Friday, November 6, 2009

The goal of decreasing the accessibility and availability of tobacco products

Reaching the goal of decreasing the accessibility and availability of tobacco products by
pricing and tobacco-use restrictions will require actions beyond the authority of DoD. DoD does
not have complete autonomy with regard to the pricing of tobacco products and is subject to
Congressional oversight on this issue. Tobacco products are offered at a discount in military
commissaries and exchanges, and the committee believes that DoD should not subsidize an
activity that adversely affects military readiness and health. The committee finds that DoD and
the services have restricted tobacco use to designated areas on installations but believes that
primary and secondary exposure to tobacco smoke could be reduced if the restrictions were
extended to decrease the number of such areas, extend the tobacco ban from basic military
training to technical training, and prohibit tobacco use in medical-treatment facilities.
The committee commends DoD for its efforts in identifying tobacco users. All the armed
services require that the VA/DoD Clinical Practice Guideline for the Management of Tobacco
Use be used by health-care providers. The guideline, a joint effort of VA and DoD, is modeled
on the 2000 PHS clinical-practice guideline Treating Tobacco Use and Dependence. It provides
a military and veteran focus for tobacco-cessation interventions. All service members are to be
asked about their tobacco status during their annual physical and dental examinations, and the
information is to be included in the patients’ medical records. DoD’s success in providing
targeted interventions to tobacco users is less clear. Although the guidelines call for health-care
professionals to advise patients to quit tobacco use and at least refer them for treatment if they
indicate willingness to make a quit attempt, adherence to this practice is not monitored. Targeted
interventions are available and are described in the VA/DoD guideline. The treatment options
used by the services are variable, and their long-term effect on abstinence rates in active-duty
personnel or their families has not been evaluated.
The committee believes that DoD should provide a nationwide quitline for military
personnel and their families in addition to the computer-based program “Quit Tobacco. Make
Everyone Proud”. A national quitline would offer consistency regardless of where service
members were stationed. Quitline counselors should be trained to deal with military-specific
issues, such as deployment and PTSD.
Many installations make available tobacco-cessation programs that include counseling
and medication, but not all do. The committee is pleased to note that the 2009 DoD appropriation
bill included a provision for TRICARE, part of the MHS, to cover smoking-cessation treatment
for its beneficiaries. The committee hopes that that coverage will include treatment for
smokeless-tobacco use, a growing problem in the military.

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Thursday, October 22, 2009

Caffeine and Nicotine Interaction

Amazingly, nicotine somehow doubles the rate by which the body
depletes caffeine. The caffeine user’s blood-caffeine level will double to 203% of normal baseline
if no intake reduction is made when quitting. This interaction is not a problem for any caffeine user
who can handle a doubling of their of normal caffeine intake without experiencing symptoms. But
consider a modest caffeine intake reduction, of up to one-half, if troubled by additional anxieties,
difficulty relaxing or trouble getting to sleep.

Subconscious Trigger Extinguishment - As mentioned, we conditioned our subconscious mind to
expect nicotine replenishment when encountering certain locations, times, events, people or emotions.
Be prepared for each such cue to trigger a brief crave episode as the subconscious mind sounds the
body’s fight or flight survival alarm. Remember, it is impossible for any trigger to cause relapse so long
as nicotine does not enter the bloodstream. Take heart, most triggers are reconditioned and
extinguished by a single encounter during which the subconscious mind fails to receive the expected
result - nicotine. See each crave episode as an opportunity to receive a reward, the return of yet
another aspect of life.

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Thursday, September 24, 2009

Bargaining whit nicotine

Bargaining can be with our particular nicotine delivery device, with us, loved ones or even our higher power. Its aim is the impossible feat of letting go, without letting go. If allowed, the emotional conflict of wanting to say “hello,” while saying “goodbye,” can easily culminate in relapse. “Just one,” “just once” can easily evolve into “this is just too hard,” “too long,” “things are getting worse not better,” “this just isn’t the right time to stop!”
Although a large portion of this book is about bargaining, the book itself will provide an abundance of fuel for the bargaining mind. Every user and every recovery are different. Sharing “averages” and “norms” will naturally generate tons of ammunition for those whose dependency or recovery traits are just beyond “average.” Key to navigating conflicted feelings is in demanding honesty while keeping our primary recovery motivations vibrant and strong.
They are the wind beneath our wings. Allowing freedom’s desire to die invites destructive and intellectually dishonest deals to be made. Instead of buying into relapse, remember, as long as 100% of the planet’s nicotine remains on the outside it’s impossible to fail. But what happens to a grieving mind once it realizes that it can’t arrest its dependency while enabling it too?
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Tuesday, September 15, 2009

Neuronal Re-sensitization - Temporarily Numb

Exactly how and why the brain diminishes the number of active a4b2-type acetylcholine receptors (down-regulation) after nicotine use ends is still poorly understood. What we do know is that once nicotine use ends we temporarily have far too many active receptors. There are so many unfed receptors that normal species survival activities (eating, drinking water, accomplishment, nurturing, peer acceptance and sex) are temporarily unable to provide adequate brain dopamine pathway stimulation.
Early recovery puts us face-to-face with hard physiological evidence of nicotine’s influence and standing among the brain’s pre-programmed priorities. Again, in terms of healing, the emptiness and emotional collision we may temporarily sense is good not bad. Our brain is working its “butt off” to diminish the number of active receptors and restore sensitivities.
Almost as quickly as we notice our sense of smell and taste being enhanced, our brain is working to restore natural sensitivities by down-regulating receptor counts. SPECT stands for Single Photon Emission Computed Tomography. It is a scan during which a radioactive substance is put into the bloodstream and can be followed as it works its way through the body and into the brain. A camera capable of detecting gamma radiation is then rotated around the body or head taking pictures from many angles. A computer is then used to put the images together to create a picture of activity within a specific slice of the body or brain.
A 2007 study used SPECT scans to follow dynamic changes in acetylcholine receptor down-regulation binding during smoking cessation. It compared those finding to receptor activity inside the brains of non-smokers.277 It found that within four hours of ending nicotine use that acetylcholine receptor binding potential had already declined by 33.5%.
The good news is that binding potential rebounded by 25.7% within ten days of ending nicotine use and then “decreased to the level of non-smokers by around 21 days of smoking cessation.” We don’t need to put radiation into our bloodstream or do a SPECT scan of our brain to know that the de-sensitized period experienced during recovery is temporary, normal and expected. It’s enough to know that we are sensing and feeling what is happening inside our brain as it adjusts to functioning without nicotine. Don’t fear it, savor it.
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Tuesday, August 25, 2009

The Law of Addiction

According to the World Health Organization, “In the 20th century, the tobacco epidemic killed 100 million people worldwide. During the 21st century, it could kill one billion.”116 Year after year, at least 70% of surveyed smokers say they want to stop,117 and 40% make an attempt of at least one day.

 There is no lack of desire or effort. Sadly, what they do not know is “how.” Key to breaking free and staying free is an understanding of the “Law of Addiction.” Whether users know it by name or simply understand the basic premise, failure to self-discover or to be taught this law is a horrible reason to die.
The “Law of Addiction” is not man-made law. It is as fundamental as the law of gravity and refusal to abide by it may result in serious injury or death. The Law is rather simple. It states, “Administration of a drug to an addict will cause reestablishment of chemical dependence upon the addictive substance.” Mastering it requires acceptance of three fundamental principles:
(1) that dependency upon using nicotine is true chemical addiction, captivating the same brain dopamine reward pathways as alcoholism, cocaine or heroin addiction;
(2) that once established we cannot cure or kill an addiction but only arrest it;
and (3) that once arrested, regardless of how long we have remained nicotine free, that just one hit of nicotine will create a high degree of probability of a full relapse.

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Wednesday, August 12, 2009

Quitting vs. Recovery

Quitting is a word that tugs at emotion. By definition it associates itself with departing, leaving, forsaking and abandonment. But the real abandonment took place on the day nicotine assumed control of our mind, when new salient memories made us forget that we functioned well without it, when we abandoned “us.” This book isn’t about quitting. It’s about recovering a person long forgotten, the real neuro-chemical “you.”

The word “quitting” tends to paint or dress nicotine cessation in gray and black, in the doom and gloom of bad and horrible. It breeds anticipatory fears, inner demons, needless anxieties, external enemies and visions of suffering. It fosters a natural sense of selfdeprivation, of leaving something valuable behind. Now contrast quitting with recovery. Recovery doesn’t run or hide from our addiction but instead boldly embraces every aspect of this temporary journey of re-adjustment. It sees The Journey Home 35 each symptom and challenge as a sign of the depth to which nicotine had infected our mind. When knowledge based, it recognizes the symptoms and celebrates each new challenge as an opportunity to reclaim yet another aspect of a life once drenched in nicotine.
Nicotine dependency recovery presents an opportunity to experience what may be our richest period of self-discovery ever. It’s a time when tissues heal, senses awaken and the brain’s neuro-chemicals again flow in response to life not nicotine. It’s a period where each challenge overcome awards the recovering addict another piece of a puzzle, a puzzle that once complete reflects a life reclaimed. It is not necessary that we delete the word “quit” from our thinking, vocabulary or this book but it might be helpful to reflect upon when the real “quitting” took place, when freedom ended and that next fix became life’s primary focus. Although nearly impossible to believe right now, you won’t be leaving anything of value behind - nothing.
Everything you did while using nicotine can be done as well, or better as “you.” All of the neurochemicals once controlled by nicotine were present before we started using and will gradually return to pre-nicotine levels. Every brain chemical that nicotine caused to flow is still present. They were always there and always yours.

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Wednesday, August 5, 2009

Tobacco Tolerance

Definitions of tolerance include:
1. Decreased responsiveness to a stimulus, especially over a period of continued exposure
2. The capacity to absorb a drug continuously or in large doses without adverse effect
3. Diminution in the response to a drug after prolonged use, or
4. Physiological resistance to a poison.
The brain attempts to fight back against its toxic intruder. As if it somehow knows that too much dopamine is flowing, it attempts to diminish the influence of nicotine by more widely disbursing it. It does so by growing or activating millions of extra nicotinic-type acetylcholine receptors in as many as eleven different brain regions.
 Although the average user’s body depletes and eliminates (metabolizes) nicotine at the rate of roughly one-half every two hours (129 minutes in Caucasians and 134 minutes in African Americans), the average nicotine intake per cigarette varies significantly.
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Friday, July 17, 2009

Master Settlement Agreement

Forty-six states, the District of Columbia, and five U.S. territories receive annual payments from tobacco manufacturers that are parties to the tobacco Master Settlement Agreement (MSA). In 2008, those payments totaled over $8 billion.
Under the terms of the MSA, those payments are adjusted annually to account for changes in the volume of cigarette sales in the United States of participating manufacturers. Because CBO estimates that enacting this legislation would result in lower consumption of tobacco products, CBO estimates that the annual payments to states under the MSA also would decline by over $150 million over the 2010-2014 period. A decline in smoking among pregnant individuals is expected to result in a reduction of low-weight births. As a result, state spending for Medicaid would decrease by an estimated $15 million over the 2010-2014 period, with additional savings in subsequent years.
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Tuesday, July 7, 2009

Studies on demand for cigarettes

Studies on demand for cigarettes have applied different economic models to two different types of data, aggregated and. individual level. Analysing each of two data-types has some advantages and disadvantages. The aggregate data are either time-series data or pooled cross-sectional and time-series data. High correlation among many of the key independent variables and prices can be a problem with time-series data. Consequently, estimates of the impact which prices and other factors have on demand can be sensitive to the inclusion and exclusion of the other variables.
The problem with using the pooled data is the measurement of cigarette consumption. Using these data, smoking is normally measured by annual state-level tax-paid cigarette sales. Both cross-border shopping between the neighbour states and the long-distance smuggling from low-tax to high-tax states can occur due to differences in taxes on cigarettes. Failure to account for this will produce upward-biased estimates of the impact of price on cigarette demand.
Finally, with aggregate data the demand and supply of cigarettes need to be modelled simultaneously since cigarette price, sale and consumption are simultaneously determined. In contrast, the use of individual-level data can ease some of the problems associated with aggregate data such as simultaneous biases resulting from the price and consumption, and multicollinearity between cigarette prices and other factors affecting the demand. In addition, using individual-level data can allow researchers to study the price responsiveness of different subpopulation groups such as those based on income, education, and age. The problem with individuallevel data is the accuracy with which consumption of cigarettes is measured. Self-reported consumption is typically under reported.
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Thursday, July 2, 2009

CIGARETTE CONSUMPTION

In Turkey, three basic types of cigarettes are marketed: Oriental blend, American blend and English blend. TEKEL produces all three types, while the two private companies produce only the American blend.
A national survey undertaken in 1988 reported that the overall prevalence of smoking among adults (age 15+ years) was 43 percent, with prevalence among males being much higher than among females, and the average starting age was falling.
Currently, 5 billion packs (100 000 tonnes equivalent) of cigarettes are consumed in Turkey annually. Over the last 30 years, the adult population has nearly doubled, with consumption increasing by almost 250 percent. The current per capita consumption rate is 2.55 kg/year, or more than one third of a pack per day per person. It is estimated that 70 000 to 100 000 people die from smoking-related health problems each year.
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