A patient recently asked if the new electronic cigarettes (e-cigarette) really work and are safe. Curiously, the question came from a patient who had broken his habit years ago with a simple decision to quit.
The recent research on e-cigarettes is far from over with some studies suggesting they are safer due to the reduction in smoke inhalation of the chemicals added to traditional cigarettes while other studies have shown there is still a great risk with any intake of nicotine at all.
A casual review of stories on e-cigarettes clearly shows the FDA is going to weigh in heavily on the regulation and taxation in a very short time. A few of my patients enjoy a fiendish glee of lighting up in a restaurant (or my waiting room) and puffing a water vapor cloud while the non-smoking patrons look on in stunned disbelief and horror. It will soon become a much more expensive practical joke.
The latest research suggests that the e-cigarettes have nearly a 20% success rate, meaning, at one year, 2 out of 10 people will no longer smoke either cigarettes or e-cigarettes. The 20% number is coincidently the same percentage of smokers who will succeed going "cold-turkey" at one year.
The 20% success at one year is also the same as a recent heavily promoted pill for smoking cessation. You might remember it from the television commercials which seemingly went on for minutes talking about the side effects of suicidal and homicidal thoughts while taking the drug. Those side effects are very real. I had one patient tell me he was sitting on top of his barn with a rifle ready to shoot up the neighborhood when he decided it was best to stop the pill and go back to smoking. I refuse to prescribe it anymore.
Isn't there a pattern here? Twenty percent success with e-cigarettes? The same with cold-turkey? With the pill?
I believe there is. It has been my clinical experience that when a person is ready to stop smoking, they will. Period. It is also my clinical experience that when a person is not wanting to stop they will find one excuse after another. And another. And another.
The biggest excuse is anxiety. However, the British Medical Journal recently published a report showing "smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke." Somewhere someone is yelling at the paper right now "Have YOU ever tried to quit?!".
From what I have observed over the past twenty years, there are three basic reasons most people will stop tobacco products (dipping and smoking): Love, Hate and Fear.
Fear, of course, is a well known thing. Fear of cancer seems to trump fear of COPD probably because the commercials tout the wonders of inhalers for COPD. When the fear of cancer moves from concept to reality, many find strength they never knew before. That lump on the neck. The blood while coughing. The CT scan. The horror of seeing a loved one die with lung cancer. I saw a man go from three packs of cigarettes a day to none when he was scared. He then jumped all over his smoking grandsons. They didn't listen.
Hate is a common one for younger adults. The hatred of what it is costing financially is a daily reality. I will ask a smoker in his twenties how long he wants to live ("Uh, I dunno, maybe 50 years...") then multiply his yearly tobacco cost (usually $1,500) by that. I ask him what he would do with $75,000 if someone gave it to him. I then suggest he write himself a check for $75,000 and put it on his refrigerator so everyday it will stare him in the face with how much it costs. The hatred builds, and, especially on payday, it gets very real to him.
And, of course, Love. The essence of true love is denying one's own desires for another. It is difficult to recall how many times I have heard an older adult say they gave up smoking when a grandchild crawled up in their lap and either asked them to stop smoking, told them they stink and they don't want to be around them, or a combination of both. But it works. Strangely, this only works with grandchildren and not children. It is one of the most successful methods I know.
There really is no more successful method for stopping smoking than simply making the decision to change. But, that is true for anything in life - diet, exercise, attitude, prayer, or a host of other things that aren't as they should be and nag at us to be changed. The power of a decided mind is incredible.
Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN. His office is located at 958 Dolly Parton Parkway. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com.
