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Sanjay Gupta MD

A Look at Smoker Cessation Programs

Aired December 31, 2005 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

SANJAY GUPTA, HOST: Good morning and welcome to HOUSECALL. This morning, we're talking about smoking, specifically how to quit. About half of all continuous smokers will die because of their habit, causing more than 400,000 deaths a year. Now that's more than AIDS, car accidents, suicides, homicides, and illegal drugs combined. Now is the time to quit.
And Elizabeth Cohen has a review of how to get started.

(BEGIN VIDEOTAPE)

ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): Lung cancer is the deadliest form of cancer. It's estimated that it killed 160,000 Americans last year. By now, most everyone knows that for smokers, the key to preventing lung cancer is to stop.

UNIDENTIFIED MALE: This is a hard thing to do, but it's the best thing a smoker can do for themselves.

COHEN: And quitting at any point can dramatically benefit your health. Many studies have shown you can reap the benefits of quitting just 20 minutes after you put out that last butt. And after 15 years of being a non-smoker, you cut the health risks associated with smoking by nearly 90 percent, but the endless onslaught of quit smoking products can be dizzying. So how do you sort through it all?

Doctors say they all work, but not necessarily for you.

UNIDENTIFIED MALE: The trick is to find what works for you. Most people still quit cold turkey, but some people profit from using a nicotine patch, which delivers nicotine in a very steady way. Some people combine a patch with gum to get through the hard parts, the cravings, sort of more sudden ways to get the nicotine are through either the inhalant or the nasal spray.

COHEN: Nicotine gums, candies, nose sprays, inhalers can all cut cravings by releasing small bursts of nicotine into your system quickly, but there are downsides. A quick burst now may leave you wanting more very shortly, in the form of more gum or a cigarette.

And how about the patch? It keeps nicotine levels in your bloodstream more constant so the cravings are reduced. But it still releases much lower levels this of nicotine than a smoker is used to. Some people choose other methods, like individual or group therapy, antidepressant medications, such as Zyban, or alternative treatments like hypnosis or acupuncture.

Elizabeth Cohen, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: We know that 70 percent of smokers want to quit. We also know this year, 40 percent will try, but only 5 percent will succeed. That's because nicotine is addictive. It would have to be people inhaling all the other components of cigarette smoke as well. Almost 4,000 chemicals in all, including cyanide and the fuel used in welding torches.

All these chemicals combined to make you sick, with heart disease, cancer, or diseases of the lung. So now you know why quitting is essential.

Let's try and get you some help today. Dr. Corinne Husten is the director of CDC's Center for Smoking and Health. And doctor, first of all, thank you for being here this morning.

CORINNE HUSTEN, CDC OFFICE OF SMOKING & HEALTH: Thank you. I appreciate the offer to come talk to you.

GUPTA: An important topic for sure.

HUSTEN: Definitely.

GUPTA: Let's just get this out of the way, first of all. Is there any safe way to smoke? People talk about social smoking. Is there any safe way to do it?

HUSTEN: Unfortunately, there isn't. There's absolutely no safe level of smoking, no safe form of tobacco. People -- if they're using tobacco, need to stop.

GUPTA: How risky is one cigarette, an occasional cigarette?

HUSTEN: Well, every cigarette can cause both acute problems, such as raising carbon monoxide, raising your heart rate, so it can have an effect on the heart. Plus, it can also do genetic damage. And you never know which is the one cigarette that's going to do the damage. So you really can't take a chance. Every cigarette's like Russian roulette.

GUPTA: So never smoke.

HUSTEN: Never smoke, it's the best option, but if you've started, quit.

GUPTA: Definitely. And we're going to talk a lot about that. We were overwhelmed by e-mails. A lot of interest in this topic, as you might imagine recently. Let's jump right in.

Joanne in Pennsylvania asks this. "Why is it so hard to quit smoking?" And obviously, there's - you know, it's addictive, but why is smoking in particular so difficult?

HUSTEN: Well, there's really two reasons. First, as you mentioned, it's very addictive. And the reason is, is because you inhale the nicotine. It goes straight to the brain. And it goes to the brain very quickly. You get that spike of nicotine. Then it tapers off. You have another cigarette, you get the spike. And that's the type of pattern that's the most addictive kind.

And so you have to deal with the withdrawal symptoms. You have to deal with that.

In addition, people have smoked cigarettes. It's been built into the daily activities of their lives for years. And so you have to figure out what are you going to do instead of smoking a cigarette when you have your coffee, when you're in the car, when you have a fight with your husband.

So you have to not only deal with the physical addiction, but you really have to figure out how to deal with those behaviors and what to do instead.

GUPTA: Let's keep on topic here, because that's important. There's another e-mail coming in about why people don't quit, because of the addiction.

Katie from Minnesota writes this. "How in the world can someone quit smoking and not gain weight? That's my biggest fear about quitting. If I was guaranteed to stay at my current weight, I would quit now."

And doctor, we get lots of e-mails with this same sort of frustration. You just mentioned you have to do something else if you're not going to smoke.

HUSTEN: Right.

GUPTA: Eating is one of those things.

HUSTEN: Well, and weight concern is an issue for a lot of people, especially a lot of women. And the good news is, is that most people either don't gain weight or they just gain a few pounds. Very few actually put on a lot of weight as a result of quitting.

GUPTA: Right.

HUSTEN: And so what we recommend are, of course, eat a balanced diet. Try to do some moderate activity. Don't try to do an intensive diet while you're trying to quit. It just doesn't really work to be trying to do both things at once.

But also, if someone's really concerned about weight gain, there are two of the medications that are available to help people quit that actually can inhibit the weight gain that can come along with it. And that's the nicotine gum and the Zyban. So if it's of particular concern, that might lead a person to use those medications as opposed to one of the others.

GUPTA: And I do want to get more into the gum and the patch and the Zyban a little bit later on. But let's keep on topic here. Another question from Tracy in Denver. "I only smoke at work during my breaks. I have a high pressure job and enjoy the company of my co- smokers on break. How can I break this bad habit?"

And doctor, it's a social activity as much as anything else, it seems. And people like to smoke with their colleagues, for example. What advice do you have for her?

HUSTEN: Well, again, it's good to have a plan going into it on what are some other ways that you could socialize with your colleagues. One thought might be, see if someone else is interested in quitting and quit with them. And then, you can go on breaks with them that don't involve smoking. And you can support each other, you know, and support each other.

The other thing is that many people have to figure out how they're going to deal with stress as they try to stop smoking, because they're used to using the cigarette. And so they have to say well what are you going to do instead? Take some deep breaths, do some relaxation techniques, take a walk. And so you have to develop that plan before you start.

GUPTA: And we're going to get some real specifics here.

HUSTEN: Yes.

GUPTA: We are talking with Dr. Corinne Husten about quitting smoking. We're going to show you how to find some free coaching to help you quit as well. A great new resource, that's straight ahead.

UNIDENTIFIED FEMALE: Gum, patches, or pills, which treatment will help you break the habit for good? Plus, losing without gaining, a new drug may help you lose the habit without gaining the weight.

But first, take today's quiz. True or false, kids become addicted to nicotine more quickly than adults? That answer after the break.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Before the break we asked, true or false, kids become addicted to nicotine more quickly than adults? The answer, true. Teens can become addicted with a lower dose of nicotine than adults. And the addiction takes hold even faster in girls than boys.

GUPTA: Really interesting. Well, experts say it often takes several tries to quit smoking, but there are some tried and true steps to success, like being prepared. Get rid of all your cigarettes and set a quit date. Think about what's worked in the past and stick to that. Next, get support from family, friends, coworkers, and your doctor. This includes setting up some form of counseling, whether it be individual, group, or maybe even over the phone.

Learn new behaviors to distract yourself from your urge to smoke. When you first quite change your routine so you won't revert to your old patterns of smoking. Also, get medication sometimes. That can help decrease the nicotine urges. And lastly, prepare yourself for a relapse. Most happen in the first three months. Have a plan to get back on your program.

Helping us stick to our program is Dr. Corinne Husten, director of the CDC's Office on Smoking and Health. First of all, doctor, we talk a lot about these different medications. Is there anything new out there to try and help people?

HUSTEN: Well, right now, there are six FDA approved medications. Five of them are nicotine replacement. And then, there's the non nicotine medication, Zyban.

Now there are some new medications that are being tested that hopefully will come on the market within the next couple of years.

GUPTA: All right. Let's keep on topic here. A lot of people interested in the medications. They get to that point where they might need that.

Let's take a hard look at some of these treatments, starting with nicotine gum, one of several nicotine replacement therapies that is available over the counter.

Sandra from Massachusetts writes this. "My husband stopped smoking a few years ago by chewing nicotine gum. However, he hasn't been able to kick this new habit and still chews quite a bit of the nicotine gum pieces a day. Am I correct to be worried?" Is the nicotine gum in and of itself harmful?

HUSTEN: Well, the nicotine that you get from the gum or any of the other products is at a much lower level than what you're getting from cigarettes. So you're not getting as much nicotine as if he was back smoking.

Plus, as -- you're not getting all of those other toxins, all those other chemicals, all those other cancer-causing agents. So the ideal thing would be to be off of it, but if it's a choice between continuing to use the gum and going back to smoking, you know, the gum is definitely going to be safer.

GUPTA: Is there a point where you say, look, you're just chewing too much gum? You know, you need to quit with the gum?

HUSTEN: Well, I would say over time, he might want to think about can he taper down a little bit and then eventually get off. But again, if it means that or going back to smoking, he's better off chewing the gum.

GUPTA: And that's the whole purpose is that you taper down over time.

HUSTEN: Yes.

GUPTA: Nicotine gum and the patch do work differently, delivering a boost of nicotine like a cigarette versus a steady dose of hours at a time. That led Greg from Maryland to ask this question about the patch's effectiveness. "Is there any benefit to the patch or does it just delay the withdrawal time? What is the actual time for withdrawal?" Doctor?

HUSTEN: The straw -- the main symptoms of the irritability, and nervousness, and trouble concentrating is usually over within one or two weeks. The cravings can last a lot longer. And for many people, that's what really continues to be a problem.

They do get less intense. They do happen less frequently, but people really do have to keep their plan in place about how to deal with the cravings.

Now the patch does alleviate the withdrawal symptoms. It gives a much lower dose, and enough to keep the person from having a withdrawal, but not such a high dose that when they taper off of the patch or stop the patch, that they go through withdrawal then. So it doesn't postpone it, it actually prevents it.

GUPTA: I really want to get at this, because you know, a lot of people are watching today and saying I've tried all these. I've tried the gum. I've tried the patches, all that sort of stuff. It doesn't work. Is there a role for adding counseling or something else like that to aiding your quitting?

HUSTEN: Oh, absolutely. The medications double your chances of succeeding. The counseling also doubles your chances of succeeding. And if you put it together, you increase your chances even more.

And the counseling, I think people have a misunderstanding about that. It's not some sort of intensive psychotherapy. It's really getting practical advice about some strategies you can use where you're faced with situations where you want to have a cigarette.

GUPTA: OK.

HUSTEN: And it's helping you think through your plan, being well prepared, having someone to talk to if you're running into difficulty.

GUPTA: And we are going to get some real specifics about getting that counseling, getting you off cigarettes as well. That's all coming up when HOUSECALL continues.

UNIDENTIFIED FEMALE: Headaches, irritability, depression. The best ways to beat the misery of withdrawal. Plus, what soda makers are recommending to help your kids stay healthy. It will surprise you.

First, this week's medical headlines in "The Pulse."

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): You have your father's smile, your mother's eyes, your aunt's sense of humor. We inherit a lot of things from our family, including health problems. That's why physicians say it's important to know your genetic health history because certain diseases can be passed down from generation to generation.

SYLVIA MEDLEY, DR.: Hypertension, diabetes, heart disease, those are the main three. Also for women, osteoporosis. For men, prostate cancer.

FEIG: Dr. Sylvia Medley says many people need to take this time during the holidays to talk with their family and record everyone's health history.

MEDLEY: And it doesn't have to be an inquisition, per se. You can just as a matter of talking start talking about you know, I went to the doctor. And oh, I'm about to go to the doctor because the New Year is coming. And is there anything I should be aware of?

FEIG: Once the notes are made, ask your doctor to keep them in your own health record, so they can be used as a reference later on.

I'm Christy Feig, reporting from Washington.

(COMMERCIAL BREAK)

GUPTA: And smoking is the most preventable cause of premature death in our society, but stopping this deadly habit takes a plan and the ability to ride out those withdrawal symptoms, like depression and irritability, plus problems sleeping and concentrating. More physical symptoms include headache, increased appetite, and general restlessness.

Dr. Corinne Husten has been our guest today, explaining how to successfully stop smoking. She's director of CDC's Office on Smoking and Health.

Let's talk about surviving some of these withdrawal symptoms, because as we're hearing from our viewers, that's their biggest concern, really.

This is an e-mail from Patricia in Connecticut who writes this. "Why do I experience a severe headache every time I try to quit smoking? I've tried the patch and I've tried Zyban. Unfortunately, I'm still smoking."

So this is - you know, she's getting far along in the game here. What do you tell her?

HUSTEN: Well, I would recommend that she see her doctor to really talk about these headaches and figure out what she can take to alleviate them. And then to also figure out what are the best medications. Maybe one of the other ones would be a better choice. Maybe she needs a combination of medications, but that's something that should be done under a doctor's advice.

GUPTA: Is there anybody that you've ever come across that just can't quit?

HUSTEN: No, everybody can. It's really hard. And people need to try many times sometimes before they succeed, but the main thing to keep in mind is every time they try to quit, they learn more about what are the triggers for them, what are the successful strategies. And they can build on those previous attempts.

And so actually, if people have tried before and failed, to some extent, they can do better the next time because they can learn from that.

GUPTA: They shouldn't consider it a failure...

HUSTEN: No.

GUPTA: ...because they gained something from it.

HUSTEN: Absolutely.

GUPTA: Let's talk about this medication, Zyban. You've mentioned this a couple of times. Is there someone who's a good candidate for this medication?

HUSTEN: Well, someone who's very concerned about weight gain would be a candidate. Certainly someone who has a history of depression would be a good candidate.

Zyban is an antidepressant, but it doesn't work as an antidepressant as far as how it helps people to quit smoking. But if people also have a problem with depression, you can get both effects from it and get a benefit there.

And the Zyban seems to work especially well for people who have trouble with the cravings, more than the rest of the withdrawal symptoms. And so for those people, it could be a very good choice.

GUPTA: All right, really good information. We're talking with Dr. Corinne Husten. We want you to quit smoking. That's the topic today. Also, chewing tobacco versus cigarettes, is the chew more dangerous? Stay tuned.

UNIDENTIFIED FEMALE: Ending the addiction to smokeless tobacco, what you need to know about quitting.

Plus...

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: I drink soda more than I drink water.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: Soft drink makers ask schools to stop selling soda. We'll tell you why after the break.

(COMMERCIAL BREAK)

GUPTA: It's time for our weekly check on childhood obesity. Soft drink makers announced this week that sodas and other sweetened drinks should be pulled from vending machines at elementary schools. So does this signal the demise of machines in schools?

Our Christy Feig has the story.

(BEGIN VIDEOTAPE)

SUSAN NEELY, PRES., AMERICAN BEVERAGE ASSOC.: We have a national crisis.

FEIG: And the beverage industry has some suggestions to help schools change that.

NEELY: There's an expectation that this beverage industry, that old step up to the plate and do something.

FEIG: One suggestion from the American Beverage Association, take soda machines out of elementary schools. Middle schools, the group says, should ban full calorie sodas and stock up on sports drinks and low calorie beverages. When it comes to high schools, the ABA recommends no more than half of the vending machines be stocked with soft drinks.

At Uman Middle School in Atlanta, children do have access to juice and sport drink machines, but only after school hours. School principal Betsy Bockman says the soda machine for students has been gone for two years. And just last week, Bockman pulled out a candy and salty snack machine after pressure from parents.

BETST BOCKMAN, UMAN MIDDLE SCHOOL: We wanted to support efforts to curb childhood obesity and promote better health.

FEIG: Bockman says while it wasn't a difficult decision to take out the junk snacks, the machine was a money-maker.

BOCKMAN: We made probably $1,500 to $2,000 last year on vending machines. And so like everybody else, your budget shrinks. You just - you make due or you do something else. So that's a loss, but it was worth it.

FEIG: Nationwide, principals call the shots when it comes to vending machines. So while the ABA's recommendations are generally seen as a positive sign, they may have little impact in your schools in the near future.

Christy Feig, CNN.

(END VIDEOTAPE)

GUPTA: All right, thanks.

More HOUSECALL coming up. Websites and phone numbers where you can find help.

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE) HOLLY FIRFER, CNN CORRESPONDENT (voice-over): Looking to drop a few pounds, but not sure where to start? Registered dietician and author Ellie Krieger says a few small changes could have big payoffs.

ELLIE KRIEGER, REGISTERED DIETICIAN: If you just cut out one sugary beverage a day, the results can be incredible. Just one sugary beverage, that's about 150 calories. It could be a soda or a lemonade or a sweetened iced tea. Just cut that out. You can lose up to 15 pounds by the end of the year.

FIRFER: Tired of that bagel with cream cheese for breakfast? Well, try some whole grain cereal, how fat milk, and strawberries. Ellie says this change alone will cut 2000 calories. That's 20 pounds a year. Lastly...

KRIEGER: Make sure that at every meal or snack, you have at least one serving of fruit and vegetables. And if you just get into the habit of doing that, you'll probably wind up eating fewer calories overall. And you will most certainly be a lot healthier.

FIRFER: Thanks, Ellie. For the bod squad, Holly Firfer, CNN.

(END VIDEOTAPE)

GUPTA: Holly, thanks. And feeling healthy is just one of the benefits of eating right and stopping smoking. The CDC's Dr. Corinne Husten is here with us. She's been our guest today. We've been talking about stopping smoking, but chewing tobacco is another obviously very bad habit. Which is worse?

HUSTEN: There's no safe form of tobacco. And people who chew tobacco need to use the same strategies that people who are trying to stop smoking use, which is the medication and the individual group or counseling.

GUPTA: Are you at the same risks for cancers and things like that?

HUSTEN: There's risk of cancer, there's risk of oral -- especially cancer is a very high risk. And really the -- it shouldn't be a comparison between smoking, which is so deadly and anything else. It should be what is compared to if you don't use tobacco at all. And it's a large risk.

GUPTA: I think it's been a clear message you've given us today.

HUSTEN: Yes.

GUPTA: There's no safe form of tobacco.

HUSTEN: Absolutely.

GUPTA: But there are a lot of resources out there when you're ready to quit. Try calling this number, 1-800-quit-now. That number's going to connect you to your local quit line, where you can get free individual counseling. Also go to smokefree.gov, where you can find instant message counseling, and a step by step guide to quitting. Really important topic today.

Unfortunately, we're out of time. I want to thank Dr. Corinne Husten.

HUSTEN: Thank you.

GUPTA: Thank you so much for spending your time with us today. I want to thank you at home as well for sending your e-mail questions. Hopefully this show will enable people to get the help that they need. It's such an important topic.

Make sure to tune in every weekend to HOUSECALL. That's 8:30 a.m. Eastern, Saturday and Sunday. And don't forget to e-mail us your comments and your questions.

Remember, this is the place where the experts answer all of your health questions.

Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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