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: kaz@hypnotherapytraining.net.au