Nicotine Dependence & Tobacco Use PDF

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Twomaintypesoftobacconicotinetypes 1 combustable smokingburning type Freens 2 smoknessspittobacco hookah Cigarettes majorityofsmokingtobaccopop Cigars Pipe tobacco Hookah IEfiIEiiiiiEii as batiste everythingin i IEiiiiE generalbecauseppl communicablediseasesanissue shareahookah canusemorethan toobepplwill dualuse type alla overallnot safer Finetobacconist.com Combustible (Smoking) Tobacco  Stillnotsafer than traditionaltobaccos tightto Vent rationsof someofthe chemical agents t ii i f.EE Bidis Kreteks hekharg.wordpress.com/is-smoking-bidis-safe/ http://eng.rexo-indonesia.com/wp- content/uploads/2015/04/clove.jpeg Bidis and kreteks have higher concentrations of nicotine, tar, and carbon monoxide than conventional U.S. cigarettes FDA banned manufacture and sale in the U.S.  Smokeless (Spit) Tobacco IIspit be whentobacco was left in the month it generated a lot of saliva from sweeteners nicotine otheragents and force a person tospit out Plugs , wads, twist can bepressed into Loose leaf groundupattashpertions will a pinch to put in between Snuff grab cheek gums Dry here Pitchof heydpgnfpfwategshfmifuiateisp.tt Moist prettypopular aliadip alsoapinchthatisputinbetween in camefromeuropepackaged Yokes sm cylinder Snus can new festination dissolvable Compressed, powdered &at don'tgeneratesmoke _riffing L time forverylong pplusehours of periods time atatime over which the YesEEn 9Te9tehiin lesionsandoral cancer  Oral NicotinenotProducts generatedfromtobacco syntheticnicotine not tobaciobetheyare rly butstillhasnicotinewhichistheaddictivesubstance Nicotine levels vary but addictive Carcinogens present in some products along with ammonia, chromium, formaldehyde, nickel, and nicotine salt attitatifathiaftp.ifeng fheraremi bumElia Long TEEN term use associated with heart disease, vascular disease and other adverse T.ir health effects T a aaiiiiiiiiii neatcleannosalivacanbeuseddiscreetly advertisedonsocialmediasoalotof iiiiii monen youngerpeopleare tothisproduct attracted nicotineproducts tobaccocessation  p re gem e term Electronic Nicotine Delivery Systems (ENDS) e-cigs, vape pens, e-cigars hasevolved overthe last 20yrs there are now disposable types badforenv w theimproperdisposal ofthe battery and chemical produits Heat not Burn Tobacco IQOS, Eclipse tobaccois notheatedtothetempcigarettesandcigarswouldbeseemssat tobacion heatedasmuchto releaseasmuch combustible cleanerneater Allthe above products aredose dependant themore they are used thehigherthe chance ofhaving consequences  What’s Burning? Cigarette Smoke Contains > 7000 chemicals and gases Tar Carbon Monoxide Hydrogen cyanide Heavy metals (lead, arsenic) Formaldehyde, acetone Pesticides itisallmorethanjustaphysicalcomponent tobacco nicotineproductaddiction The Chain of comefrom3factorsthatmakeup Mutai thereaction Mothico Nicotine Addiction Eaddr ifeng.ie Ia mm itto stress relieve heYup y 1 to 91 ij gow  THE BRAIN’S RESPONSE TO NICOTINE nicotineisabsorbedveryreadily in thebloodstream and hitsthebrain within8selonds givingthe nicotineeffects of releasingdopamin The nicotine molecule is shaped like a neurotransmitter, acetylcholine, whose receptors are involved in many functions: muscle movement, breathing, heart rate, learning, mood, appetite and memory. When nicotine gets into the brain, it attaches to acetylcholine receptors and mimics its actions. Nicotine activates areas of the brain which produce feelings of pleasure and reward by producing dopamine andovertimetherewillbechangesinthechemistryofthebrainwhichareanupregulationinthenicotinereceptors whichiswhatcausesthe nicotinecravings  downregulated disappearbuttheyhavea Whenpersontriestoquitnicotine nicotinereceptorswillbe sortofmemorywhichcanbeeasilytriggered iftheperson experiences aque exsmellingsmokeorbeingaround asmoker Nicotine Changes Brain Chemistry Nicotinic receptors (green) on brain cells of smokers (left) and nonsmokers or ex-smokers (right).  primarychemical Pleasure & releasedwhennicotinebinds Appetite Suppression toitsnicotinicreceptor Arousal & Appetite Suppression Arousal & Cognitive Enhancement Nicotine Memory Enhancement appeimpia releasedafter Mood Modulation & nicotinebindingto Appetite Suppression receptors Reduce Anxiety & Beta- Tension positive for theuser short term when the effects ofnicotineandthe all of this temporary is feel release of feelgood chemicals declineovertime that is whenyou thecravings tosmoke again reinforcingthe cycleDr. Neal Benowitz, 1997  NICOTINE ADDICTION 1. Addiction leads to compulsive use, despite adverse consequences. 2. Addiction involves a psychoactive substance with reinforcing properties: o Dopamine, released in the nucleus acumbens, triggers CNS effects such as pleasure, anxiety relief, better task performance, improved memory 3. The addicted subject develops tolerance. 4. aiii EE.in iiiiiiai mmnanit An addictive substance causes physical dependence, withdrawal and relapse. maYears ii Et  thesesymptomsarevery Withdrawal and Cravings andthatis uncomfortable toppl Whytheyrelapse Anger Frustration Anxiety Hunger Craving Irritability Depression Impatience Difficulty concentrating Restlessness buttaperedoff Fatigue Nervousnesscontinence9199 Nausea 98 ahoimaiyhatehthaparaywhosm.ie cig its cravinghavea gonerepeats Shakinesstriggered 5 10yrscanbe bymemory of PIE Goup a lot speaks cravings inc and areintense withdrawalsymptoms yellow physical worstin first 72 hrs 1week ifthey can getthroughthat initial physical discomfortthentheyhave success to agreaterchance of  9 CIRCADIAN TOBACCO USE PATTERNS Rhythmic repetition of tobacco use at about the same time each day. thesepatternsthatpplhaveforwhentheysmoke can reinforcethe cycleofaddiction betheirmind theirbodyisusedtowhattoexpect sowhenwehelpthemquit wewanttobreaktheir pattern AM PM steadystate pattern ismoreconsistentw nicotinereplacement therapyfora to straitteron Christen (Fairbanks) 2009  wewanttoknowtheirpatternANDhowoftentheysmoke ANDtheirhistoryofsmoking Types of Smokers Nonsmoker Never smoker Former smoker Social smoker / nondaily smoker 87nF show Light smoker / Chipper himYeah t.it few Regular daily smoker daybut aday cigarettes notmuch every Heavy smoker halfapack Ipackaday a 120 cig.inpack 1 sameforsmokelessvaping itisusedoftenonadailybasi 1 packormoreaday thisgrouphasdeclinedthesedays moreofthelightsmokersnow  Cardiovascular & Respiratory Effects willmeasurepackyears ofpacksday ofyrssmoked to and Tom inesisYa h intake e't Coronary heart disease & stroke Peripheral vascular disease Lung Cancer Abdominal aortic aneurysm Emphysema Chronic bronchitis  Smoking & Cancer Acute myeloid Bladder cancer Kidney cancer leukemia Cancer of the Lung cancer Oral cavity uterus & cervix GI cancer: larynx, esophagus, Pharyngeal cancer stomach, pancreas  Endocrine & Gastrointestinal Systems Smoking is considered a causal factor in the development of Type 2 Diabetes Mellitus nicotinehassuch anegativeinfluenceoninsulinregulation thatithasbecomeacausalfactor All complications of diabetes such as cardiovascular disease, neuropathy, renal and eye disease are worsened by smoking. Thyroid disease Stimulates release of some pituitary hormones and adrenal gland hormones Parathyroid hormone & Vitamin D Heartburn GI disease (e.g., ulcers, Crohn’s disease) Kapoor D. et al Eur J Endocrinology, 2005  Smoking Effects: Skin & Hair intraorallytoo Poor wound healing alotoftimessurgeonswill requireppltohavev6weeks nosmokingbeforethedo a Premature wrinkling procedure onthemso dental surgeriescouldbeagoodtime forppltoquitoverall Smoker’s face Brittle, dry hair; hair loss Benign skin lesions Cancerous skin lesions Smith, JB Cutaneous manifestations of smoking. Medscape, Oct. 2009  Women & Tobacco havemoreseverehealth consequences likehigher riskfor More difficulty quitting cancersaswellasimpacton fertility healthypregnancies ex Y liar a Postmenopausal women who smoke have lower bone density than female never smokers. Higher risk for some cancers than male smokers Reproductive Infertility Miscarriage, premature or low birth weight babies Increased risk of nicotine addiction in child Increased risk of cleft lip/palate Sudden infant death syndrome (SIDS) http://www.drugabuse.gov/infofacts/tobacco.html  Health Effects of Vaping Evidence on health effects of e-cigs/vaping devices is limited beofthelackofthebeststygiementthefastevolutionofthem There is conclusive evidence that nicotine e-cigs can cause poisoning and inhalation toxicity in kids/teens, and addiction in non-smokers There is conclusive evidence that malfunctioning devices can cause oral injury and burns, and lung injury (EVALI) espwhenThe pitop Conclusive evidence complete switching may reduce cornlung exposure to toxicants relativetotraditionalproducts Cellular cytotoxic effects e.g. human gingival fibroblasts negativeimpactnow notsureaboutlongterm Banks et al. Med J Aust 2023 Figueredo et al Clin Exp Dent Res 2021, Yang et al, 2020 Critical Reviews Toxico  theother Smokeless – Not Harmless Cardiac effects Damage to DNA and Key Enzymes Adverse oral health effects  Stained teeth, restorations & dentures Reduced taste and smell Halitosis ofthelingual discoloration overgrowth Hairy Tongue, Smokers’ onthe papilla tongue Melanosis, Nicotine Stomatitis Candidiasis, Leukoplakia, thealivarygian of Inflamation Carcinomas; Periodontal disease, Dental caries and have alotof leave pplwill timethemi these sweeteners Increased risk of surgical foralong place complications, poor wound healing, increased risk of implant failure Environmental Tobacco Smoke (ETS) Second-hand smoke Mainstream smoke – what the smoker exhales Sidestream smoke- what comes directly from the burning tobacco product Extremely potent Mathlotof chemicals carcinogens "Third-hand" smoke - the cigarette by-products that cling to smokers' hair and clothing as well as to fabrics, carpets and surfaces — even after secondhand smoke has cleared. http://www.epa.gov/smokefree/pubs/etsfs.html  CLINICAL PRACTICE GUIDELINE: TREATING TOBACCO USE and DEPENDENCE 4am hnYitittteioheitwPeP'starthem ihhhffh topharmacotherapy yesitsnicotinebutitis Pharmacotherapy Y ete hinges.inEnepiaPeni dankntymex.to apple.ly Practical counseling T.tt other bupropn iineiaretiain Motivational interviewing (MI) Medication in combo with counseling http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf With help from a clinician, the odds of quitting approximately doubles. 30 Compared to patients who receive no assistance from a Estimated abstinence at n = 29 studies clinician, patients who receive assistance are 1.7–2.2 times as likely to quit successfully for 5 or more months. 5+ months 20 2.2 1.7 10 1.0 1.1 0 No clinician Self-help Nonphysician Physician material clinician clinician Type of Clinician Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008.  HELPING PATIENTS QUIT IS a CLINICIAN’S RESPONSIBILITY TOBACCO USERS DON’T PLAN TO FAIL. MOST FAIL TO PLAN. Clinicians have a professional obligation to address tobacco use and can have an important role in helping patients plan for their quit attempts. THE DECISION TO QUIT LIES IN THE HANDS OF EACH PATIENT.  Pharmacotherapy All ~ double the quit rates compared to placebo & reduced withdrawal symptoms 7 first-line FDA approved therapies reliably increase long-term smoking abstinence rates Nicotine replacement therapy (NRT): gum, lozenge, patch, inhaler, nasal spray Bupropion & Varenicline notnicotine New medication in clinical trials- Cytisinicline  Nicotine Replacement Therapy Shouldnoteatdrinkw theoralproductsbe it andaffectthenicotinethatis Ebsorbed insightsproductivity pplwilltrytoeatdrinkwthesebeitiswhattheyprobablyenjoyedwhenthey smoked theseproductsareverysafeandhavebeenused fordecades it havenodifficultytryingthemusingthemifppldo correctly mostppl canalsobecombined w eachTheaton w thegum canalsoreferppltotobaccocounselinglike about auittheapegaipnaiat.am national to pc Common Elements of Practical Counseling 2 helpsthemrecognizewhattheirtriggersare 3 howtodevelopcopingskills Recognize Provide Basic Develop Relapse Info/Education Coping Skills Triggers Addiction Negative Moods Anticipate Stress & Avoid Withdrawal Triggers Symptoms Alcohol Urges Relationship Other Coping With of Lapse to Smokers Urges Relapse Smoking Cues plan highrisktorelapse quittingishard wout a game  Guideline Recommendations Tobacco use is a CHRONIC DISEASE Document use document dentalcare must providers use tobacco Treatment effective and cost effective Advise all users to QUIT Brief intervention Medications (7 first line drugs) Individual, group and phone counseling WORK Combination therapies work EVEN BETTER Motivational approaches are effective for the unwilling  Tapering (Cut Down to Quit) Whenpplsay nothemedications wayeasiertotaperthangocoldturkey Cold Turkey vs Tapering Reduce # cigarettes smoked Lengthen time between cigarettes A useful tool in treatment Hazards  ENDS / Vaping Devices For patients interested in quitting tobacco recommend effective evidence-based cessation aids Behavioral counseling bestapproach for ppl whohavent Pharmacotherapy vaped For patients currently using e-cigs to quit smoking Support the quit attempt & Encourage quitting all traditional tobacco use Emphasize lack of evidence for safety and efficacy of vaping Urge a 1quit 1date for vaping device bestto quitTausetuseonlythevapingdevices  Great American Smoke Out November 21, 2024