Todays Topic in Medical Hypnosis: NICOTINE DEPENDENCE
Transcript of Todays Topic in Medical Hypnosis: NICOTINE DEPENDENCE
More than 7,000 harmful chemicals, over 70 known carcinogens, mutagens and toxins are present in tobacco smoke,
which can reach the brain, heart and other organs within 10 seconds of inhaling the smoke.
Radioactive lead, polonium, and hydrogen cyanide can all be found in cigarette smoke. History buffs will recognize
hydrogen cyanide as a compound used back in World War II as a genocidal agent
Chemical Health effect
Carbon monoxide Robs the body of oxygen and makes the blood sticky
Phenols Paralyses and kills cilia (the hair-like cells lining airways)
Tar Clogs airways and causes or stimulates cancer
Fine particles Irritates the throat and lungs, causes smoker’s cough
and damages lung tissue
Cadmium, lead, formaldehyde and
hydrogen cyanide
Toxic to all organs of the body
Polonium-210 A radioactive substance that causes cancer
Smoking
Most adults who smoke started smoking when they were teenagers,
therefore preventing tobacco use among young people is an integral
part of ending the tobacco epidemic.
Encouraging Australian data show that in 2014, the prevalence of
smoking among teenagers was at its lowest since surveys began more
than three decades earlier.
Tobacco contains the stimulant drug nicotine. Nicotine speeds up your
central nervous system and makes you feel like you have more energy.
It can also affect the brain so that you feel ‘good’ after smoking.
Nicotine is highly addictive so you can get ‘hooked’ fast making it hard
to quit.
When tobacco is smoked, nicotine reaches peak blood level
concentration within five minutes. Nicotine half-life is estimated to be
90 to 150 minutes
In Australia, tobacco use is responsible for approximately 15,000 deaths
each year. In 2004–2005 approximately three-quarters of a million
hospital bed-days were a result of tobacco use.
Powerful Stimulant of Dopamine D2 Receptors - Ie: Reward pathway//
Arousal & Pleasure
Smoking and depression are highly related: 40-50% of patients with
depression smoke.
About 45–60% of people with anxiety smoke – short ½ life increase of
anxiety with withdraw – vicious circle
Individuals with mental health conditions have a higher prevalence of
smoking and those who smoke tend to smoke more heavily than the
general population. Australian research has reported smoking rates of
up to 35% among patients suffering from common mental disorders
Smoking and Addiction
Burning tobacco releases nicotine, the primary addictive substance in
cigarettes.
Burning tobacco releases nicotine, the primary addictive substance in
cigarettes.
Nicotine, and other compounds, are suspended in smoke ‘tars’ that
are quickly absorbed in the lungs, mouth, nose, skin, stomach, and
intestines.
Research in the 1990s established that the average cigarette
contained approximately 10 milligrams (mg) of nicotine
Nicotine blood concentrations vary depending on the amount of
smoke inhaled, genetic and demographic factors, and health issues.
During the course of a day a typical daily smoker absorbs 20 to 40 mgs
of nicotine to maintain an estimated 15 mg steady state blood
concentration to avoid withdrawal symptoms or cravings.
When nicotine is absorbed from the lungs it is carried directly to the heart, and then to the brain.
Once in the bloodstream, nicotine is distributed widely throughout the body including to the liver,
kidneys, spleen, and lungs.
nicotine is passed to the baby via breast milk.
Childhood death from meningococcus X 20 in smoking households
Within the central nervous system nicotine receptors are widely distributed, including nerve cells that
release other neurotransmitters including dopamine, acetylcholine, and glutamate.
The pleasurable effects of nicotine are thought to be related to dopamine release throughout
structures in the brain that are associated with the experience of pleasure.
Nicotine causes an increase in blood pressure, heart rate, cardiac contractions, release of
adrenaline, and increases in the activity of the gastrointestinal tract. The stimulation of the heart
typically dilates coronary arteries resulting in more blood flow to the heart. However, if arteries are
unable to sufficiently dilate, the lack of blood flow and oxygen will put additional stress on the heart’s
functioning, increasing the likelihood of heart pain or a heart attack.
A high dose of nicotine can cause a person to overdose. This means that a person has taken more
nicotine than their body can cope with. The effects of very large doses can include:
an increase in the unpleasant effects
feeling faint
confusion
rapid decrease in blood pressure and breathing rate
seizures
respiratory arrest (stopping breathing) and death.
60 mg of nicotine taken orally can be fatal for an adult.
A small sample of cartridges tested by the FDA labs detected carcinogens, including nitrosamines
and toxic chemicals (including diethylene glycol, a toxic chemical found in antifreeze) to which
users could be exposed.
Some of the
long-term
effects of
smoking
increased risk of stroke and brain damage
eye cataracts, macular degeneration, yellowing of whites of eyes
loss of sense of smell and taste
yellow teeth, tooth decay and bad breath
cancer of the nose, lip, tongue and mouth
possible hearing loss
laryngeal and pharyngeal cancers
contributes to osteoporosis
shortness of breath
coughing
chronic bronchitis
cancer
triggering asthma
emphysema
heart disease
blockages in blood supply that can lead to a heart attack
high blood pressure (hypertension)
myeloid leukaemia, a cancer that affects bone marrow and organs that make blood
stomach and bladder cancers
stomach ulcers
decreased appetite
grey appearance
early wrinkles
slower healing wounds
damage to blood vessel walls
increased likelihood of back pain
increased susceptibility to infection
lower fertility and increased risk of miscarriage
irregular periods
early menopause
damaged sperm and reduced sperm
Biological determinants of smoking
behaviour
Nicotine Blood levels: 10-80mg/ml
HOMEOSTASIS: behaviour self regulation will maintain “optimal” blood levels.
Nicotine an anxiolytic and antidepressant
DEPENDENCE: the higher the blood level (80mg/ml), the bigger the drop
Fast metabolisers smoke more, and are more prone to addiction.
Slow metabolisers: less addictive
Fast Metabolisers: greater risk of Cancer of the Lung
Typography of
Smoking
(Biological &
Psychological)
Monitor CO Carbon Monoxide levels. High blood CO levels are associated with high Nicotine levels.
Family history of smoking, details
Gender: Women tend to be slow nicotine metabolisers
Ethnicity: Afro-Americans NOT big smokers, verses Middle Eastern that are big smokers.
Location: Mosman NSW AND Virginia USA, non-smoking councils. Smoking banned from all public places. All Australian States have significant bans on smoking in public spaces.
Psycho-
social
determinants
Quitters are cheap drunks
Therefor the AHA - Australian Hotels Association opposes smoking cessation
Alcohol, Nicotine, caffeine, Gambling…. Similar/ identical neurophysiological drivers on function MRI
Post Prandial hypoglycaemia – post eating
“I need a cigarette!” / need a dessert
Jelly beans
Nicotine
withdraw
symptoms
CRAVINGS
ANXIETYIf you associate your smoking with specific times, such as handling pressure or relaxing with a drink, it's not unusual to feel anxious when you're deprived of the 'support
RESTLESSNESSYou might have a difficult time concentrating when going through nicotine withdrawal, as your brain gets used to operating without nicotine.
IRRITABILITY
FRUSTRATION
LOW MOOD
SLEEP ISSUESGiving up smoking can make you feel drowsy,
WEIGHT GAINNicotine can decrease your appetite, so some people put on weight when they give it up
HEADACHESIt's pretty common to start getting headaches as you clear the nicotine out of your system.
SOCIAL
CONTEXT
Close proximity to family and friends who smoke is a risk factor for RELAPSE.
“The key in the door effect!”
Social policy – “the more you ban it the better it is!”
Make smokers smoke outside…..ALWAYS
Childhood death from meningococcus X 20 in smoking households
Second hand smoke and increased risk of infectious diseases – ref: Tobacco in Australia Facts and Issues
Increased susceptibility to and worsens respiratory infection in adults and young children
Increased inflammation of the airways
Increased permeability of the protective mucosal layer of the airways
Impairment of mucocilliary clearance
Reduced immune function
Doubles risk of invasive Meningococcal disease
Second hand smoke and increased risk of infectious diseases – ref: Tobacco in Australia Facts and Issues
Exposed children are more likely to be carriers of the bacteria, N. Meningitides, which is responsible for meningococcal disease
01Increased cause of illness and death in children and young adults
02Increased association of development of Tuberculosis disease
03Increased infections in children including Otitis Media, respiratory tract infections including bronchitis and pneumonia.
04
NICOTINEPOTENT IMPACT ON
METABOLISMINDUCES LIVER ENZYME
ACTIVATION. “REVS UP”
CAFFEINE INTAKE X 2 IN SMOKERS
ALCOHOL INTAKE X 2 IN SMOKERS
QUITTERS: NEED TO REDUCE CAFFEINE AND
ALCOHOL INTAKE –LESS TOLERANCE.
Contraindications
of Quitting
Smoking appears to induce drug-metabolising enzymes that reduce the effectiveness of antipsychotic medications such as clozapine and olanzapine, other psychotropic drugs including benzodiazepines, and specific antidepressants, antipsychotics, pain relief medication, medicines for the prevention and treatment of cardiac arrhythmias, and medications for the regulation of menstrual cycles.
Psychotropic blood concentration levels can be lower in smokers compared to non-smokers, where smoking cessation can result in increases in psychoactive blood concentration levels.
Smoking while taking the contraceptive pill increases the risk of blood clots forming.
NOTE - Always check with your doctor or other health professional whether nicotine might affect any medications you are taking and how it may effect your medication while making any attempt to reduce or quit smoking.
Nicotine
reduction :
Quitters
Need less: insulin, pain relievers, antipsychotics, anti-coagulants
Insulin induced Hypoglycaemic Coma – not uncommon in people giving up cigarettes.
Less Blood thinners, such as Warfarin, Heparin, Clexane, Xarelto, Pradexa, Eliquis, Plavix, due to increased risk of a significant bleed. Also drugs like Aspirin and Fish oil.
Effect within hours of quitting
RE-ASSESS DRUG AND ALCOHOL DOSAGES – under DOCTORS CARE.
TREATMENT –
Medical
interventionI
Nicotine replacement therapy (NRT)
Zyban, Champix (High Risk for those with heart disease or ‘creative types’), SSRI’s (Selective Serotonin Re-uptake Inhibitor)-Antidepressants
Response to Replacement Therapy may vary
Response to Replacement Therapy may be heritable…….what is the family history?
Fast metabolisers do NOT do well on NRT
Born to Smoker??.......>70%
In uterine exposure??
If one family member does well on Zyban, another will do well.
Nicotine
Replacement
Therapy
Hypnosis is the most effective in most cases for Smoking
Cessation
“Harm minimisation”
Patches take hours to peak
Safer to wear a patch and smoke, than to Smoke.
No evidence that weaning off is required
No evidence to support starting at a lower dose. USE as MUCH as
IS NEEDED.
Evidence that combination is better
Smoking whilst using NRT is safe BUT
Nicotine is NOT SAFE for the Fetus. ADHD, lower IQ
PHARMACOLOGY
Flood the nicotine receptor
“More, lots for a long time, and don’t hurry off NRT
If you must smoke, CUT DOWN TO QUIT
Increase and combine NRT, ie: Gum and patches
Suggest using 21mg patch at night
Nicotine
Withdrawal
Do not confuse Nicotine withdrawal with nicotine toxicity or medication side effects, ie: NRT, Champix
Or with Caffeine Withdrawal
Nicotine toxicity or overdose is extremely RARE
NO Nicotine deaths from NRT.
Nicotine
Dependence
– TIME TO
FIRST
CIGARETTE
TTFC is the most important feature of Nicotine Dependence.
Nicotine withdrawals are more severe premenstrually
Champix: depression, anxiety, suicidality or Nicotine Withdrawal?? It is not known whether these side effects are from Champix or Nicotine Withdrawal. If occurs then must stop the Champix immediately and seek medical help.
NUTRITION: zinc levels
Fagerstrom Test for nicotine dependence (in study guide)
Smoking History Taking
o Age at first use/age when regular use began
o Family history of smoking
o Current pattern of use: how much, what brand
o Has the pattern recently changed, and if so, why?
o Smoking triggers and patterns of use
o What situations, moods, social situations and other triggers prompt the cli-ent to smoke?
o Negative consequences of smoking
o Does the client have health concerns related to smoking?
o Has the client been advised to stop smoking by a physician?
o Other difficulties: family, financial
o History of past quit attempts
o Specifics of reasons for quitting each time
o Explore the longest and most recent quit attempts: What worked? What might help or hinder next
time?
o What quitting methods have been tried?
o What were the causes of relapses to tobacco use?
Role of smoking in a client’s life
What pleasures does the client derive from smoking?
What role does smoking play in client’s moods or emotional well-being?
Support systems
Who/what are current supports for client’s recovery from substance use? Are these people/institutions supportive of quitting
tobacco use?
Which strategies being used to stay clean and sober could help the client stay smoke-free and away from chewing tobacco or
snuff?
Other psychosocial issues which might affect ability to quit
Does the client have support for mental health issues to help monitor for anxiety and depression?
What medications is the client currently on?
Level of readiness to quit
What is the client’s goal regarding his/her tobacco use?
What is the client’s actual stage of change (precontemplation, contemplation, preparation, action, maintenance, relapse)?
The 7 D’s
• Delay the cigarette
• Deep breathe
• Drink water
• Do something different
• Dialogue with a friend
• Divert energies positively
• Dial the Smoker’s Helpline: 1-800-QUIT-NOW or visit the website:
www.makesmokinghistory.org
The 3 R’s
• Remind yourself of the reasons you quit
• Rehearse tricky situations
• Refuse to give into negative thoughts
After the Quit Date (24 hours or more smoke-free):
o Ask the person, “What situations have been difficult that you’ve overcome successfully?”
o Emphasize the strategies that have worked.
o This helps the person build self-efficacy
o In the early days of quitting, most people focus on how difficult things feel. They need to be reminded of what they are doing right!
o Were the situations anticipated in the planning stage?
o Listen for close calls or strategies that might not work well in the future.
o Help the client refine, reinforce, further develop strategies.
o After talking about what they have been dealing with so far ask, “Is there anything that’s coming up that you need to plan for?”
o People need to learn to plan ahead, so they are not caught off guard.
o Eventually, as they have more experience with handling triggers, they will be more able to “think on their feet” when they have an
urge to smoke.
o If there has been a slip or relapse:
o Deal with the feelings about it (shame, embarrassment, etc.).
o The good news is that he or she is there to talk about it with you.
o Help the client diagnose the “real problem” and plan for the future.
Assignment: Introduction to Medical Hypnosis
Assignment length : 2000 words
Describe your approach to assisting a client who wants to QUIT smoking.
Include your appraisal of your client’s needs, with special reference to contra-indications to Hypnosis and to quitting.
Describe your hypno-therapeutic process to achieving a positive outcome (Outline 4 sessions)
How might you evaluate your client’s outcome?
Email: [email protected]