In all of our discussions about controlling the cost of workers comp, we continually come up against two lifestyle issues that have a direct impact on costs: obesity and smoking. Let’s leave obesity for another day and focus on smoking.
According to a compelling article by Stephen Smith in the Boston Globe, 70 percent of smokers want to stop, but fewer than 10 percent will succeed each year. For non-smokers, this might appear to be a matter of will. But that is both condescending and a gross over-simplification.
Nicotine, the primary addictive agent in tobacco, steals into the brain, setting on fire circuitry that regulates our sense of pleasure [emphasis added]. At the same time, cigarettes acquire a sort of social permanence in smokers’ lives – a way to start the day, to end a meal, to celebrate good times, to muddle through bad times.
Smith uses a rather terrifying analogy to describe how nicotine enters the brain:
Smoking is a uniquely efficient manner of delivering an addictive substance to the brain. “That’s why crack cocaine is so much more addictive than regular cocaine,” said Dr. Nancy Rigotti, chief of Massachusetts General Hospital’s tobacco treatment center. “Cigarettes are kind of like the crack cocaine of nicotine.”
Inhaled nicotine from a cigarette arrives in the brain in 10 seconds. There, it attaches to an especially pivotal region of neurons, those cobweb-like structures that govern our physical and mental actions.
Nicotine, said Dr. Jonathan Winickoff, a tobacco control researcher at Mass. General, “stimulates the same area that get stimulated when you have a wonderful gourmet meal or when you have sexual intercourse. It lights up that part of the brain, which is the rewards center. It drives human behavior. It’s powerful stuff.”
Hmm. Similar to gourmet meals and love making. No wonder people have trouble walking away from the habit, despite the known and often dire consequences of continuing to smoke. It would take powerful medicine indeed to counteract nicotine’s overwhelming appeal.
If there is good news in all of this, it is that a combination of drug therapy and counseling increase the chances of success.
“The data are very clear that you can double your chances if you use a medication if it’s appropriate for you, and you can triple your chances if you use a medication and counseling,” said Thomas Glynn, director of cancer science and trends at the American Cancer Society.
The medicine cabinet now includes seven first-line treatments, anchored by five forms of nicotine replacement. Regardless of the delivery system, the goal is to stave off the withdrawal symptoms and cravings that bedevil so many people who want to quit.
Finally, perseverence is key. You just have to keep at it.
“It takes smokers seven to 11 quit attempts to quit for good,” said Lois Keithly, director of the Massachusetts Tobacco Control Program. “We need to get the message out that if you make a quit attempt and you relapse, you don’t give up.”
Smoking Out Smokers
It will be interesting to see if the nation’s pending experiment with universal health care attempts to tackle the issue of smoking. Will smokers be charged higher premiums? (With a significant portion of smokers qualifying for premium subsidies, such penalties may prove difficult to enforce.) Will the new insurance rules mandate coverage for smoke cessation programs, including the full range of pharmacology options plus counseling? On the one hand, the success rates are low, so smokers are likely to keep smoking; on the other hand, any and all successes project to future cost savings.
Let there be no doubt about how hard it is to give up cigarettes. After all, we have the image of our president: a self-possessed, calm and extremely bright (American born!) man sneaking out of the White House for secretive puffs. Good luck to him and to all smokers who strive valiantly to give up this nasty habit once and for all.
