, to get and then stay nicotine free just never deliver nicotine again from any replacement source and as far as the smoked form goes, to stay nicotine free is as simple as just knowing to never take another puff!

Joel

From the page http://whyquit.com/patient_cessation.html

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Patient Nicotine Dependency Recovery
Resources for Medical Professionals
Health care professionals know that quitting is one of the best things their patients can do to improve their overall health and quality of life. But when alerting patients to existing tobacco related health problems, or the long-term consequences of smoking, far too often the provider’s warnings go unheeded. When coupled with extremely high relapse rates among patients who do attempt, the endless cycle of frustration can condition health care professionals to simply stop trying to motivate cessation. The fact is, adequately armed, as a medical professional you are perfectly positioned to make a major difference.

Studies have shown that patients do hear their provider’s health risk messages and that your intervention can make a tremendous difference in them attempting cessation and recovery.1 While health care professionals know the benefits of smoking cessation, they are not always informed or trained on successful intervention measures. Many providers have been sold on believing that alternate nicotine delivery vehicles such as the over-the-counter nicotine gum, patch, lozenge are state-of-the-art treatment strategies. While they are considered to be “state of the art,” in real world settings they are actually quite ineffective treatment strategies. A March 2003 meta-analysis shows that 93% of patients using these approaches relapse within six-months. 2, 3, 4

No matter how much or how long a patient has smoked nicotine, they need to understand that the possibility of quitting exists for them. The self-help resources and materials below can aid you in helping patients quit smoking or end dependence upon other forms of nicotine delivery. Whether used to develop a deeper personal understanding to share with patients, as printed and shared patient handouts, or their existence and availability is simply brought to the patient’s attention, given an opportunity, these free motivation, education and support resources have the potential to make a significant difference over what you’ve previously experienced.

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Motivation Nicotine dependent patients who try quitting and fail generally attribute relapse to a lack of strength or willpower. In reality the inability for people to quit is much more likely to be from a lack of understanding of how to quit that from a lack of strength or willpower. WhyQuit.com can give your patients the information and understanding they need to successfully quit smoking once and for all.

Founded in July 1999 by John R. Polito, a once hopelessly addicted sixty cigarette-a-day smoker, the original WhyQuit was originally a motivational site whose goal was to provide a potent sampling of the hazards of smoking. WhyQuit.com evolved over time to a site that now that can provide additional motivation, education and support for any patient who you may have began to move toward making the decision to quit. Your guidance can prime your patients to want to quit; our additional information can support them through the quitting process.

 

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Education The American Cancer Society’s Cancer Facts & Figures 2003 report indicates that 91.4% of all successful long-term quitters quit entirely on their own without NRT products such as nicotine gum, the patch, lozenge, spray, inhaler, bupropion (Zyban/Wellbutrin) and without hypnosis or acupuncture. These people basically quit by going cold turkey. We’ve designed our site to help smokers understand that they too can quit if they implement this successful approach.

Joel’s Library is WhyQuit’s education cornerstone. Joel Spitzer has been developing and conducting smoking prevention and cessation programs for the past 32 years. His programs are designed to help his clients understand why people smoke, why they should stop, how to quit, and most importantly how to stay quit. His library’s roughly one hundred short articles present smoking and nicotine as a true chemical dependency. Indexed under seven topics – dependency, health risks, quitting, relapse prevention, weight control, youth prevention, and history – each article in the collection is united by the underlying theme that to get off and stay off of cigarettes the smoker must learn to “Never Take Another Puff.”

A quick sampling of the library shows how Joel addresses the cessation blood-sugar swing issue, the emotional loss associated with quitting, sleep adjustments, fixating, anger, quitting crutches, “cheating,” and the important issue of cessation weight gain.

Joel’s “My Cigarette My Friend” has become a staple in cessation programs around the globe and is an excellent ice-breaking article to keep available in your patient waiting area.

We have compiled an online Ebook that you may wish to download and print for patients who do not have Internet access. Entitled “Never Take Another Puff” Joel’s Library is available in .PDF book format (1.75 MB – 141 pages) and can be printed and presented as gifts to patients. Our only request is that our materials be made as freely available to patients as we have made them to you, without any cost or charge.

This link is to Joel’s upcoming clinics and seminars in and around the Chicago area. Health care providers and staff are invited to attend, take notes, and incorporate Joel’s cessation teachings, content and concepts into your practice or wellness program.

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Serious Group Support Founded on September 8, 1999 by John R. Polito and Joanne Diehl, Freedom from Tobacco is a free 3,000+ member MSN hosted message board support forum . With the help of scores of dedicated volunteers, and the guidance of Joel Spitzer, Freedom evolved into a world-class education oriented abrupt cessation forum where every member remains highly focused on a single topic – no nicotine today, Never Take Another Puff!A 100% nicotine-free environment in every respect, Freedom’s rules may sound harsh but they not only provide important rehabilitation sanctuary from those still under the influence of nicotine, they hammer home the essential understanding of relapse prevention that will be necessary if your patient is going to sustain a permanent quit.

New arrivals are given a road-map of reading assignments designed to help navigate the first 72 hours of detoxing nicotine. They are also encouraged to explore Freedom’s more than 170,000 indexed and archived messages. New quitters are granted group posting privileges once they provide written certification of having remained completely nicotine free for 72 hours.

Today hundreds of Freedom graduates form a knowledgeable, skilled and supportive army of dedicated volunteers who are waiting to reach out to a new generation of arrivals that can include your smoking patients. Freedom’s last two efficacy reviews both generated 39% midyear continuous nicotine cessation for new members demonstrating participation in the group by posting at least once.

Please rest assured that Freedom has strictly enforced policies against any member rendering medical advice regarding any symptom described on the message board. Freedom’s Courtesies and Rules expressly forbid members from rendering advice or making any recommendations regarding specific health concerns, answering member medication or herb concerns, or from making dieting recommendations. Instead members are strongly encouraged to see the assistance of qualified professionals.

We’re here to help and there’s only one rule ….


No nicotine today, Never Take Another Puff!
February 2008 commentary from John Polito from WhyQuit.com
Physicians Missing
Golden Opportunity to
Teach, Heal and Save Lives

In June, my oldest daughter Carmen graduated as an M.D. from the  Medical University of South Carolina. We’re extremely proud of Carmen as she graduated #3, 4 or 5 (the exact finish was kept secret) and was the top female grad. But what’s shocking is that her class received no formal instruction time in how to counsel patients regarding our nation’s leading cause of premature death. What students were instead exposed to was watching doctors advising patients during clinical rotations, primarily in how to prescribe pharmaceutical “cessation” products, very much in line with what the 2004 UK study above seeks to achieve.

I’m about to complete presenting two hour cessation seminars to thousands of inmates in 28 prisons. Not only does each inmate have in hand WhyQuit’s quitting tips sheet, they now have access to library copies of “Never Take Another Puff” by Joel. Yes, sadly, many of these inmates will soon be better prepared, knowledge wise, to counsel friends and family regarding cessation, than their own doctors. Why?

What medical students and physicians need to ask themselves is, what dependency recovery learning takes place by slapping on a patch, swallowing a pill, chewing nicotine gum, being hypnotized or when stuck with needles? None, absolutely none. Knowledge truly is a quitting method but that knowledge can never be shared unless known.

Yes, practicing physicians are short for actual patient contact time but if the doctor has a smoking patient sitting and waiting in a patient examination room, they have before them a captive audience and golden opportunity to dim the lights and treat the patient with a dose of education. Short 15 to 30 minute video clips played upon an exposed wall could teach patients: (1) the price their body is paying, (2) how and why their mind became nicotine’s slave (3) how to arrest their dependency, or (4) relapse prevention clips at follow-up appointments.

The enslaved mind’s priorities teacher was long ago fooled into believing that arriving nicotine was a species survival event, every bit as real and important as eating. This isn’t some “nasty little habit” but nicotine’s presence or absence causing brain neuro-chemicals to flow or not flow, rewarding anticipation or compliance with dopamine pathway “aaah” sensations and punishing abstinence with insula generated anxieties and craves. These amazing behavior control pathways are believed to generate the most vivid or powerful memories the mind can record, memories that quickly over-write and bury nearly all remaining memory of life without nicotine. The new drug addict is compelled to believe that nicotine use defines who they are, gives them their edge, helps them cope and that life without it would be horrible. If the physician isn’t going to tell the patient the truth about what’s happened to their brain then who will?

Every physician encountering chemically enslaved patients must have some means of instructing patients regarding the time needed to rid the mind of all nicotine and achieve peak withdrawal, and the law of addiction, the fact that they are not fighting a whole pack or even a whole cigarette but just that one powerful puff of nicotine that would, within 8-10 seconds, cause roughly 40% of their brain’s nicotinic-type acetylcholine receptors to be occupied, creating a powerful dopamine explosion that their mind’s priorities teacher would find nearly impossible, in the short term, to ignore.

Patients need to understand how nicotine was their spoon and the importance of again learning to eat regular meals now that nicotine, via fight or flight pathways, is no longer pumping stores fats and sugars into their bloodstream with each puff. They need to realize that encountering and extinguishing their mind’s conditioned feeding cues, their crave triggers, is good not bad, as with each extinguishment they are rewarded with the return of another aspect of life, a time, place, location, person or emotion during which their brain once expected the arrival of a new supply of nicotine.

They need to be taught not to run and hide from smoking thoughts rattling about inside the conscious thinking mind but to grab hold of each and closely examine it for truth. You want “one”? For the true drug addict, there’s no such thing as one as one is too many and a thousand never enough. You miss the taste? There are zero taste buds in human lungs, the place you’ll instantly such the smoke. You’re bored? Your brain is not addicted because it’s bored, it’s bored because smoking one pack-a-day consumed roughly 5 minutes per cigarette or 11.5 hours per week, and when quitting you notice all the extra time you wasted while the cigarette’s 4,000 chemicals slowly destroyed your body. You “loved” smoking? Stop and think about the beauty of your pre-addiction mind, before nicotine took control, and going months and years without once craving nicotine. If you can no longer remember the beauty of that mind then what basis exists for honest comparison? None.

Increasingly, both health insurance and government treatment programs are showing greater willingness to compensate physicians for nicotine dependency recovery counseling. Just one or two wires running from an existing office computer to a less than $300 examining room LCD or DLP projector and a less than $50 speaker could instantly deliver your personalized slide show cessation presentation to your smoking patients, a presentation that can sequence automatically with your voice on recorded audio clips explaining exactly what they are seeing and why it’s important. Imagine $350 and a few hours recording time actually helping save a patient’s life.

What’s stopping you? Need help putting it together? Here at Freedom you’ll find hundreds of the most knowledgeable ex-smokers on earth and I’m sure any one of them would be delighted to assist. Knowledge truly is power, but only if put to work!

Breathe deep, hug hard, live long,

John (Gold x8)