Smoking and Tobacco
It is not disputed that smoking tobacco is harmful to health. Helping a person through this kind of lifestyle change can be challenging. Most patients know that smoking is not to their advantage, but comparatively few are successful in quitting. A significant success rate in effecting change occurs when coaching educates and brings people along, as opposed to trying to more impress them with the threat of severe and dire consequences. Helpful suggestions that provide a way out can be much more effective than reminders of cancer risk.
At some point in a patient’s encounter must come the realization that there has been an injury that their body could not heal well enough for them to be living without the remnant of chronic pain. Sometimes it is a tendon injury, other times it might be a joint or spine injury. Explaining that the body has a very difficult time healing bone, ligament, and tendon with nicotine and tobacco exhaust in the blood may provide a different motivation for cutting down or quitting. Patients need to realize that providing opiate medication to make inflammation-producing behaviors more comfortable has quite gone out of style, since high levels of these medicines have been shown to be dangerous and even counterproductive.
Rather than discussing lung cancer, there is a different impact to discussing how cigarette smoke closes blood vessels and decreases blood supply to injured tissue.7 And in the absence of nicotine, even a tobacco extract adversely affects healing.8 There may be a more significant impact to hearing that one’s tender and injured tendon or ligament cannot heal as well with nicotine in the blood than a discussion about lung cancer. At a later visit further discussion can include encouraging the patient to look up the health effects of cadmium poisoning, and later keep asking why they continue to sign up for this exposure.
In the meantime, it is imperative that the patient see decreasing smoking as easier and less threatening than expected. Suggesting the same old path they’ve tried before, or some therapy like acupuncture or hypnosis that requires a prohibitive expenditure does not help break down their difficult barriers to success. In considering the use of tobacco, I refer to three main addictions:
- • Nicotine
- • Social (purchase, friends, breaks, ritual of lighting, etc.)
- • Chemicals in the tobacco smoke, planted by manufacturers to maintain addiction
Of these, the most significant is the addictive effect from what is added to the tobacco in process of making cigarettes.9 This realization can have a profound effect on the psychology of quitting. Learning that the tobacco companies deliberately did this to you needs to come at the same time as providing an easy solution for getting out of this circle. All that one has to do to make this first change in behavior is to self-roll all cigarettes from organic or other pipe tobacco. Now without quitting or even the anxiety of setting a quit date, it is possible to detox from these chemicals over the next 2 months, and the most difficult next steps of cutting down are likely to be easier.
Encouraging change and providing a path and choice with little downside increases the likelihood of success. Admit that rolling requires effort and will taste different. Getting over these differences is important, and a certain amount of “sucking it up” will be necessary. Suggest that immediate cost savings could be better than 50% and why not check it out. At the next visit the not yet motivated person might be reminded about why they haven’t yet looked into saving all that money. Also suggest shopping carefully for a cigarette rolling machine. The process of self-rolling needs to be as easy as possible, and available devices have different degrees of difficulty for deployment. With this philosophy of discussion, you are now on your patient’s side against a problem with which they have struggled for perhaps many years. The balance of motivation and fear just needs a little tilting, and making it easier to change encourages people to flex their power of self-control.
Another and gentler step toward quitting is to only smoke cigarettes out of doors. Just this step may decrease exposure by more than 75% without even changing the number of cigarettes smoked. Smoking inside a closed environment dramatically increases toxic exposures to many chemicals.10 For patients who live with smokers, this can be a therapeutically powerful negotiation in gaining health and self-respect.
Suggest not smoking in the car, especially on the way to their office visit. No one in your office needs to be exposed to the high level of toxicity that comes off the clothes of someone who was just in a smoke-filled closed space. Perhaps set a day aside for “stinky people” delegated to patients who are the worst offenders of your office environment. You might also start leaving the worst offenders in the exam room with a HEPA filter for 30-40 minutes before going in to see them. Making their disrespecting behavior inconvenience them can reduce your exposure and provide motivation for change, especially if someone else drove them.
A good next step is the progression to vaporizer technology that avoids fire and resultant cadmium exposure while maintaining the social structure of the habit. Odor disappears, toxicity of clothing decreases, and possibilities for quitting concomitantly increase. Suggesting using vaporizer technology indoors and all fire and flame outside can be a helpful step, especially for situations where other family members smoke. While vaporizing is not without toxicity, chemical exposures for oneself and one’s contacts are dramatically lower, and for many this step can be very helpful progress."
Along with sharing the effect tobacco smoking has on healing, comes the practitioners’ advice to delay elective surgery or elective dental work until enough changes can be made in these lifestyle parameters for an improved chance of success. People can understand not wanting to sign up for an elective procedure when conditions for healing are significantly compromised, especially when they can see good possibilities for lifestyle change. These surgeries may include elective dental work of tooth pulling and implants, joint fusions, tendon repair, and joint replacement surgery.
