Chapter 15Chapter 15

Hallucinogen Abuse and Hallucinogen Abuse and AddictionAddiction

What are hallucinogens?What are hallucinogens?

Hallucinogens are drugs that cause Hallucinogens are drugs that cause hallucinations - profound distortions hallucinations - profound distortions in a person's perceptions of reality. in a person's perceptions of reality. Under the influence of Under the influence of hallucinogens, people see images, hallucinogens, people see images, hear sounds, and feel sensations that hear sounds, and feel sensations that seem real but do not exist. Some seem real but do not exist. Some hallucinogens also produce rapid, hallucinogens also produce rapid, intense emotional swings. NIDAintense emotional swings. NIDA

PharmacologyPharmacology

Hallucinogens cause their effects by Hallucinogens cause their effects by disrupting the interaction of nerve cells disrupting the interaction of nerve cells and the neurotransmitter serotonin. and the neurotransmitter serotonin. Distributed throughout the brain and Distributed throughout the brain and spinal cord, the serotonin system is spinal cord, the serotonin system is involved in the control of behavioral, involved in the control of behavioral, perceptual, and regulatory systems, perceptual, and regulatory systems, including mood, hunger, body including mood, hunger, body temperature, sexual behavior, muscle temperature, sexual behavior, muscle control, and sensory perception. NIDAcontrol, and sensory perception. NIDA

Most usedMost used

LSD (an abbreviation of the German LSD (an abbreviation of the German words for "lysergic acid diethylamide") is words for "lysergic acid diethylamide") is the drug most commonly identified with the drug most commonly identified with the term "hallucinogen" and the most the term "hallucinogen" and the most widely used in this class of drugs. It is widely used in this class of drugs. It is considered the typical hallucinogen, and considered the typical hallucinogen, and the characteristics of its action and the characteristics of its action and effects described in this Research Report effects described in this Research Report apply to the other hallucinogens, apply to the other hallucinogens, including mescaline, psilocybin. NIDAincluding mescaline, psilocybin. NIDA

History of Hallucinogens in History of Hallucinogens in the USthe US

See videoSee video

NamesNames

LSD-acid, blotter, zen, dots, paper, LSD-acid, blotter, zen, dots, paper, sugarsugar

PCP-angel, angel dust, boatPCP-angel, angel dust, boat Ketamine-Kat, K, purple, bumpKetamine-Kat, K, purple, bump Ecstacy/MDMAEcstacy/MDMA

MDMAMDMA

http://www.drugabuse.gov/http://www.drugabuse.gov/infofacts/ecstasy.htmlinfofacts/ecstasy.html

Chapter 16Chapter 16

Inhalants and AerosolsInhalants and Aerosols

How are inhalants used?How are inhalants used?

IInhalants can be breathed in through the nose nhalants can be breathed in through the nose or the mouth in a variety of ways, such as:or the mouth in a variety of ways, such as:

"Sniffing" or "snorting" fumes from containers; "Sniffing" or "snorting" fumes from containers; Spraying aerosols directly into the nose or Spraying aerosols directly into the nose or

mouth; mouth; "Bagging"-sniffing or inhaling fumes from "Bagging"-sniffing or inhaling fumes from

substances sprayed or deposited inside a plastic substances sprayed or deposited inside a plastic or paper bag; or paper bag;

"Huffing" from an inhalant-soaked rag stuffed in "Huffing" from an inhalant-soaked rag stuffed in the mouth; and the mouth; and

Inhaling from balloons filled with nitrous oxide. Inhaling from balloons filled with nitrous oxide.

What are they?What are they?

Inhalants are volatile substances that Inhalants are volatile substances that produce chemical vapors that can be produce chemical vapors that can be inhaled to induce a psychoactive, or inhaled to induce a psychoactive, or mind-altering, effect. Although other mind-altering, effect. Although other abused substances can be inhaled, the abused substances can be inhaled, the term "inhalants" is used to describe a term "inhalants" is used to describe a variety of substances whose main variety of substances whose main common characteristic is that they are common characteristic is that they are rarely, if ever, taken by any route other rarely, if ever, taken by any route other than inhalation. NIDAthan inhalation. NIDA

Volatile solventsVolatile solvents

liquids that vaporize at room liquids that vaporize at room temperatures. They are found in a temperatures. They are found in a multitude of inexpensive, easily multitude of inexpensive, easily available products used for common available products used for common household and industrial purposes. household and industrial purposes. These include paint thinners and These include paint thinners and removers, dry-cleaning fluids, removers, dry-cleaning fluids, degreasers, gasoline, glues, correction degreasers, gasoline, glues, correction fluids, and felt-tip marker fluids. NIDAfluids, and felt-tip marker fluids. NIDA

AerosolsAerosols

sprays that contain propellants and sprays that contain propellants and solvents. They include spray paints, solvents. They include spray paints, deodorant and hair sprays, deodorant and hair sprays, vegetable oil sprays for cooking, and vegetable oil sprays for cooking, and fabric protector sprays.fabric protector sprays.

GasesGases

include medical anesthetics as well as gases include medical anesthetics as well as gases used in household or commercial products. used in household or commercial products. Medical anesthetic gases include ether, Medical anesthetic gases include ether, chloroform, halothane, and nitrous oxide, chloroform, halothane, and nitrous oxide, commonly called "laughing gas." Nitrous oxide commonly called "laughing gas." Nitrous oxide is the most abused of these gases and can be is the most abused of these gases and can be found in whipped cream dispensers and found in whipped cream dispensers and products that boost octane levels in racing products that boost octane levels in racing cars. Household or commercial products cars. Household or commercial products containing gases include butane lighters, containing gases include butane lighters, propane tanks, whipped cream dispensers, and propane tanks, whipped cream dispensers, and refrigerants. NIDArefrigerants. NIDA

NitritesNitrites often are considered a special class of often are considered a special class of

inhalants. Unlike most other inhalants, inhalants. Unlike most other inhalants, which act directly on the central nervous which act directly on the central nervous system (CNS), nitrites act primarily to system (CNS), nitrites act primarily to dilate blood vessels and relax the muscles. dilate blood vessels and relax the muscles. While other inhalants are used to alter While other inhalants are used to alter mood, nitrites are used primarily as sexual mood, nitrites are used primarily as sexual enhancers. Nitrites include cyclohexyl enhancers. Nitrites include cyclohexyl nitrite, isoamyl (amyl) nitrite, and isobutyl nitrite, isoamyl (amyl) nitrite, and isobutyl (butyl) nitrite, and are commonly known as (butyl) nitrite, and are commonly known as "poppers" or "snappers." NIDA"poppers" or "snappers." NIDA

What is theWhat is thescope ofscope of

inhalant abuse?inhalant abuse? Inhalant abuse was up significantly for the second Inhalant abuse was up significantly for the second

year in a row among 8th-graders, according to the year in a row among 8th-graders, according to the latest MTF (Monitoring the Future study, an annual latest MTF (Monitoring the Future study, an annual NIDA-supported survey of the Nation's secondary NIDA-supported survey of the Nation's secondary school students) while use among 10th- and 12th-school students) while use among 10th- and 12th-graders continued to decline.graders continued to decline.

The rate of high school seniors who abused inhalants The rate of high school seniors who abused inhalants in the past year was 4.2 percent in 2004, down from in the past year was 4.2 percent in 2004, down from the peak of 8.0 percent in 1995. the peak of 8.0 percent in 1995.

Annual abuse of inhalants among 10th-graders was Annual abuse of inhalants among 10th-graders was 5.9 percent in 2004, also down from a high in 1995 5.9 percent in 2004, also down from a high in 1995 (9.6 percent). (9.6 percent).

Among 8th-graders, 2004 abuse figures, at 9.6 Among 8th-graders, 2004 abuse figures, at 9.6 percent, were down overall from the 1995 peak of percent, were down overall from the 1995 peak of 12.8 percent, but were up from the 2002 rate of 7.7 12.8 percent, but were up from the 2002 rate of 7.7 percent. NIDApercent. NIDA

How can inhalant abuse be How can inhalant abuse be recognized?recognized?

Chemical odorsChemical odors Paint on face, hands, clothingPaint on face, hands, clothing Hidden spray or solvent cans and Hidden spray or solvent cans and

ragsrags Slurred speechSlurred speech Acting drunk but no smell of alcohol Acting drunk but no smell of alcohol

detecteddetected

Complicatins of useComplicatins of use Asphyxiation - from repeated inhalations, which lead Asphyxiation - from repeated inhalations, which lead

to high concentrations of inhaled fumes displacing to high concentrations of inhaled fumes displacing the available oxygen in the lungs; the available oxygen in the lungs;

Suffocation - from blocking air from entering the Suffocation - from blocking air from entering the lungs when inhaling fumes from a plastic bag placed lungs when inhaling fumes from a plastic bag placed over the head; over the head;

Convulsions or seizures - caused by abnormal Convulsions or seizures - caused by abnormal electrical discharges in the brain; electrical discharges in the brain;

Coma - the brain shuts down all but the most vital Coma - the brain shuts down all but the most vital functions; functions;

Choking - from inhalation of vomit after inhalant use; Choking - from inhalation of vomit after inhalant use; or or

Fatal injury - from accidents, including motor vehicle Fatal injury - from accidents, including motor vehicle fatalities, suffered while intoxicated. fatalities, suffered while intoxicated.

PharmacologyPharmacology

A recent study indicates that toluene, a A recent study indicates that toluene, a solvent found in many commonly abused solvent found in many commonly abused inhalants, including model airplane glue, inhalants, including model airplane glue, paint sprays, and paint and nail polish paint sprays, and paint and nail polish removers, activates the brain's dopamine removers, activates the brain's dopamine system. The dopamine system has been system. The dopamine system has been shown to play a role in the rewarding shown to play a role in the rewarding effects of many drugs of abuse. Nitrites, in effects of many drugs of abuse. Nitrites, in contrast, dilate and relax blood vessels contrast, dilate and relax blood vessels rather than acting as anesthetic agents. rather than acting as anesthetic agents. NIDANIDA

Chapter 17Chapter 17

SteroidsSteroids

SteroidsSteroids

Refer to your text forRefer to your text for Scope of problemScope of problem Medical usesMedical uses Legal statusLegal status Problems with use/abuseProblems with use/abuse ComplicationsComplications

Chapter 18Chapter 18

OVER THE COUNTER ANALGESICSOVER THE COUNTER ANALGESICS

OTCOTC

Refer to your textRefer to your text Medical usesMedical uses UsesUses OverdosesOverdoses

Chapter 19Chapter 19

TOBACCO PRODUCTS TOBACCO PRODUCTS

&&

NICOTINE ADDICTIONNICOTINE ADDICTION

Why Is It So Hard to Quit Why Is It So Hard to Quit Smoking?Smoking?

Mark Twain said, "Quitting smoking Mark Twain said, "Quitting smoking is easy. I've done it a thousand is easy. I've done it a thousand times." Maybe you've tried to quit times." Maybe you've tried to quit too. Why is quitting and staying quit too. Why is quitting and staying quit hard for so many people? The hard for so many people? The answer is nicotine. answer is nicotine.

SCOPE OF THE SCOPE OF THE PROBLEMPROBLEM

It wasn’t until 1964 that the Surgeon It wasn’t until 1964 that the Surgeon General stated that cigerette smoking General stated that cigerette smoking was dangerouswas dangerous

Estimate is 1 billion smokers Estimate is 1 billion smokers worldwideworldwide

Estimate that 1 in 3 who smoke that Estimate that 1 in 3 who smoke that first smoke will become addictedfirst smoke will become addicted

Estimate 46.5 million out of 265 Estimate 46.5 million out of 265 million in US smoke cigerettesmillion in US smoke cigerettes

Substance Abusers & Substance Abusers & NicotineNicotine

Prevalance rate is between 71%-Prevalance rate is between 71%-100%100%

Why? Why? Some research indicates that a Some research indicates that a

recovering addict will have a 4x recovering addict will have a 4x greater chance at recovery if they greater chance at recovery if they stop nicotine. Why?stop nicotine. Why?

How does tobacco deliver How does tobacco deliver its effects?its effects?

There are more than 4,000 chemicals found in the There are more than 4,000 chemicals found in the smoke of tobacco products. The cigarette is a very smoke of tobacco products. The cigarette is a very efficient and highly engineered drug delivery system. efficient and highly engineered drug delivery system. By inhaling tobacco smoke, the average smoker takes By inhaling tobacco smoke, the average smoker takes in 1 to 2 mg of nicotine per cigarettein 1 to 2 mg of nicotine per cigarette88. When tobacco . When tobacco is smoked, nicotine rapidly reaches peak levels in the is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain. A typical smoker bloodstream and enters the brain. A typical smoker will take 10 puffs on a cigarette over a period of 5 will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who minutes that the cigarette is lit. Thus, a person who smokes about 1-1/2 packs (30 cigarettes) daily gets smokes about 1-1/2 packs (30 cigarettes) daily gets 300 “hits” of nicotine to the brain each day. In those 300 “hits” of nicotine to the brain each day. In those who typically do not inhale the smoke—such as cigar who typically do not inhale the smoke—such as cigar and pipe smokers and smokeless tobacco users––and pipe smokers and smokeless tobacco users––nicotine is absorbed through the mucosal membranes nicotine is absorbed through the mucosal membranes and reaches peak blood levels and the brain more and reaches peak blood levels and the brain more slowly.slowly.NIDANIDA

ImpactImpact Tobacco use is the leading preventable cause of Tobacco use is the leading preventable cause of

death in the United States. The impact of tobacco death in the United States. The impact of tobacco use in terms of morbidity and mortality costs to use in terms of morbidity and mortality costs to society is staggering. Economically, more than $75 society is staggering. Economically, more than $75 billion of total U.S. healthcare costs each year is billion of total U.S. healthcare costs each year is attributable directly to smokingattributable directly to smoking77. However, this cost . However, this cost is well below the total cost to society because it does is well below the total cost to society because it does not include burn care from smoking-related fires, not include burn care from smoking-related fires, perinatal care for low birth-weight infants of mothers perinatal care for low birth-weight infants of mothers who smoke, and medical care costs associated with who smoke, and medical care costs associated with disease caused by secondhand smoke. In addition to disease caused by secondhand smoke. In addition to healthcare costs, the costs of lost productivity due to healthcare costs, the costs of lost productivity due to smoking effects are estimated at $82 billion per year, smoking effects are estimated at $82 billion per year, bringing a conservative estimate of the economic bringing a conservative estimate of the economic burden of smoking to more than $150 billion per burden of smoking to more than $150 billion per yearyear77..NIDANIDA

Brain Reward SystemBrain Reward System Research has shown how nicotine acts on the brain to Research has shown how nicotine acts on the brain to

produce a number of effects. Of primary importance to its produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates addictive nature are findings that nicotine activates reward reward pathways—the brain circuitry that regulates feelings of pathways—the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits.increases levels of dopamine in the reward circuits. This This reaction is similar to that seen with other drugs of abuse, and reaction is similar to that seen with other drugs of abuse, and is thought to underlie the pleasurable sensations experienced is thought to underlie the pleasurable sensations experienced by many smokersby many smokers99. Nicotine’s pharmacokinetic properties . Nicotine’s pharmacokinetic properties also enhance its abuse potential. Cigarette smoking produces also enhance its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalationpeaking within 10 seconds of inhalation99. However, the acute . However, the acute effects of nicotine dissipate in a few minutes, as do the effects of nicotine dissipate in a few minutes, as do the associated feelings of reward, which causes the smoker to associated feelings of reward, which causes the smoker to continue dosing to maintain the drug’s pleasurable effects continue dosing to maintain the drug’s pleasurable effects and prevent withdrawal.and prevent withdrawal.NIDANIDA

Medical ConsequencesMedical Consequences Cigarette smoking harms every organ in the body. It Cigarette smoking harms every organ in the body. It

has been conclusively linked to leukemia, cataracts, has been conclusively linked to leukemia, cataracts, and pneumonia, and accounts for about one-third of and pneumonia, and accounts for about one-third of all cancer deathsall cancer deaths1414. The overall rates of death from . The overall rates of death from cancer are twice as high among smokers as cancer are twice as high among smokers as nonsmokers, with heavy smokers having rates that nonsmokers, with heavy smokers having rates that are four times greater than those of nonsmokersare four times greater than those of nonsmokers1717. . Foremost among the cancers caused by tobacco use Foremost among the cancers caused by tobacco use is lung cancer—cigarette smoking has been linked to is lung cancer—cigarette smoking has been linked to about 90 percent of all lung cancer cases, the about 90 percent of all lung cancer cases, the number-one cancer killer of both men and womennumber-one cancer killer of both men and women1818. . Smoking is also associated with cancers of the mouth, Smoking is also associated with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, ureter, and bladdercervix, kidney, ureter, and bladder77..NIDANIDA

Medical ConsequencesMedical Consequences In addition to cancer, smoking causes lung In addition to cancer, smoking causes lung

diseases such as chronic bronchitis and diseases such as chronic bronchitis and emphysema, and it has been found to emphysema, and it has been found to exacerbate asthma symptoms in adults and exacerbate asthma symptoms in adults and children. More than 90 percent of all deaths children. More than 90 percent of all deaths from chronic obstructive pulmonary diseases from chronic obstructive pulmonary diseases are attributable to cigarette smoking. It has are attributable to cigarette smoking. It has also been well documented that smoking also been well documented that smoking substantially increases the risk of heart substantially increases the risk of heart disease, including stroke, heart attack, disease, including stroke, heart attack, vascular disease, and aneurysmvascular disease, and aneurysm77. It is . It is estimated that smoking accounts for estimated that smoking accounts for approximately 21 percent of deaths from approximately 21 percent of deaths from coronary heart disease each yearcoronary heart disease each year1616..NIDANIDA

Second hand smokeSecond hand smoke Environmental tobacco smoke is a major Environmental tobacco smoke is a major

source of indoor air contaminants; secondhand source of indoor air contaminants; secondhand smoke is estimated to cause approximately smoke is estimated to cause approximately 3,000 lung cancer deaths per year among 3,000 lung cancer deaths per year among nonsmokers and contributes to more than nonsmokers and contributes to more than 35,000 deaths related to cardiovascular 35,000 deaths related to cardiovascular diseasedisease77. Exposure to tobacco smoke in the . Exposure to tobacco smoke in the home is also a risk factor for new cases and home is also a risk factor for new cases and increased severity of childhood asthma and has increased severity of childhood asthma and has been associated with sudden infant death been associated with sudden infant death syndrome. Additionally, dropped cigarettes are syndrome. Additionally, dropped cigarettes are the leading cause of residential fire fatalities, the leading cause of residential fire fatalities, leading to more than 1,000 deaths each yearleading to more than 1,000 deaths each year2020..NIDANIDA

Pregnancy & NicotinePregnancy & Nicotine In the United States, it is estimated that 18 percent of In the United States, it is estimated that 18 percent of

pregnant women smoke during their pregnanciespregnant women smoke during their pregnancies11. . Carbon monoxide and nicotine from tobacco smoke may Carbon monoxide and nicotine from tobacco smoke may interfere with the oxygen supply to the fetus. Nicotine interfere with the oxygen supply to the fetus. Nicotine also readily crosses the placenta, with concentrations in also readily crosses the placenta, with concentrations in the fetus reaching as much as 15 percent higher than the fetus reaching as much as 15 percent higher than maternal levelsmaternal levels2424. Nicotine concentrates in fetal blood, . Nicotine concentrates in fetal blood, amniotic fluid, and breast milk. Combined, these factors amniotic fluid, and breast milk. Combined, these factors can have severe consequences for the fetuses and can have severe consequences for the fetuses and infants of smoking mothers. Smoking during pregnancy infants of smoking mothers. Smoking during pregnancy caused an estimated 910 infant deaths annually from caused an estimated 910 infant deaths annually from 1997 through 20011997 through 20011515, and neonatal care costs related , and neonatal care costs related to smoking are estimated to be more than $350 million to smoking are estimated to be more than $350 million per yearper year7,7,2525..NIDANIDA

Pregnancy & NicotinePregnancy & Nicotine The adverse effects of smoking during pregnancy can The adverse effects of smoking during pregnancy can

include fetal growth retardation and decreased birth include fetal growth retardation and decreased birth weights. The decreased birth weights seen in infants of weights. The decreased birth weights seen in infants of mothers who smoke reflect a dose–dependent mothers who smoke reflect a dose–dependent relationship—the more the woman smokes during relationship—the more the woman smokes during pregnancy, the greater the reduction of infant birth pregnancy, the greater the reduction of infant birth weightweight26,2726,27. These newborns also display signs of . These newborns also display signs of stress and drug withdrawal consistent with what has stress and drug withdrawal consistent with what has been reported in infants exposed to other drugs28. In been reported in infants exposed to other drugs28. In some cases, smoking during pregnancy may be some cases, smoking during pregnancy may be associated with spontaneous abortions, sudden infant associated with spontaneous abortions, sudden infant death syndrome, as well as learning and behavioral death syndrome, as well as learning and behavioral problems in children. In addition, smoking more than a problems in children. In addition, smoking more than a pack a day during pregnancy nearly doubles the risk pack a day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco that the affected child will become addicted to tobacco if that child starts smoking29.if that child starts smoking29.NIDANIDA

Gender DifferencesGender Differences women smoke fewer cigarettes per day, tend to use women smoke fewer cigarettes per day, tend to use

cigarettes with lower nicotine content, and do not inhale cigarettes with lower nicotine content, and do not inhale as deeply as men. However, it is unclear whether this is as deeply as men. However, it is unclear whether this is due to differences in sensitivity to nicotine or other factors due to differences in sensitivity to nicotine or other factors that affect women differently, such as social factors or the that affect women differently, such as social factors or the sensory aspects of smoking.sensory aspects of smoking.

The number of smokers in the United States declined in The number of smokers in the United States declined in the 1970s and 1980s, remained relatively stable the 1970s and 1980s, remained relatively stable throughout the 1990s, and declined further through the throughout the 1990s, and declined further through the early 2000s. Because this decline in smoking was greater early 2000s. Because this decline in smoking was greater among men than women, the prevalence of smoking is only among men than women, the prevalence of smoking is only slightly higher for men today than it is for women30. slightly higher for men today than it is for women30. Several factors appear to be contributing to this narrowing Several factors appear to be contributing to this narrowing gender gap, including increased initiation of smoking gender gap, including increased initiation of smoking among female teens and women being less likely than men among female teens and women being less likely than men to quit31.to quit31.

Why do women quit less?Why do women quit less? Although postcessation weight gain is typically Although postcessation weight gain is typically

modest (about 5–10 pounds), concerns about this modest (about 5–10 pounds), concerns about this may be an obstacle to treatment success. In fact, may be an obstacle to treatment success. In fact, NIDA research has found that when women’s weight NIDA research has found that when women’s weight concerns were addressed during cognitive-behavioral concerns were addressed during cognitive-behavioral therapy, they were more successful at quitting than therapy, they were more successful at quitting than women who were in a program designed only to women who were in a program designed only to attenuate postcessation weight gain32. Other NIDA attenuate postcessation weight gain32. Other NIDA researchers have found that medications used for researchers have found that medications used for smoking cessation, such as bupropion and smoking cessation, such as bupropion and naltrexone, can also attenuate postcessation weight naltrexone, can also attenuate postcessation weight gain and could become an additional strategy for gain and could become an additional strategy for enhancing treatment success33,34.enhancing treatment success33,34.NIDANIDA

Numerous forms of Numerous forms of treatmenttreatment

Nicotine replacement therapies (NRTs), such as nicotine Nicotine replacement therapies (NRTs), such as nicotine gum and the transdermal nicotine patch, were the first gum and the transdermal nicotine patch, were the first pharmacological treatments approved by the Food and pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation Drug Administration (FDA) for use in smoking cessation therapy. therapy.

NRTs are used (in conjunction with behavioral support) to NRTs are used (in conjunction with behavioral support) to relieve withdrawal symptoms—they produce less severe relieve withdrawal symptoms—they produce less severe physiological alterations than tobacco-based systems and physiological alterations than tobacco-based systems and generally provide users with lower overall nicotine levels generally provide users with lower overall nicotine levels than they receive with tobacco12. An added benefit is that than they receive with tobacco12. An added benefit is that these forms of nicotine have little abuse potential since these forms of nicotine have little abuse potential since they do not produce the pleasurable effects of tobacco they do not produce the pleasurable effects of tobacco products—nor do they contain the carcinogens and gases products—nor do they contain the carcinogens and gases associated with tobacco smoke. Behavioral treatments, associated with tobacco smoke. Behavioral treatments, even beyond what is recommended on packaging labels, even beyond what is recommended on packaging labels, have been shown to enhance the effectiveness of NRTs and have been shown to enhance the effectiveness of NRTs and improve long-term outcomes.improve long-term outcomes.

The PatchThe Patch The nicotine patch is a small, self-adhesive patch that slowly releases The nicotine patch is a small, self-adhesive patch that slowly releases

nicotine into the bloodstream through the outer layer of skin. It can be nicotine into the bloodstream through the outer layer of skin. It can be applied anywhere between the waist and neck — often the upper arm or applied anywhere between the waist and neck — often the upper arm or shoulder. Patches must be replaced every 24 hours.shoulder. Patches must be replaced every 24 hours.

Brand names include Nicoderm CQ and Habitrol. Generic patches also Brand names include Nicoderm CQ and Habitrol. Generic patches also are available.are available.

Pros:Pros: The patch is easy to use and provides a steady release of nicotine. The patch is easy to use and provides a steady release of nicotine. It's available without a prescription and in various doses. This flexibility It's available without a prescription and in various doses. This flexibility allows you to manage your withdrawal symptoms and cravings, as well allows you to manage your withdrawal symptoms and cravings, as well as to taper the amount of nicotine you receive gradually. as to taper the amount of nicotine you receive gradually.

Cons:Cons: You can't quickly adjust the amount of nicotine in the patch in You can't quickly adjust the amount of nicotine in the patch in response to cravings. The patch may cause itching and irritation where response to cravings. The patch may cause itching and irritation where it's applied. Other side effects may include headache, dizziness, upset it's applied. Other side effects may include headache, dizziness, upset stomach and blurred vision. Occasionally, patches may cause sleep stomach and blurred vision. Occasionally, patches may cause sleep disturbances and vivid, colorful dreams. Removing the patch at night disturbances and vivid, colorful dreams. Removing the patch at night may help. may help.

Timelines:Timelines: The patch is often used for eight weeks or longer. The patch is often used for eight weeks or longer. Caution:Caution: The patch may not be appropriate if you have certain skin The patch may not be appropriate if you have certain skin

conditions, such as eczema or psoriasis. Don't smoke while using the conditions, such as eczema or psoriasis. Don't smoke while using the patch. Rarely, you may get too much nicotine and experience nausea or patch. Rarely, you may get too much nicotine and experience nausea or dizziness. dizziness.

GumGum Nicotine gum is made of a special material called polacrilex. To Nicotine gum is made of a special material called polacrilex. To

release nicotine from the gum, chew a piece until it has a peppery release nicotine from the gum, chew a piece until it has a peppery taste or you notice a tingly sensation in your mouth. Then, to absorb taste or you notice a tingly sensation in your mouth. Then, to absorb the nicotine, hold the chewed gum between your gum and cheek until the nicotine, hold the chewed gum between your gum and cheek until the taste or tingly sensation disappears. Chew and hold again to the taste or tingly sensation disappears. Chew and hold again to release more nicotine. Repeat the cycle for about 30 minutes, until release more nicotine. Repeat the cycle for about 30 minutes, until most of the nicotine has been released from the gum.most of the nicotine has been released from the gum.

Brand names include Nicorette. Generic gum also is available.Brand names include Nicorette. Generic gum also is available. Pros:Pros: Nicotine gum keeps your mouth busy. It can help satisfy Nicotine gum keeps your mouth busy. It can help satisfy

cravings quickly. You can buy it over-the-counter in 2- or 4-milligram cravings quickly. You can buy it over-the-counter in 2- or 4-milligram doses and chew it as often as needed — up to 24 pieces a day. When doses and chew it as often as needed — up to 24 pieces a day. When nicotine gum is used alone, most people find it most effective to chew nicotine gum is used alone, most people find it most effective to chew one piece every hour for the first few weeks. one piece every hour for the first few weeks.

Cons:Cons: Nicotine gum may cause gum, tooth or jaw soreness if chewed Nicotine gum may cause gum, tooth or jaw soreness if chewed like regular gum. You may experience nausea or hiccups if you chew it like regular gum. You may experience nausea or hiccups if you chew it too fast or swallow the nicotine rather than holding the gum against too fast or swallow the nicotine rather than holding the gum against the side of your mouth as directed. the side of your mouth as directed.

Timelines:Timelines: Nicotine gum is recommended for up to 12 weeks. Nicotine gum is recommended for up to 12 weeks. Caution:Caution: Nicotine gum may stick to dentures or other dental work. Nicotine gum may stick to dentures or other dental work.

Don't smoke while using the gum. Rarely, you may get too much Don't smoke while using the gum. Rarely, you may get too much nicotine and experience nausea or dizziness. nicotine and experience nausea or dizziness.

LozengesLozenges Nicotine lozenges can be used discreetly to quickly satisfy Nicotine lozenges can be used discreetly to quickly satisfy

cravings.cravings. Nicotine lozenges are similar to hard candy. You place them Nicotine lozenges are similar to hard candy. You place them

between your gum and cheek and suck them slowly. Each lozenge between your gum and cheek and suck them slowly. Each lozenge lasts 20 to 30 minutes.lasts 20 to 30 minutes.

Lozenges are sold under the brand name Commit.Lozenges are sold under the brand name Commit. Pros:Pros: Nicotine lozenges can be used discreetly to quickly satisfy Nicotine lozenges can be used discreetly to quickly satisfy

cravings. You can use them as often as needed, up to 20 lozenges cravings. You can use them as often as needed, up to 20 lozenges a day. They're available in 2- or 4-milligram doses without a a day. They're available in 2- or 4-milligram doses without a prescription. prescription.

Cons:Cons: Occasionally, they may cause nausea, heartburn or hiccups. Occasionally, they may cause nausea, heartburn or hiccups. Timelines:Timelines: Nicotine lozenges are recommended for up to 12 Nicotine lozenges are recommended for up to 12

weeks. weeks. Caution:Caution: Nicotine lozenges may stick to dentures or other dental Nicotine lozenges may stick to dentures or other dental

work. They're not meant to be chewed or swallowed whole. Don't work. They're not meant to be chewed or swallowed whole. Don't smoke while using the lozenges. Rarely, you may get too much smoke while using the lozenges. Rarely, you may get too much nicotine and experience nausea or dizziness. nicotine and experience nausea or dizziness.

InhalerInhaler The nicotine inhaler allows you to mimic the hand-to-mouth The nicotine inhaler allows you to mimic the hand-to-mouth

motions of smoking.motions of smoking. The nicotine inhaler is a device that allows you to receive some nicotine The nicotine inhaler is a device that allows you to receive some nicotine

using the same hand-to-mouth motions of smoking. When you puff using the same hand-to-mouth motions of smoking. When you puff gently on the device, nicotine vapor is released from a cartridge inside gently on the device, nicotine vapor is released from a cartridge inside the device. Hold the vapor in your mouth for a few seconds and then the device. Hold the vapor in your mouth for a few seconds and then blow it out — don't try to inhale it into your lungs. The nicotine is blow it out — don't try to inhale it into your lungs. The nicotine is absorbed through the lining in your mouth and throat.absorbed through the lining in your mouth and throat.

The inhaler is available by prescription under the brand name Nicotrol.The inhaler is available by prescription under the brand name Nicotrol. Pros:Pros: The inhaler keeps your hands and mouth busy. You control the The inhaler keeps your hands and mouth busy. You control the

dose. You can take as few puffs as needed and save the rest of the dose. You can take as few puffs as needed and save the rest of the cartridge for later in the day. cartridge for later in the day.

Cons:Cons: It may cause coughing and mouth or throat irritation. It may cause coughing and mouth or throat irritation. Timelines:Timelines: The inhaler is often used for six to 12 weeks. Most people The inhaler is often used for six to 12 weeks. Most people

use six to 16 cartridges a day at first and gradually taper to nothing. use six to 16 cartridges a day at first and gradually taper to nothing. Caution:Caution: The inhaler may not be appropriate for people who have lung The inhaler may not be appropriate for people who have lung

diseases, such as asthma. Don't smoke while using the inhaler. Rarely, diseases, such as asthma. Don't smoke while using the inhaler. Rarely, you may get too much nicotine and experience nausea or dizziness. you may get too much nicotine and experience nausea or dizziness.

ZybanZyban Bupropion is a prescription stop-smoking aid that doesn't contain nicotine.Bupropion is a prescription stop-smoking aid that doesn't contain nicotine. The antidepressant drug bupropion can help control nicotine cravings. It's available The antidepressant drug bupropion can help control nicotine cravings. It's available

as a prescription stop-smoking aid under the brand name Zyban.as a prescription stop-smoking aid under the brand name Zyban. Pros:Pros: Bupropion is a pill, so it's easy to use. It doesn't contain nicotine and isn't Bupropion is a pill, so it's easy to use. It doesn't contain nicotine and isn't

addicting. addicting. Cons:Cons: Side effects may include insomnia and dry mouth. Rarely, a severe allergic Side effects may include insomnia and dry mouth. Rarely, a severe allergic

reaction can occur. reaction can occur. Timelines:Timelines: Bupropion is often used for seven to 12 weeks, beginning one to two Bupropion is often used for seven to 12 weeks, beginning one to two

weeks before you plan to quit smoking. For the first three days of bupropion weeks before you plan to quit smoking. For the first three days of bupropion therapy, many people take a 150-milligram tablet each morning. On the fourth day, therapy, many people take a 150-milligram tablet each morning. On the fourth day, they take another 150-milligram tablet about eight hours after the morning tablet. they take another 150-milligram tablet about eight hours after the morning tablet. Bupropion may be used for smoking cessation maintenance for up to six months. Bupropion may be used for smoking cessation maintenance for up to six months.

Caution:Caution: Bupropion isn't appropriate for people who have a seizure or eating Bupropion isn't appropriate for people who have a seizure or eating disorder, those who have lost consciousness for more than an hour due to trauma to disorder, those who have lost consciousness for more than an hour due to trauma to the head, those already taking a medication containing bupropion or those who take the head, those already taking a medication containing bupropion or those who take a type of antidepressant known as a monoamine oxidase inhibitor. If the second a type of antidepressant known as a monoamine oxidase inhibitor. If the second tablet is taken too close to bedtime, it may cause disturbed sleep. tablet is taken too close to bedtime, it may cause disturbed sleep.

Smoking is a complex addiction with both physical and behavioral elements. If you Smoking is a complex addiction with both physical and behavioral elements. If you aren't able to successfully quit smoking this time, talk with your doctor again. For aren't able to successfully quit smoking this time, talk with your doctor again. For most people, quitting for good takes several serious attempts. The most effective most people, quitting for good takes several serious attempts. The most effective strategy is to combine medication with a more intensive behavioral program that strategy is to combine medication with a more intensive behavioral program that includes support from professionals specially trained to treat tobacco dependence. It includes support from professionals specially trained to treat tobacco dependence. It may also be helpful to adjust medication doses or use several smoking cessation may also be helpful to adjust medication doses or use several smoking cessation products together.products together.

Nasal SpraysNasal Sprays The nicotine in nasal spray reaches the bloodstream The nicotine in nasal spray reaches the bloodstream

quickly.quickly. Nicotine nasal spray is sprayed inside your nostril. The Nicotine nasal spray is sprayed inside your nostril. The

recommended dose is a spray in each nostril one to five times an recommended dose is a spray in each nostril one to five times an hour.hour.

It's available by prescription under the brand name Nicotrol.It's available by prescription under the brand name Nicotrol. Pros:Pros: The nicotine in nasal spray reaches the bloodstream more The nicotine in nasal spray reaches the bloodstream more

quickly and begins working faster than other nicotine quickly and begins working faster than other nicotine replacement products. You control the dose. replacement products. You control the dose.

Cons:Cons: Side effects often include nasal, sinus and throat irritation. Side effects often include nasal, sinus and throat irritation. You may also develop watery eyes, sneezing and coughing. You may also develop watery eyes, sneezing and coughing.

Timelines:Timelines: Nicotine nasal spray is often used for eight to 12 Nicotine nasal spray is often used for eight to 12 weeks. Most people use one to two mists an hour at first and weeks. Most people use one to two mists an hour at first and gradually taper to nothing. gradually taper to nothing.

Caution:Caution: Nicotine nasal spray isn't recommended for people who Nicotine nasal spray isn't recommended for people who have a nasal or sinus condition, allergies or asthma. Don't smoke have a nasal or sinus condition, allergies or asthma. Don't smoke while using the nasal spray. Rarely, you may get too much while using the nasal spray. Rarely, you may get too much nicotine and experience nausea or dizziness. nicotine and experience nausea or dizziness.

QuittingQuitting

Smoking is a complex addiction with both Smoking is a complex addiction with both physical and behavioral elements. If you aren't physical and behavioral elements. If you aren't able to successfully quit smoking this time, talk able to successfully quit smoking this time, talk with your doctor again. For most people, with your doctor again. For most people, quitting for good takes several serious quitting for good takes several serious attempts. The most effective strategy is to attempts. The most effective strategy is to combine medication with a more intensive combine medication with a more intensive behavioral program that includes support from behavioral program that includes support from professionals specially trained to treat tobacco professionals specially trained to treat tobacco dependence. It may also be helpful to adjust dependence. It may also be helpful to adjust medication doses or use several smoking medication doses or use several smoking cessation products together.cessation products together.

Thinking about Quitting Thinking about Quitting Smoking?Smoking?

Before you attempt to stop, think about preparing. It is a bit like Before you attempt to stop, think about preparing. It is a bit like training for a race. The better trained you are, the higher the training for a race. The better trained you are, the higher the likelihood of success. Here are some suggestions for your training:likelihood of success. Here are some suggestions for your training:

Decide positively that you want to quit Decide positively that you want to quit Make a list of reasons, including personal reasons, medical effects, Make a list of reasons, including personal reasons, medical effects,

health benefits, financial advantages and obligations to others health benefits, financial advantages and obligations to others Repeat one of these reasons to yourself several times each morning Repeat one of these reasons to yourself several times each morning Start conditioning yourself physically with a modest exercise Start conditioning yourself physically with a modest exercise

routine. Get lots of rest and drink more fluids routine. Get lots of rest and drink more fluids Set a target date for quitting. Do not allow anything to change this Set a target date for quitting. Do not allow anything to change this

date date Make a list of people who can support your intentions to quit, such Make a list of people who can support your intentions to quit, such

as co-workers, family members and friends as co-workers, family members and friends Make a list of activities, hobbies and interests that you can do with Make a list of activities, hobbies and interests that you can do with

your support group your support group Prepare yourself through knowledge of the withdrawal symptoms Prepare yourself through knowledge of the withdrawal symptoms

and ways to cope with them and ways to cope with them

ResourcesResources

http://www.public-health.uiowa.edu/http://www.public-health.uiowa.edu/itrc/quitline/default.htmitrc/quitline/default.htm

www.cancer.orgwww.cancer.org www.lungusa.orgwww.lungusa.org http://www.nicotine-anonymous.org/http://www.nicotine-anonymous.org/