Dear Dr. Garner,
My daughter insists on smoking three packs of cigarettes a day, despite everything she knows about the danger it poses. I am very depressed, not only with her situation but also with the fact that my grandchildren are exposed to the horrible smoke every day as well.
I heard about a new vaccine that helps people quit. What do you think of it?
Sad Mom of a Super Stupid Smoker
 
Dear Sad Mom,
I don’t blame you for being sad. I was just talking about this problem with my good friends, Dr. Anthony Saleh, a noted pulmonary specialist, and Dr. Emile Baccash, a specialist in geriatric care.

With the Thanksgiving holiday upon us, I asked the callers to our most recent “Ask the Doctor” show on The Prayer Channel about what they were most thankful for. Almost every caller mentioned friends and family, not fancy homes or cars. You are watching your daughter destroy herself. She is also causing harm to your grandchildren, not only from the secondhand smoke, but also from the possibility that she might not be there for them in the future.

The facts tell it all:

• One smoker out of two dies from a smoking-related illness and on average, smokers live eight years fewer than non-smokers.

• 530,000 people die each year from disease caused by smoking — the equivalent to 1,325 crashes of a 747 air plane — more than three crashes every day.

• Smoking not only causes lung cancer, but causes strokes, osteoporosis, bronchitis, stomach ulcers and causes deterioration of gums (the least of your problems when you have cancer).

• Smokers cause 33% of all fires.

• Every eight seconds, someone in the world dies from a tobacco-related illness.

• Over 50,000 people a year die from secondhand smoke exposure.

• 90% of smokers begin smoking before the age of 21 — advertising plays a big role.

• Only about 30% of women who smoke stop smoking when they find out they are pregnant.
 

Effects on Other People

If she will not quit for her own benefit, perhaps this will help:

• Among infants under 18 months, secondhand smoke is associated with as many as 300,000 cases of bronchitis and pneumonia each year.

• Secondhand smoke from a parent’s cigarette, increases a child’s chances for middle ear infection, causes coughing and wheezing and worsens asthma.

• If both parents smoke, a teenager is more than two times as likely to smoke as a young person whose parents are nonsmokers.

• If all women who smoke during pregnancy stopped, about 4,000 new babies would not die each year.
 
Studies show that quitting without help is usually not successful. The smoker is addicted to the chemical nicotine, but also there is a strong psychological dependence on smoking.
 

Physical Benefits

The first thing to do when deciding to quit, is to understand the benefits your body will achieve:

•  People who quit smoking, regardless of age, live longer than people who continue to smoke.

• Quitting substantially decreases the risk of lung, esophagus, pancreatic, bladder and cervical cancer.

• When smokers quit, in just 24 hours the chances of a heart attack decrease.

• At 48 hours after someone quits smoking, nerve endings in the mouth and tongue begin to regenerate and the ability to smell and taste begins to return.

• Within 20 minutes of quitting smoking, blood pressure and pulse rate drops.

• At eight hours, poisonous carbon monoxide levels drop to normal and oxygen levels increase.

Once you have decided to quit, here are some tips to be successful:

• Set a date for quitting – today would be good.

• Get rid of all cigarettes and carry other things to put in your mouth, such as gum, hard candy or a toothpick.

• Start a money jar with the money you save by not buying cigarettes. (A one-pack-a-day smoker saves over $1,000 a year.)

• When you get the urge to smoke, exercise, drink a glass of water or do some other activity.

• Stay away from other smokers.

• Discard lighters and ashtrays.

• Eat regular well-balanced meals to cut down on binge eating.

• Most importantly, one should have the help of a doctor. Most people who stop smoking have tried 608 times — the big reason for the failure is that they did not use any of the medications available to stop smoking. In fact, only about one in seven people actually use medications to help stop.
 

Medications to Help You Stop

What are the medications available and how do they work?

Nicotine replacement products – patches, gum, lozenges, nasal sprays and inhalers each have benefits and can be tailored to the amount of nicotine one needs. Most are non-prescription items. The inhaler allows the person to control the dose of nicotine he or she receives but should not be used for people who also have asthma or lung disease.

Chantix – This is a prescription stop-smoking medication that doesn’t contain nicotine. It helps control cravings for tobacco. It blocks the part of the brain that is stimulated by nicotine. It lessens the pleasure one gets and also helps cut down on withdrawal symptoms. It has about a 22% success rate after one year. It must not be used in people who drink a lot of alcohol.

Zyban – This medication is an antidepressant, that doesn’t contain nicotine and isn’t addicting. It is available as a prescription, and lessens the craving for nicotine.

Vaccine – This is what you were referring to in your question. This past week, a major breakthrough was announced, with the discovery of a vaccine that helps people stop smoking. It works by binding to nicotine and forming antibodies that prevent the nicotine from getting to the brain. One no longer gets pleasure from smoking. It works about two times as well as those getting placebo shots. It is not available at this time for use by the general public. There are ongoing trials to test the efficacy and safety of the vaccine. After these tests are successfully completed it may become available to the public. You can ask your doctor about these trials to see if any are available for your daughter’s participation.

In summary, cigarette smoking is a real and powerful addiction. Your daughter is not alone in this struggle, as there are 45 million other Americans still smoking.

If at First, You Don’t Succeed

It is a combination of chemical addiction from nicotine, and psychological addiction. Any attempt to stop should address both issues. Behavioral therapy and counseling can help address the psychological issues and the medications above can address the nicotine addiction. Most people who quit, don’t do it on the first try, so as the song says — if at first you don’t succeed — “Pick yourself up and start all over again.”
 
I hope that this column helps your daughter to see how important it is that she works on the difficult process of kicking her smoking habit. It will most likely not happen overnight, but with perseverance, she will be successful.

Until next time, have a great week and be well.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also is the host of “Ask the Doctor,” the weekly cable TV show seen on The Prayer Channel.