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Smoking cessation (colloquially quitting) is the process of discontinuing the practice of inhaling a smoked substance.[1] Smoking cessation programs mainly target tobacco smoking, but may also encompass other substances that can be difficult to stop using due to the development of strong physical addictions or psychological dependencies resulting from their habitual use. This article will focus exclusively on cessation of cigarette smoking. However, the methods described may apply to cessation of smoking other substances.

It is believed that very few smokers can successfully quit the habit in their very first attempt. Many studies indicated that many smokers find it difficult to quit, even after they get afflicted with tobacco related diseases. A serious commitment and resolve is required to arrest nicotine dependency.

  • There is good news about cessation: in a growing number of countries, there are more ex-smokers than smokers.[2]
  • Up to three-quarters of ex-smokers have quit without assistance (“cold turkey” or cut down then quit), and unaided cessation is by far the most common method used by most successful ex-smokers.
  • A serious attempt at stopping need not involve using nicotine replacement therapy (NRT) or other drugs or getting professional support.
  • Early “failure” is a normal part of trying to stop. Many initial efforts are not serious attempts.
  • NRT, other prescribed pharmaceuticals, and professional counselling or support also help many smokers, but are certainly not necessary for quitting.

Contents

Smoking Habit

Tobacco contains the chemical nicotine. Smoking cigarettes leads to a dependence on nicotine. Cessation of smoking leads to physiological symptoms of withdrawal. Methods of smoking cessation must address this dependency and subsequent withdrawal symptoms.

Methods of smoking cessation

Abrupt vs gradual

  • Quitting "cold turkey": abrupt cessation of all nicotine use as opposed to tapering or gradual stepped-down nicotine weaning. It is the quitting method used by 80[3] to 90%[4] of long-term successful quitters in some populations.
  • Gradual reduction involves slowly reducing one's daily intake of nicotine. This can be done in two ways: 1) by repeated changes to cigarettes with lower levels of nicotine; 2) gradually reducing the number of cigarettes smoked each day.

Research suggests that gradual reductions may lead to levels below the "minimum daily amounts" required to maintain an addiction, which could then facilitate complete cessation of smoking.[5]

Pharmacological

The U.S. Food and Drug Administration has approved seven medications for treating nicotine addiction. All of these helped with withdrawal symptoms, cravings.

  • Nicotine replacement therapy (NRT) Five of the approved medications are different methods of delivering nicotine in a form that does not involve the risks of smoking.

The five NRT medications are:

1) transdermal nicotine patches deliver doses of the addictive chemical nicotine, thus reducing the unpleasant effects of nicotine withdrawal. These patches can give smaller and smaller doses of nicotine, slowly reducing dependence upon nicotine and thus tobacco. This method becomes most effective when combined with other medication and psychological support.

A 21mg dose Nicoderm CQ patch applied to the left arm.


2) gum
3) lozenges
4) sprays
5) inhalers).


6) Antidepressants: bupropion is an antidepressant marketed under the brand name Zyban.
Bupropion is contraindicated in epilepsy, seizure disorder; anorexia/bulimia (eating disorders), patients use of psychosis drugs (MAO inhibitors) within 14 days, patients undergoing abrupt discontinuation of ethanol or sedatives (including benzodiazepines such as Valium)[6]


7) nicotinic receptor agonist: varenicline is a marketed in the U.S. as Chantix and Champix in the UK and Canada. Varenicline Tartrate is a prescription drug that can be used to alleviate some of the withdrawal symptoms. It can also be taken as a form of aversion therapy by smokers to make the act of smoking more repulsive.

  • Other Pharmacological Approaches: Recently, an injection given multiple times over the course of several months, which primes the immune system to produce antibodies which attach to nicotine and prevent it from reaching the brain, has shown promise in helping smokers quit. However, this approach is still in the experimental stages.[7]

Second line pharmocological treatments

Two other medications have been used in trials for smoking cessation, although they are not approved by the FDA for this purpose. Both of these may be used under careful physician supervision if the first line medications are contraindicated for the patient.[8]
1) Clonidine may reduce craving for cigarettes after cessation. However it does not consistently ameliorate other withdrawal symptoms.
2) Nortriptyline is another antidepressant.

Psychosocial approaches

  • Great American Smokeout is an annual event that invites smokers to quit for one day, hoping they will be able to extend this forever.
  • Smoking-cessation support and counseling is often offered over the internet, over the phone quitlines (e.g. the US toll-free number 1-800-QUIT-NOW), or in person.
  • Attending a self-help group such as Nicotine Anonymous[9] and electronic self-help groups such as Stomp It Out[10]

Substitutes for cigarettes

  • Vaporizer: heats to 410°F. or less, compared with 1500°F./860°C. in the tip of a cigarette when drawn upon; eliminates carbon monoxide and other combustion toxins.
  • Electronic cigarette: Shaped like a cigar or cigarette, this device contains a rechargeable battery and a heating element that vaporizes liquid nicotine (and other flavorings) from an insertable cartridge, at lower initial cost than a vaporizer but with the same advantages including significantly reducing tar and carbon monoxide. However in September 2008, the World Health Organization issued a release proclaiming that it does not consider the electronic cigarette to be a legitimate smoking cessation aid, stating that to its knowledge, "no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy."[11]
  • Smokeless tobacco: There is little smoking in Sweden, which is reflected in the low cancer rates for Swedish men. It is claimed that Swedish men are more likely to use smokeless tobacco than to smoke.[citation needed] However, claims that spit tobacco might reduce the exposure of smokers to carcinogens or the risk for cancer (and even be used as a way to stop smoking) are not supported by the available evidence. Oral and spit tobacco increase the risk for leukoplakia a precursor to oral cancer.[12] Chewing tobacco has been known to cause cancer, particularly of the mouth and throat.
  • Smoking herb substitutions (non-tobacco)[13].

Alternative medical approaches

  • Hypnosis clinical trials studying hypnosis as a method for smoking cessation have been inconclusive. (The Cochrane Database of Systematic Reviews 2006, Issue 3.)
  • Aromatherapy based treatments and herbal preparations such as Kava and Chamomile, the efficacy of which has not been established.[citation needed]
  • Acupuncture clinical trials have shown that acupuncture's effect on smoking cessation is equal to that of sham/placebo acupuncture. (See Cochrane Review)
  • Laser therapy based on acupuncture principles but without the needles.

Self help

  • Interactive web-based programs which specialize in teaching participants how to quit.
  • Quit meters: Small computer programs that keep track of quit statistics such as amount of "quit-time", cigarettes not smoked, and money saved.
  • Self-help books.
  • Spirituality Spiritual beliefs and practices may help some smokers quit.[1]

Smoking cessation services

Group or individual therapy can help people who want to quit. Some smoking cessation programs employ a combination of coaching, motivational interviewing, cognitive behavioral therapy, and pharmacological counseling.

Research Results - Comparison of success rates

Quitting can be harder for individuals with dark pigmented skin compared to individuals with pale skin since Nicotine has an affinity for melanin-containing tissues. Studies suggest this can cause the phenomenon of increased nicotine dependence and lower smoking cessation rate in darker pigmented individuals.[14]

There is an important social component to smoking, which can be utilized by the counselors while advising the addicts. Study analyzing a densely interconnected network of over 12,000 individuals found that smoking cessation by any given individual reduced the chances of others around them lighting up by the following amounts: a spouse by 67%, a sibling by 25%, a friend by 36%, and a coworker by 34%.[15]

Controlled trials

To determine the benefit or harm of a new therapy, ideally, a randomized controlled trial is usually conducted, a "gold standard" trial, as it is often called. In such a trial, one group of people are exposed to the treatment and another similar group is not. After some months or years have elapsed, mortality and morbidity in the two groups is compared. In the case of smoking cessation trials, the measures focus on rate of successful withdrawal, length of time in withdrawal and relapses.

There are many people and organizations touting what are claimed to be effective methods of helping smokers to stop. Such claims of success are rarely backed up by independent comparative clinical trials or correctly calculated success rates. A separate thorough review of the evidence for each of several methods and aids for stopping smoking is available via the Cochrane Library website.[16]

Many such trials have been conducted to determine the health effects of quitting smoking although most have used quitting plus other lifestyle changes in diet and exercise, with or without drugs to improve blood pressure and blood cholesterol. The Cochrane Collaboration [17] have examined these trials and concluded that such interventions do not improve life expectancy or the death rate due to heart disease. They conclude that "Contrary to expectations, these lifestyle changes had little or no impact on the risk of heart attack or death" and "The continued enthusiasm for health promotion practices given the failure of these community intervention trials is curious, especially given the huge resources which have been put into them."

U.S Clinical Practice Guideline

A U.S government study of smoking cessation research was published in 2000 called “Clinical Practice Guideline: Treating Tobacco Use and Dependence” [18] This was updated in 2008 in the publication "Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update" [19] (to be called here the "Clinical Practice Guideline", or "2008 update" or simply "Guideline" report). Experts screened over 8700 research articles published between 1975 and 2007. More than 300 studies passed the criteria for the gold standard trials. Using these 300 studies for a meta-analysis of relevant treatments, it gives advice on smoking cessation treatment. An additional 600 reports were not included in the meta-analysis, but helped formulate the recommendations.

In general: a) Control groups quit at a rate of around 10%. b) Pharmacological treatments resulted in 15-33% quit rates. d) Psychosocial interventions resulted in 14-25% quit rates. e? Little or no evidence was found to support use of alternate medicine or cigarette substitutes.

For the meta-analysis, The Clinical Practice Guideline used percent of subjects who were not smoking at a follow-up 5-6 months after the start of the study as their common measure of success. The authors state that this measure is representative of successful cessations. Most relapses occur before this time and longer term measures are generally comparable to this measure. (See chapter 1, section Outcome Data for a further discussion). Comparisons between treatment group and control group measures is expressed as the ratio of the treatment group scores divided by the control group scores. (see chapter 1, section on Meta-Analytic Techniques for a further discussion). The report includes tables setting forth percentage of subjects abstaining from smoking at the 6 month follow-up ("quit rates") and success rates for various treatments relative to control groups. Some of the statistically significant results are listed below (reported in chapter 6 of the Guideline report).

Pharmacological Treatments

The following results are shown in Table 6.26 comparing placebo effect to pharmacological treatments.

  • The placebo quit rate for all of these comparisons was (13.8%) (table 6.26).
  • All forms of dugs approved by the FDA for smoking cessation show more that twice the quit rate of the placebo group.
  • The quit rate for using Varenicline(2 mg/day) (33.2%) as much as tripled over the placebo (13.8%) (Table 6.26). This was one of the highest quit rates for any single treatment. However, counter indications and adverse side effects might make it use undesirable for many smokers.
  • Nicotine gum increased quit rate to 19%.
  • All other FDA approved drugs alone increased quit rate about the equally well (22.5-26.7%).
  • Use of non-FDA approved, second line medications, did not significantly increase quit rates.

Combined Pharmacological Treatments

  • The Nicotine Patch plus ad lib use of gum or spray increased quit rates to 36.5%, the largest quit rate reported in the study.
  • The patch plus other FDA approved medications raised quit rates to between 25.8-28.9%.

Psychosocial Interventions

  • A physician's advice to quit can, significantly, increase quitting odds by 25 percent to (7.9% for no advise to 10.2% for advice. (Table 6.7) Not reported in the Guideline, several studies have found that smoking cessation advice is not always given in primary care in patients aged 65 and older,[20][21] despite the significant health benefits which can ensue in the older population.[22]
  • Intensity of clinical intervention affects the degree of successful cessations.


(1) Contact of 3 to 10 minutes can increase quit rate 60%. (Table 6.8)
(2) Cessation programs involving more than 30 minutes of contact time increased success rates over no contact (11%) as much as 2 to almost 3 times (26% to 38.4%), regardless of other quitting method included (Table 6.9)
(3) Number of Sessions: Programs involving 8 or more treatment sessions can double success rates (24%) over 0 or 1 session (12%). (Table 6.10)

  • Multiple formats of psychosocial interventions increase quit rates: 10% for no intervention, average 15.1% for one format, 18.5% for 2 formats, and 23.2% for three or four formats (Table 6.14).
  • Self-help: Evidence did not support the efficacy of any self-help method (Table 6.15). The Authors advise more research on this in the future.
  • Quitlines counseling significantly increased quit rate (12.7%) over self-help, minimal or no counseling (8.5%). Quitline counseling combined with medication (28.1%) also increased quit rate over medication alone (23.2%).
  • Computerized Interventions (web-based or stand-alone) was identified in the Guideline report as having significant effects on quit rate, but no specifics were given.

Formats of intervention

The Guideline report from 2000 showed significant results for two methods. However, the Guideline 2008 update indicates that these methods may not be as effective as shown in 2000. The two methods are given a lower "Strength of Evidence" rating in the 2008 Guideline. These methods are as follows:

  • Practical counseling: involving teaching problem solving skills related to challenges faced during smoking cessation increase quit rate over no counseling.
  • Support and Encouragement during treatment.

Ten other formats of intervention are not recommended. See Chapter 6, section 3. Treatment Elements for further explanation.

Combined Psycohosocial and Pharmacological Treatments

  • High intensity counseling of two or more sessions increased success rates to 27.6 to 32% when added to using any form of medication (Table 6.22, 6.23)
  • The success rate of counseling alone (14.6%) was improved by adding use of medication to any counseling form (22.1%)

Alternative Methods and Cigarette Substitutes

The authors indicate that there is no adequate evidence to support the use of hypnosis, acupuncture, or laser therapy as treatments for smoking cessation. No research meeting the required "Gold Standard" criteria was reported on use of cigarette substitutes.

Side effects of smoking cessation

Weight gain

Some studies have concluded that those who do successfully quit smoking may gain weight. "Weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit." (Williamson, Madans et al., 1991). Therefore, drug companies researching smoking-cessation medication often measure the weight of the participants in the study. In 2009, it was found that smoking over expresses the gene AZGP1 which stimulates lipolysis, which is the possible reason why smoking cessation leads to weight gain.[23]

Depression

In the case of especially women, a major hurdle for quitting may emanate through Major depression and challenge smoking cessation. Quitting smoking is especially difficult during certain phases of the reproductive cycle, phases that have also been associated with greater levels of dysphoria, and subgroups of women who have a high risk of continuing to smoke also have a high risk of developing depression. Since many women who are depressed may be less likely to seek formal cessation treatment, practitioners have a unique opportunity to persuade their patients to quit.[24]

Prognosis - health benefits of smoking cessation

Many of tobacco's health effects can be minimized through smoking cessation. The British doctors study[25] showed that those who stopped smoking before they reached 30 years of age lived almost as long as those who never smoked. Some research has indicated that some of the damage caused by smoking tobacco can be moderated with the use of antioxidants.[26]

Upon smoking cessation, the body begins to rid itself of foreign substances introduced to the body through smoking. These include substances in the blood such as nicotine and carbon monoxide, and also accumulated particulate matter and tar from the lungs. As a consequence, though the smoker may begin coughing more, cardiovascular efficiency increases.

Many of the effects of smoking cessation can be seen as landmarks, often cited by smoking cessation services, by which a smoker can encourage him or herself to keep going. Some are of a certain nature, such as those of nicotine clearing the bloodstream completely in 48 to 72 hours, and cotinine (a metabolite of nicotine) clearing the bloodstream within 10 to 14 days. Other effects, such as improved circulation, are more variable in nature, and as a result less definite timescales are often cited.

As with other addictions, apart from the dependence of the body on chemical substances, a smoking addiction is often related to everyday lifestyle events, which can include thinking deeply, eating, drinking tea, coffee or alcohol, or general socializing. As a result, smokers may miss the act of smoking particularly at these times, and this may increase the difficulty inherent in a cessation attempt. As a result of a lower dopamine response from nicotine receptors in the brain, a degree of depression may ensue, along with somatic responses where the smoker feels less able to perform the day to day tasks previously related to smoking without having the usual cigarette to accompany them.

High stress often results when heavily addicted individuals or long-time smokers attempt to quit, in part because their everyday lifestyle events have been altered and they may miss the social interaction normally associated with the habit.

Smoking cessation will almost always lead to a longer and healthier life. Stopping in early adulthood can add up to 10 years of healthy life and stopping in one's sixties can still add three years of healthy life (Doll et al., 2004). Stopping smoking is associated with better mental health and spending less of one's life with diseases of old age.

The immediate effects of smoking cessation include:

  • Within 20 minutes blood pressure returns to its normal level
  • After 8 hours oxygen levels return to normal
  • After 24 hours carbon monoxide levels in the lungs return to those of a non-smoker and the mucus begins to clear
  • After 48 hours nicotine leaves the body and taste buds are improved
  • After 72 hours breathing becomes easier
  • After 2–12 weeks, circulation improves

Longer-term effects include:

  • After 5 years, the risk of heart attack falls to about half that of a smoker
  • After 10 years, the risk of lung cancer is almost the same as a non-smoker.

Programs

Pfizer provides general facts and tips about smoking cessation and nicotine addiction as well as information about their prescription treatment program.[27]

United States Federal, State and Local Government

Federal Government

Policy coherence in US tobacco control: beyond FDA regulation.[28] describes the widespread involvement of the U.S. Federal Government in issues of smoking cessation and makes proposals for improving the interaction between the agencies involved. Many departments of the U.S. Federal Government play a role in smoking cessation.

Health and Human Services (HHS): The most prominent role of the US Government comes under the authority of several agencies within the Department of Health and Social Services.

  • Food and Drug Administration (FDA): H.R. 1256: Family Smoking Prevention and Tobacco Control Act was signed into law as Public Law No:111-31, on June 22, 2009. [29] [30] This law grants the Secretary of HHS and the FDA extensive powers to regulate production, marketing and use of tobacco products. It grants them the power to collect and record information concerning contents of cigarettes and to disseminate that information to the public.
  • National Institute of Health (NIH): through its National Institute of Drug Abuse (NIDA): supports grants for research on drug abuse, including nicotine addiction. Some of these grants study cessation programs. NIDA also publishes non-technical reports of this research for benefit of the public, as well as publications that summarize what is know about nicotine addiction and tobacco cessation programs.
  • Office of the Surgeon General: Publishes in print and on the web, a variety of materials related to smoking health issues and cessation of smoking.[31]
  • Center for Disease Control (CDC): through its Offiice of Smoking and Health (OSH) is the lead federal agency for comprehensive tobacco prevention and control.
  • Centers for Medicare and Medicaid Services (CMS): reimburses costs for limited counseling by physicians and other healthcare providers. Medicare will pay for certain approved prescription drugs under Medicare Part D coverage.[32]
  • Agency for Healthcare Research and Quality (AHRQ): through its Evidence-based Practice Center (EPC) published a report in 2005, "Tobaco Use: Prevention, Cessation and Control", based on a systemmatic review of literature using data from the Surgeon General's 2000 report, Cochrane Collaboration Reviews and several other systematic reviews and meta-analysis. [33]

1) Smoking Quitline answers questions by live counselors in English and Spanish by telephone.
US toll-free number 1-800-QUIT-NOW
2) LiveHelp is an online chatline for confidential consultations by smokers.
www.nci.nih.gov/livehelp
3) SmokeFree.gov is a web site with resource materials on smoking cessation.
4) Smokefree Women.[34]

Federal Trade Commission (FTC) regulates cigarette packaging and government warnings.

Department of Defense (DOD) According to the National Defense Authorization Act of 2009, the Navy now has an authorized tobacco cessation benefit, called "Make a Donation to the Marielle Foundation". Prior to this time, the military healthcare system (known as TRICARE) was prohibited from funding a tobacco cessation benefit. At Great Lakes Naval Healthcare Clinic there are numerous opportunities for free tobacco cessation support to include walk-up cessation help available at the pharmacy window, cessation care via medical visits, and cessation support during dental visits as well.[35] By instruction, the recruits that train at the Navy's only boot camp, cannot use any tobacco products. The clinic has instituted an education program for all recruits which advises them to remain tobacco free after they leave their 8-week training program.[36]

Environmental Protection Agency (EPA): The EPA is responsible for monitoring and enforcing clean air laws. Clean air laws, being enacted throughout the United States of America as well as many other countries, also help those looking to quit smoking[37].

State Governments

The American Lung Association reports on how states influence smoking cessation. In the report they grade each states on a number of criteria: [38]

  • cessation programs - Money paid through state medicaid funds, State health plans, standards for private health coverage for cessation programs.
  • smoking bans in (1) Government workplaces (2) Private Workplaces (3) Schools and a range of other public places.

Local Governments

Many local governments have instituted smoking bans in public buildings.

See also

Notes

  1. ^ "Guide to Quitting Smoking". American Cancer Society. 2009-10-01. http://www.cancer.org/docroot/ped/content/ped_10_13x_guide_for_quitting_smoking.asp. Retrieved 2009-11-30. 
  2. ^ Chapman, Simon and MacKenzie, Ross (February 9, 2010). "The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences". PLoS Medicine (Public Library of Science). http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000216. 
  3. ^ Doran CM, Valenti L, Robinson M, Britt H, Mattick RP. Smoking status of Australian general practice patients and their attempts to quit. Addict Behav. 2006 May;31(5):758-66. PMID 16137834
  4. ^ American Cancer Society. "Cancer Facts & Figures 2003" (PDF). http://www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf. 
  5. ^ Hughes et al.. ""Smoking reduction may lead to unexpected quitting"". 
  6. ^ Charles F. Lacy et al., LEXI-COMP'S Drug Information Handbook 12th edition. Ohio, USA,2004
  7. ^ ""Nicotine Vaccine Shows Promise for Combating Tobacco Addiction"". http://www.nih.gov/news/pr/dec99/nida-17.htm. 
  8. ^ American Cancer Society. "Cancer Facts & Figures 2003" (PDF). http://www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf. 
  9. ^ "Nicotine Anonymous:A 12 Step Program". http://www.nicotine-anonymous.org/. 
  10. ^ "Experience Project: Stomp it Out". http://www.experienceproject.com/mk/smokefree/index.php. 
  11. ^ "Marketers of electronic cigarettes should halt unproved therapy claims". World Health Organization. 2008-09-19. http://www.who.int/mediacentre/news/releases/2008/pr34/en/index.html. Retrieved 2008-10-01. 
  12. ^ Detailed Guide: Cancer (General Information) Signs and Symptoms of Cancer http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_What_are_the_signs_and_symptoms_of_cancer.asp
  13. ^ http://en.wikiversity.org/wiki/Smoking_cessation#Herbal_alternatives
  14. ^ King G, Yerger VB, Whembolua GL, Bendel RB, Kittles R, Moolchan ET. Link between facultative melanin and tobacco use among African Americans.(2009). Pharmacol Biochem Behav. 92(4):589-96. doi:10.1016/j.pbb.2009.02.011 PMID 19268687
  15. ^ Fratiglioni L, Wang HX (May 2008). "The collective dynamics of smoking in a large social network". N Engl J Med 358 (21): 2249–58. doi:10.1056/NEJMsa0706154. PMID 18499567. 
  16. ^ Cochrane Topic Review Group: Tobacco Addiction
  17. ^ http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001561/pdf_fs.html
  18. ^ [www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf "Clinical Practice Guideline: Treating Tobacco Use and Dependence"]. www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf. 
  19. ^ [www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf "Clinical Practice Guideline: Treating Tobacco Use and Dependence:2008 Update"]. www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf. 
  20. ^ Maguire CP, Ryan J, Kelly A, O'Neill D, Coakley D, Walsh JB. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing. 2000 May;29(3):264-6. PMID 10855911
  21. ^ Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J. Smokers ages 50+: who gets physician advice to quit? Prev Med. 2000 Oct;31(4):364-9. PMID 11006061
  22. ^ Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction. 2005 Apr;100 Suppl 2:59-69. PMID 15755262
  23. ^ "Cigarette Smoking Induces Over expression of a Fat-Depleting Gene AZGP1 in the Human.". Chest 135 (5): 1197–208. 2009. PMID 19188554. 
  24. ^ The impact of depression on smoking cessation in women.
  25. ^ Doll R, Peto R, Boreham J, Sutherland I (June 2004). "Mortality in relation to smoking: 50 years' observations on male British doctors". BMJ 328 (7455): 1519. doi:10.1136/bmj.38142.554479.AE. PMID 15213107. PMC 437139. http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38142.554479.AEv1. 
  26. ^ Panda K, Chattopadhyay R, Chattopadhyay DJ, Chatterjee IB (July 2000). "Vitamin C prevents cigarette smoke-induced oxidative damage in vivo". Free Radic. Biol. Med. 29 (2): 115–24. doi:10.1016/S0891-5849(00)00297-5. PMID 10980400. http://linkinghub.elsevier.com/retrieve/pii/S0891-5849(00)00297-5. 
  27. ^ "My Time To Quit". Pfizer. http://www.mytimetoquit.com. Retrieved 2009-12-07. 
  28. ^ "Policy coherence in US tobacco control: beyond FDA regulation". http://www.ncbi.nlm.nih.gov/pubmed/19440534. 
  29. ^ "H.R. - Summary: Family Smoking Prevention and Tobacco Control Act (GovTrack.us)". http://www.govtrack.us/congress/bill.xpd?bill=h111-1256. 
  30. ^ "H.R. - Summary: Family Smoking Prevention and Tobacco Control Act (GovTrack.us)". http://www.govtrack.us/congress/bill.xpd?bill=h111-1256&tab=summary. 
  31. ^ "Tobacco Cessation - You can quit now". http://www.surgeongeneral.gov/tobacco. 
  32. ^ [htp://www/cms/hhs/gov/Smoking Cessation "Overview Smoking Cessation"]. htp://www/cms/hhs/gov/Smoking Cessation. 
  33. ^ "140: Tobaco Use: Prevention, Cessation, and Control". http://www.ncbi.nlm.nin.gov/bookshelf/br.fcgi?book=hserta&part=A222072. 
  34. ^ "Smoking - National Cancer Institute". http://www.cancer.gov/canertopics/tobacco. 
  35. ^ Williams LN , “Tobacco Cessation: An Access to Care Issue”, Navy Medicine, 2002
  36. ^ Williams LN , “Oral Health is Within REACH”, Navy Medicine, Mar-Apr 2001
  37. ^ Giving Pennsylvania A Clean (Air) Bill of Health, Institute for Good Medicine at the Pennsylvania Medical Society, http://www.myfamilywellness.org/MainMenuCategories/FamilyHealthCenter/SmokingCessation/IntheNews.aspx, accessed January 5, 2010
  38. ^ "State of Tobacco Control 2009". http://sotc2009.pub30.convio.net/2009/ALA_SOTC_09.pdf. 

References

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  • Hutter H.P. et al. Smoking Cessation at the Workplace:1 year success of short seminars. International Archives of Occupational & Environmental Health. 2006;79:42-48.
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Psychology, Health & Medicine. 2005;7:17-24.

  • Marks, D.F. Overcoming Your Smoking Habit. London: Robinson.2005.
  • Peters MJ, Morgan LC. The pharmacotherapy of smoking cessation. Med J Aust 2002;176:486-490. Fulltext. PMID 12065013.
  • Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004(3):CD000146.
  • USDHHS. Treating Tobacco Use and Dependence. Rockville, MD: Agency for Healthcare Research Quality; 2000.
  • West R. Tobacco control: present and future. Br Med Bull 2006;77-78:123-36.
  • Williamson, DF, Madans, J, Anda, RF, Kleinman, JC, Giovino, GA, Byers, T Smoking cessation and severity of weight gain in a national cohort N Engl J Med 1991 324: 739-745
  • World Health Organization, Tobacco Free Initiative
  • Zhu S-H, Anderson CM, Tedeschi GJ, et al. Evidene of real-world effectiveness of a telephone quitline$for smokers. N Engl J Med 2002;347(14):1087-93.
  • Williams LN , “Oral Health is Within REACH”, Navy Medicine, Mar-Apr 2001
  • Williams LN , “Tobacco Cessation: An Access to Care Issue”, Navy Medicine, 2002

External links


Study guide

Up to date as of January 14, 2010

From Wikiversity

Contents

Smoking Reduction May Lead To Unexpected Quitting

"Cutting back is approved as a method of quitting in several European countries, but not in the United States," said lead author John Hughes, M.D., a professor of psychiatry at the University of Vermont College of Medicine. "Our review contradicts the commonly held belief that quitting requires stopping abruptly and provides evidence that smokers can quit successfully by reducing the amount of cigarettes smoked." --Medical News Today, 12 Dec. 2006[[1]]

Smoking dosage reduction options

The following ideas for a syllabus of smoking cessation will attempt to go beyond the parameters of Hughes et al.[[2]] ("reduction in the amount of cigarets smoked") and start by eliminating the cigaret altogether, by substituting several options including the vaporizer, the e-cigarette, and perhaps initially, more cheaply, a screened single-toke utensil, or long-stemmed one-hitter]], which offers a uniform 25-mg. serving size replacing the hot-burning-overdose cigaret (near-compulsory 700 mg. every time you want a smoke).

After that required initial transition, further options include exploring different types of tobacco or other herb species, or continuing with one favorite type or another, but staying within a limitation such as ten tokes per day (total 250mg.-- slightly more than one third of one "normal" commercial cigaret).

If Hughes et al. are correct for a reduced number of (700-mg.)cigarets, the above reduced number of reduced (25 mg.) dosages will result in a high percent of smokers who eventually "forget to smoke any more". And those who continue "smoking" will do so with major risk-reduction, by partial or total conversion to vaporizing.

History of smoking: not the smoking, the cigaret is the problem

For centuries, partly because tobacco was expensive, smoking pipes were used, usually with a long stem and a narrow bowl (crater) in which small amounts of tobacco were burned at a low temperature by sucking much more slowly than on a present-day cigaret.

Technology first, then marketing opportunists

In the late 19th century cigaret-rolling machines were developed, and marketers since have discovered they could sell much more tobacco by attracting customers to the "sanitation", "convenience", "mildness" etc. of hot-burning paper tubes with specially pre-toasted mild tobaccoes inside, of which one could inhale large overdoses without coughing, and get a large intake of nicotine quickly, right into the bloodstream. Instead of learning the more sophisticated art of sucking continuously very slow, possibly for 5-15 seconds (see hatha yoga/pranayama breathing), youngsters (through ad pictures, movies, etc. and filtered down through peer groups) were taught to suck hard for a short time (a one-second "puff", a 2-4 second "drag") from a device (the cigaret) which is designed to burn hot enough to keep burning and be ready, without re-lighting, for further puffs. Particularly strong heroic men were supposed to be able to "drag" without flinching (as "to bogart a joint"). Abusing oneself ostentatiously relieved anxieties by showing others, especially bullies, that one was fearless and capable of inflicting punishment (either on oneself or, by implication, on others).

20th C.: 200 million

Pursuit of the magic "pleasure = bloodsugar" drug nicotine lured the customers on to inhale massive amounts of carbon monoxide (CO), tars etc. By the mid-20th century research began to show catastrophic death increases, but by that time it was too late to prevent a possible 200 million human fatalities in just one century, the greatest genocide (so far) in the history of the planet.

21st C.: 1 BIL?

The World Health Organization (Feb. 7, 2008) estimates the current yearly cigaret death toll at 5.4 million and predicts in a generation it could rise to 10 million (approaching a BILLION per century) as teenagers in China and India begin to have enough cigaret money to buy more overdoses.

How to reconcile above allegations with scientific evidence that shows small amounts of second- hand smoke detrimental to non-smokers in the vicinity of smokers? citations needed How do the suggested reduced doses above compare to dose ingested via second hand smoke?
Thanks, I'll look for citations. Meanwhile, it was published in the 1970's that "side-stream" smoke(SSS)-- the part that rises directly off the tip of a cigaret, NOT same as "second-hand" smoke (SHS)-- contains 5 times as much carbon monoxide (the no. 1 cardiovascular toxin), 5 times as much sulfur dioxide, 50 times as much ammonia etc. etc. as "main-stream"(MSS) (the part inhaled through the interior of the device).

Eliminate SSS; SHS not so bad

Eliminating the CIGARET (and all other overdose smoking methods that produce more smoke than the smoker inhales) and substituting a narrow (1/4 inch i.d.) enclosed utensil in which only a small amount of smoke can be produced at a time, just enough for the user to inhale and no more, eliminates the "SSS" problem. Then, it turns out, true "second-hand" smoke (SHS), that part which has been in and out through the smoker's lungs, actually contains the LEAST carbon monoxide. His/her lungs have "purified" that smoke and made it less bad for bystanders than either the SSS or the MSS.

  • (Taboo has made it difficult for modern humans to admit to themselves that in every crowded ballroom, church, courtroom or auditorium they routinely rebreathe expired breath from other humans-- largely harmlessly of course. They look for ways to either ignore or disparage such breath, such as confusing "side-stream" with "second-hand" smoke and ignoring a vital biomedical distinction between the two. As soon as they "discover" i.e. admit the latter, there might be prompt widespread agreement on the virtues of a single-toke utensil. (This term includes "double toke"-- see article for important physics details about two persons sucking simultaneously.)

The 3 fractions, proposed clarification

  • MSS = Mainstream Smoke - the part inhaled into mouth through cigaret or pipestem
  • SSS = Sidestream Smoke - the part which, being lighter than ambient air, rises initially off the tip of a cigaret-- or from a cigaret or pipe just after a smoker has finished puffing on it and it is burning particularly hot. The cigaret is designed to offer continued burning and readiness for the next puff any time you want it, but only if you bring the temperature up to nearly 1500° F on each puff. Right after you finish a puff is when most of the sidestream smoke is released.

(This term confuses some persons because the smoke rises directly up and does not leave the cigaret in a sideways direction except due to wind.)

  • SHS = Second-hand Smoke - the part which has been breathed in and breathed out by the smoker; generally least harmful but ignorantly feared most by many.

Cigaret advertising history, or there's a sucker started every second

An overwhelming barrage of advertising has been the key to recent genocidal "success" of the tobacco industry. Surplus profit from overdose addicts was recycled into seductive ads to create new addicts (ad + diction = addiction, get it?).

  • In 1913, with the introduction of the Camel brand, U. S. cigaret maskers launched an unprecedented advertising onslought. One source has alleged that the U.S. cigaret market doubled between 1913 and 1918. (Oh, yes, something else happened between 1914 and 1918-- a war or something. Well, cigarets were appreciated as convenient for soldiers worried about losing their pipe, right? General Pershing praised tobacco as the nation's number one soldier, or something like that. Nicotine helped soldiers stay awake when they were on guard (by paralyzing the sleep process), and focus their mind (on spying, aiming, killing etc.).
  • The famous Eleanor Roosevelt, whose husband was U. S. Undersecretary of the Navy, was one of those ladies who appeared in hospitals providing free cigarets to wounded Navy boys in 1918. (See Joseph P. Lash, Eleanor and Franklin, 1972.)

Show business showed kids how to smoke

  • When Frank Sinatra stepped out to sing, "Light Up a Lucky, It's Light-Up Time" and pre-programmed pubescent girls screamed, pubescent boys listening to the radio learned girls will respond to men who smoke.
  • Ronald Reagan earned future campaign money in 1937 (a picture postcard says, "Yours for Kentucky Club, (signed) Dutch Reagan"), 1943 (a magazine-page picture ad says, "Chesterfield is My Cigarette, (signed) Ronald Reagan"), etc., even though Reagan was personally a non-smoker (See Life Magazine, Dec. 1980).
  • Such recruitment, slowed in the US, has accelerated in Asia-- a survey showed 89% of movies made in India (2004-5) contained depictions of tobacco use, over 70% of it by the leading stars of the picture. (The India Ministry of Health[[w:Ministry_of_Health_and_Family_Welfare_%28India%29]w:Indian_health_ministry], publicly embarrassed, has since promised to take action against such abuse.)

What's behind the anti-cannabis laws?

As President, Reagan promoted the War on Drugs, really a War Against Cannabis-- an alternative herb which could substitute for tobacco! By 2007 over 872,000 Americans were arrested for cannabis "violations" in a single year, with the billions of dollars for all this arresting and processing law-enforcement function amply covered by over $36 billion (as complained-- or bragged?-- on an R. J. Reynolds website) collected by the selfsame government entities in the form of tobacco excise taxes, license fees, etc., not to mention campaign contributions primarily to the Republican Party and its candidates.

Why Big Tobackgo fears cannabis

In ascending order:

2. Over 100 million persons smoke cannabis today worldwide, and it could, if legalized, readily replace tobacco among many smokers now each paying up to $2000 a year (pack a day) to the Industry;
1. (Much worse) because cannabis contains no overdose-addictive drug such as nicotine, many users are content to use infinitesimally small amounts, and have learned to use a miniature pipe or single-toke utensil. If this conservative behavior, legalized de facto along with the cannabis, began to be adopted widely by tobacco smokers instead of the profitable overdose cigaret, the industry profit margin would be doomed.
The above is medically disputed. THC is an active addictive element in marijuana. Further, despite the early hysteria and humor associated with propaganda like "Reefer Madness" shown in U.S. schools in the 60s and 70s, scientific studies have found a clear correlation between use of Marijuana and subsequent use of harder drugs such as cocaine, heroin, meth, etc. [3].
While THC may appear to be psychologically addictive for some, it is rare to encounter anyone craving 20 hot-burning overdose cigarets of it a day-- routine for nicotine. For a discussion of gateway drug theory, see Talk page.

Why Big Pharma fears cannabis

In ascending order:

2. Cannabis is alleged to be a viable cheap, natural substitute for many present-day highly profitable drugs;
1. Should cannabis legalization result in a sudden drastic reduction in deaths and illnesses caused by tobacco, due to correlative legalizing of an anti-overdose smoking utensil which can be used by tobacco smokers instead of the profitable overdose cigaret, the result could be a matching drastic reduction in the demand for high-profit drugs and treatments needed by patients suffering diseases such as high blood pressure which result from chronic cigaret overuse.

Why so many cannabis users smoke a "joint" or "blunt" rather than use a conservative utensil

2. Partly, of course, it's the cigaret advertising, the glamorized grown-upness of fearlessly holding an overdose torch in your hand like a gun.

Most recently, it is alleged that, in the 90's, tobacco companies slipped money to rap artists who included references to "blunts" in their songs. (A "blunt" is a cigar-skin with the tobacco filler discarded and an overdose of expensive cannabis rolled inside-- because the cigar wrapper contains nicotine, it's a sneaky way to get youngsters hooked.) Note artist names such as "Cool" and "Tu-Pac".

1. The main reason is fear of the law-- it's easier to hide or dispose of a "joint" than a pipe, you aren't in danger of losing your investment in the utensil (such as a $600 vaporizer), and people say, "If the cops found one of those in my car, I'd lose my car!"

Some legal issues concerning utensils

  • Try to get a signed official letter from your congressman or other government official, or a prescription from a physician, authorizing you to possess and use an anti-overdose smoking utensil, on the premise that its purpose is to enable you to protect your health by reducing cigaret consumption.
Keep in mind that in the U.S. no letter from an official can exempt you from equal application of statutes as written. At worst it may embroil the official in criminal conspiracy charges.
  • That being the case, it might be necessary to remind politicians that suppressing anti-overdose smoking equipment to prevent "drug use" is like suppressing condoms to prevent sexually transmitted diseases.
Be aware that some medical cannabis users in the U.S. have found federal law enforcement willing and able to lock up medical users despite full compliance with local and state laws. I am looking for citations from California. Please find links provided below. Mirwin 02:49, 16 December 2007 (UTC)
True, but bear in mind the above suggestions concern only possession of a utensil, for stated tobacco-reduction use, and not possession of cannabis. In the above recommended letter, and in political advocacy, maybe one could present the argument that possession of an anti-overdose utensil is evidence of the intent to be a sober responsible citizen, more within the law than a reckless self-destructive hot-burning-overdose nicotine slave.

Vaporizer

The most effective way to eliminate cigaret-smoking immediately may be to acquire and use a vaporizer, which instead of burning herb material at 1500° F/860° C every time user sucks on it, can be set to heat the herb at an appropriate temperature not exceeding 410° F, thus avoiding all the combustion toxicity which accounts for the majority of health damage from smoking.

The top-of-the-line Volcano, selling for $600, has been endorsed by Allen F. St. Pierre, Executive Director of NORML, for medicinal cannabis patients. Note that instead of cannabis, an amount of shredded tobacco removed from a cigaret can be used, or strong pipe tobacco or a segment cut from a cigar. At first glance, the price looks steep, but consider that a pack-a-day cigaret addict is burning up $2000 a year.

If, according to an estimate, medical consequences of cigaret smoking cost, for example, the US economy $50 billion every year, it would be cost-effective for the taxpayer to buy all 45 million cigaret addicts each a Volcano vaporizer for a one-time outlay of $27 billion. This could be paid for out of the 1998 Clinton $200B tobacco settlement money, in case any of it is left over from roads, schools, police etc.; that money was supposed to be used for stop-smoking programs.

Vaporizer Cafes

If, in the meantime, you wish to try vaporization, there are numerous brands in the $200-$400 range which operate several different ways; where can one try more than one kind of vaporizer to decide which to buy, or get some practice and counseling so that after investing the money you don't break the device by some mistake which voids your rights under the guarantee?

One way to address this hurdle and introduce larger numbers of persons to vaporization would be to set up a chain of vaporizer cafes, at any of which one can for an introductory fee try various vaporizers and have the services of a trained staff person or coach, as you learn the art of slow inhaling etc.

E-cigarette

This product, developed in China, has a rechargeable battery and a heating element which vaporizes liquid nicotine, alone with propylene glycol to create a smoke-like fog after each toke, and other flavorings so you can get one which tastes like a cigar, or a Marlboro etc. At under $100 each and 5 cartridges for $10 it is a cheaper way to get started than a vaporizer.

Single-toke utensil

Because for most of the 1.2 billion smokers worldwide, vaporizers may not be available immediately and it would certainly be cheaper to manufacture several billion miniature smoking utensils. If made from metal or pyrex glass, these deserve to be named semi-vaporizers, for if while sucking extremely slow the user holds a moderate lighter flame near the outside of the crater-head heating the glass or metal, much of the herb essence will have time to vaporize out from each particle being heated by the crater wall or, once burning has started, by adjacent burning particles, before that particle itself catches on fire.

Selection of appropriate mini-utensil

  • The premier qualifying attribute is smallness of the burning chamber (bowl, or to make it sound smaller, crater). The narrower the diameter of the crater, the lower a burning temperature can be achieved while sucking as slowly as possible through an extension tube-- and you will get all the smoke, eliminating side-stream smoke (ETS).
  • Ideal crater size is 1/4 inch/6- or 6.5-mm. i.d., with a Mesh-40 (40 windows per linear inch) wire screen sitting at a depth of 3/16 inch/4 mm. This is small enough to permit a 25-mg.(1/40 gram) single serving-- 28 of these from one broken-down cigaret.
  • The extension tube should be very long to provide maximum distance for heated aerosol (smoke) to travel cooling down before it reaches your trachea. The fancy tubes used on hookahs are acceptable, or some clear flexible p.v.c. tubing.

Two O.K. traditional types

Kiseru[[[w:Kiseru]]]

Used in Japan since about 1600, this has a wrought metal crater-head and mouthpiece with a long stretch of bamboo in between. Get a cylindrical-shaped crater instead of conical so your screen will sit securely inside. For a store marketing kiseru on line (and a special Japanese type of stringy tobacco like corn silk), see [[4]].

Midwakh[[[w:Midwakh]]]

A small pipe of Arabian origin, in which dokha is smoked, a confection of tobacco and other herbs. Especially popular in the U.A.E. where teenagers are said to be converting from cigarets, in the wake of smoking bans introduced in September 2007. You might attach a long hookah tube when using it.

Consider making your own

  • The easiest utensil to make features a quarter-inch (or 6 mm. or 6.5 mm.) socket wrench. Wedge a screen 3/16"/4 mm. down into the hex end and cram a long quarter-inch o.d. flexible tube up into the square (driver) end. Tape around to air-seal the crack. Use 1-mm. colorful plastic-shielded telephone wires (the kind in grey cables, that you find being thrown away when houses are remodeled) to wrap around the taped area, then form a 5-inch braid leading out to a big safety-pin. This will be handy every time you need to clear screen windows.
  • Use a brass barbed hose-nipple (to get your quarter-inch diameter crater, you may start with one that is too narrow and drill it wider with a quarter-inch Speedbor drill bit in a variable speed electric drill). The extension tube slips tight over the barbed end.
  • With oxy-acetyl flame, a 1/4-inch o.d. carbon rod (for crater-shaping) and needle-nose tongs, it is easy to make little Pyrex glass utensils of about the same shape as the hose-nipple described above, stretching out a narrow tip over which the flexible tube fits. Get some instruction first in safe use of the equipment.
  • With a set of diamond masonry drill bits in an electric hammer-drill, making first smaller, then larger and larger holes, it is possible to produce a crater-head from a beautiful hard stone pebble, imitating the interior shape of a socket wrench with the narrower mid-channel.
  • In a hardwood bead or branch segment you can make a quarter-inch crater, to a depth of 3/16"/4 mm., with a narrower mid-channel as above, or narrowing down further leading to a tightly inserted 3/16" brass tube segment as an exit arm over which the extension tube fits. You can get away with not lining the wood crater because you are burning so little herb at such a low temperature!
  • To use a beautiful piece of softwood, drill a 9/32" crater-hole to depth of 3/16" and slip a ring of brass tube, 9/32" o.d., 1/4" i.d., down inside it. You'll need a tube-cutter (cheap) to make a ring 3/16" long. Many elaborate forms of toker can be made of wood using telescoping sizes of brass tubing (esp. 3/16", 7/32", 1/4", 9/32" outer diameters) available from K & S Engineering, Chicago [[5]].
  • Jan. 31, 2008: cannabis-advocacy organizations such as NORML should be lobbied to invest their advocacy power in legalizing and legitimizing an anti-overdose utensil, as described above, for everyone who can not afford to buy a vaporizer or have one confiscated by "tobacco enforcement" officials.

Preparation of herb

  • Make your first decisive "break" with the overdose habit by carrying just one or two cigarets around instead of a whole pack (20)!
  • Tear a tiny amount of tobacco off the tip of a cigaret and put it in the screened 1/4" crater. The shredded tobacco found in most cigarets will do just fine!
  • Pipe and cigar tobaccoes, and other herb species, may require to be first sifted through a Mesh #16 screen strainer (window size = 1/16th-inch/1.6-mm.), producing uniform-sized smooth-burning particles. Don't smoke any larger chunks. Suggestions for sifting very delicate expensive herb species are found in "Re Manufacturing", on the Talk Page of Wikipedia Article, "Kief" [[[w:Talk:Kief]]].

Directions for use

  • First practice sucking continuously very slow for up to 15 seconds through an unlit utensil (after perhaps consulting articles about hatha yoga breathing exercises).
  • Use a lighter instead of matches-- you may need to light more than once.
  • After loading a long-stemmed utensil, hold it crater-upright and, while sucking slowly, bring the lighter flame near very briefly, more than once if necessary, only enough to get the material just barely going.
  • Then, while sucking, with the metal shield at the head of the lighter (another reason why matches won't do) tap the top of the crater several times, shaking the coal (burning herb) so that it falls downward into a compact mass over the operative screen center windows and continues burning to completion.
  • After burning appears exhausted, briefly light once again to finish any unburned material.
  • Guess what-- you can suck out and eat the ashes (even tobacco, if completely burned)-- they contain nutritious minerals which combustion has rendered more digestible. (Why pass up any benefit or enjoyment?) Swish the material around on your tongue to get an idea of the taste. Scratching the screen with the maintenance utensil (see above) will loosen up remaining ashes for this purpose.
  • If no one's looking, breathe in and out of a bag (Breathbonnet)several times. Remember, your aim is to make this 25-mg. single toke substitute for an entire 700-mg. cigaret!
(With cigarets, of course, the "official" (i.e. expensively advertised) method has always been to hold the flame near for a second or two while sucking hard enough to get the entire tip burning at 1500° F/860° C.-- and that's seven inches from your trachea! No, not to make it "smoother", "better tasting" or anything, but just to get it started burning on its own power so it doesn't go out until you have had those 9-10 more overdose "puffs" they have taught you to want-- which are the KEY TO ADDICTION.
(They want you to feel guilty about throwing some away without "using it up", but you wouldn't dare put it out for later use and try to carry it with you on a bus, would you? Yukh.)
  • Your long slow low-burning-temperature toke may last 5-15 seconds. (If in doubt, consult a hatha yoga expert.) By contrast, a "puff" on a hot-burning cigaret usually means about 1-2 seconds, and a "drag" is 2-4 seconds. (Think a moment how hot that gets. Humphrey Bogart died age 57 of cigaret cancer. What a drag.)

Further harm reduction tips

Double toke

With a two-stemmed utensil and a partner, the following surprising benefits are available:

  • While burning the same 25-mg. serving size, each partner sucks twice as slow-- twice the yoga training.
  • Each partner gets half the heat,
  • making it twice as mild!
  • You need the encouragement/resocialization. (Think of the advertising money spent making you think overdose cigarets or "joints" were something shared or sociable. Instead, victims were isolated, each with their own thumb-suckin' cigaret, living in a fantasy world of fear of germs or whatever.)

Paperwork-- not the rolled kind

Many smoking cessation experts recommend keeping a diary. Here's how it works with your reduction utensil program:

On a single line, after maybe just the date, write a "t" for each single toke you did and a capital "C" for each entire cigaret. It will look something like this:
Monday, September 12: ttCtttCtttttCttt (etc.)
All those little "t"'s and big "C"'s will keep reminding you that you are "Ctttttin' down!"

Other brands

  • Try substitutin' tobacco from other cigaret brands (trade off one-for-one with this friend and that friend, etc.!) and get knowledgeable about different tastes in your new format.
  • Try high-nicotine brands, including exotic imports.
  • Try cigar and pipe tobaccoes (use that 1/16th-inch screen sifter). Get a collection of little cannisters to carry the different tobacco types in.

Herbal alternatives

  • Here's a list of smokable herbs legally available from health food stores, usually buyable by the ounce or a few ounces in a package at lower prices than the tobacco in cigarets. (*)Starred items should be broken down, dry and just a little at a time, in a blender at slow speed before sifting, unless the supplier has already done so. Any chunks too large to go through the sifter go in the "pot"-- the tea pot, I mean. Any dust so fine it would clog the crater screen of your utensil may be screened out with a 1/30"-mesh sifter and used to co-flavor your next crockpotload of veggie stew.

Please add further information to this list, both names of herbs you know about (original research encouraged) and how to sift, prepare and serve them in a vaporizer, one-hitter or other utensil.

alfalfa, anise (leaf), aloe (leaf), Althaea officinalis (marshmallow leaves)
basil (considered the King of Herbs by ancient Greeks), borage, *buchu(Barosma), burdock
camomile, catnip (Nepeta cataria. Actually, there are over 250 species of genus Nepeta, probably all usable), *chaparrel (Larrea tridentata. One Arizona specimen of this shrub is allegedly 11,600 years old), clover, comfrey, corn silk (wait till they get brown)
damiana, dandelion, dill
echinacea, elder(flowers), *eucalyptus
fo-ti-tieng
garlic (the paper), ginkgo, ginseng(leaf, not root), goldenseal, gotu kola
hawthorn, heather, hibiscus, hops (Humulus lupulus)(the yellow flowers; mildest of all herbs for smoking), huckleberry (Vaccinium myrtillus) (leaf)
*kinnickinnick (Uva ursi(leaf; widely used by Native Americans in mixtures with tobacco)
lavendar(three or four little buds per serving), lemon balm (Melissa), lemon grass, linden, lobelia(often recommended because the effect mimics nicotine)
marjoram, marygold, *matté, mugwort, mullein
nettle (Urtica. Despite its source, surprisingly mild)
orange(flowers), oregano (most popular of all herbs. Two cents worth of oregano ads $4 to the price of a pizza)
pennyroyal, peppermint, plantain
rosebud, rosemary (chop the little logs down to 3-mm. length and use up to 6 at a time)
saffron(flowers), sage (Salvia; dozens of species even if you can't get divinorum), St.-John's-wort (w:Hypericum), sassafras (leaves), savory, scullcap, senna, slippery elm, spearmint, stevia
tarragon, thyme
verbena
willow (bark shavings or leaf), wintergreen, wormwood (Artemisia absinthia; grotesque-tasting but safe in moderate quantity despite its reputation)
yarrow, yohimbe (bark shavings)
Just about any dried flower petal salvaged from a wedding or funeral...

Hundreds of other good herbs can be tracked down in herb guide books and websites.

  • At the end of the year, gather dry brown leaves from your favorite trees and bushes (screen grinding usually needed; store in little cannisters labeled on top). Get to know nature right in your neighborhood without illegal carbon monoxide leaf-bonfires.
  • Concerning the #1 Alternative herb, (a) you'll be using such small quantities you're unlikely to get caught, (b) you'll be using such small quantities it can hardly do any harm.

Like, real drugs

  • The War on drugs is there to protect you from trying concentrated pharmaceutical weapons like cocaine and heroin; meanwhile have you ever tried toking a little bit of coca leaf? poppy petal? Could a 25 mg. single toke of one of those possibly be more dangerous than 200 sledgehammer overdoses of carbon monoxide a day (reckoning 10 puffs x 20 cigarets)?

It's break time-- does the following profile fit you?

"Cool"

It started in school-- or in the schoolyard, where the key to escaping the bullies was to be "cool"-- i.e. inconspicuous, impassive, undemonstrative, unemotional, someone they can't "get a rise out of". Nicotine constricts the capillary system so the blood vessels leading to the skin carry 40% less warmth and you're really "cool".

School

(Yep-- this word is really a derivative of "cool" with a processing prefix added. "Cool" is the major part of what kids really learn at school.)

Not at first, but once you have inhaled enough side-stream smoke hanging out with the cool kids, or sucked a few sucker-hits yourself, one of those nights arrives when the big test is the next day and you know if you smoke a few cigarets you will be able to stay awake and cram all night! Or slog through writing the tedious source-theme that is due tomorrow. This is the critical moment when true crutch-dependence is established. (Fortunately you're grown-up enough now, i.e. no more beginner symptoms-- Chills, Nausea, Dizziness, Faintness-- your immune system's resistance is blown away, and you can take it like a man.

"Parents"

Well, after all, survival is at stake! If you don't qualify to get into that Ivy League college you'll never get the diploma needed to qualify for the high paying job after your parents spent so much money on you & now they are counting on you to be a source of economic security in their old age.

They probably won't like your cigaret smoking but... "Well, I guess it means he's going to settle down and get a steady job." Besides, it might help you hide your cannabis use-- watch it, they've seen all those Partnership scare ads. Your dad will threaten; your mother will burst into tears. "Please don't throw away all we did for you, we'll die soon enough and then you can do anything you damn please!"

Marriage facade

If kissing scares you (P & G taught you to fear germs, etc.), it's less disgusting if both partners do something more disgusting first, i.e. a cigaret, you're USED to that.

Playboy Magazine cartoons often show someone in bed, after sex, smoking a cigaret. Cigarets might not directly improve sex, but they are counted on to snuff the emotional turmoils that sabotage it (more "cool").

Career crutch

What steroids are to the big time athlete, nicotine is to the stayawake bureaucrat busywork hireling. You need the money; survival is the issue. "Stay awake, look busy, fool the boss, bring home paycheck." In the last decade of your life you may have to give much of that money you made to doctors, hospitals, drug companies, etc. to squeeze out a few more years and disappear safely into the "average" lifespan statistics.

What about weight gain?

Today one of the most controversial grounds for dependency on smoking is weight control. Can a dosage reduction without quitting be the key to maintaining weight control without paying the overdose-disease price for it?

  • Keep a small knife in your purse or briefcase for cutting easily carried things like pears, apples, etc. Let long chewing episodes with a mouthful of veggies replace the 5-10 minutes that you used to keep a cigaret going.
  • If you open a can of beef stew, use it as a flavoring and budget yourself a week to use it up. Program meat and junk foods etc. to be used in small amounts or occasionally. Carry zapsacks (ziplock bags) with you to put meat or heavily oversalted, oversugared foods in, to take safely to your distant refrigerator, instead of eating them on the spot out of megadose guilt.
  • PLEASE ADD FURTHER HINTS TO THIS LIST.

Quitting through short-term memory reduction

  • The nicotine addict is a prodigy athlete of scheming and planning. He or she takes on tons of mental exercise just planning when and where the next cigaret, the next ten cigarets, etc. will be served up, and how and when the next pack will be purchased. (Even a major percentage of car mileage consists of driving somewhere where cigarets are sold at any hour, etc., adding in all the further esoteric bureaucracy-- parking and unparking, not losing the car keys etc.))
  • Something can be done to unlearn that obsessive mental grip on the schedule, the sequence of smoking breaks etc. littering the available waking time of addicts. One (1) toke of any other herb than tobacco (not just cannabis, many others listed above) can break the grip of this overcommitted memory function, which is the body's response to a nicotine overdose.
  • In the first minutes after any toke, if there is any short span of time when it is necessary to wait for something, try to fill up that interval with a few isometric (small muscular) exercises, and mentally count how many you do as they are going on.
  • Spend a few hours each week learning long-term material, such as music, through memorization practice. Reading a score or libretto while hearing music (do-it-yourself audio-visual) provides practice in the form of mental coordination effort. Singing in a choir or congregation supplies the same kind of exercise. The better you know any song or piece, the more easily it can draw you into exercising spontaneously, should that same tune emerge in your mind at an opportunte time. Conductors, who read scores while hearing music, are said to have the longest life span in western society. They study a piece until they have a merging of identity with it which is expressed in their rhythmic arm movements conducting, and so an identity of present-moment exercise and 1ong-term memory is achieved.
  • Socially obligatory eating rituals and how to escape them, or the Haro1d Washington Syndrome (in preparation)







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