Transcript The PRIME Theory of motivation and its application to smoking

What happens to smokers in the
first few weeks after stopping
smoking?
Robert West
University College London
Practical Cardiology, Oxford
September 2007
1
Quiz
Indicate which of the following are true and which are false
Stopping smoking ...
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
causes a lasting drop in blood pressure
causes a temporary increase in adrenaline output
causes a temporary increase in heart rate
causes a temporary increase in coughing as the lungs start to recover
causes a temporary increase in weight gain
reduces healthcare costs within the first year
causes a temporary increase in tremor
increases hunger because of smokers’ need for an ‘oral substitute’
causes a temporary increase in headaches
causes a temporary increase in alcohol consumption
Outline
• Psychological effects of stopping smoking
• Physiological effects of stopping smoking
• Health effects of stopping smoking
Psychological effects
Effect
Increased irritability/aggression
Depressed mood
Increased anxiety
Increased restlessness
Difficulty concentrating
Increased appetite
Feeling light-headed
Sleep disturbance
Urges to smoke
Duration
< 4 weeks
< 4 weeks
< 1 week
< 4 weeks
< 2 weeks
>10 weeks
<48 hours
< 1 week
>2 weeks
Prevalence
50%
60%
50%
60%
60%
70%
10%
25%
70%
The following have not been demonstrated to be affected by stopping
smoking: tiredness, headaches, alcohol consumption
Physiological effects of
smoking cessation
Effect
Drop in heart rate (8 bpm avg)
Decreased adrenaline
Decreased cortisol
Decreased tremor
Decreased resting metabolic rate
Increased skin temperature
Decreased salivary IgA
Decreased caffeine metabolism
Duration
Long-term
Short-term
<4 weeks
Long-term
Long-term
Long-term
<14 days
Long-term
Prevalence
>80%
nk
nk
>80%
nk
>80%
nk
>80%
Health effects of smoking
cessation
Effect
Constipation
Cold symptoms and mouth ulcers
Reduced insulin resistance
Hospital admissions
Increased resting blood pressure
Increase in weight (6kgs avg)
Duration
>4 weeks
Short term
Long term
<1 year
Long term
Long term
Prevalence
10%
10%
Unknown
Unknown
~10%
>80%
Definition of withdrawal
symptoms
• Physical and mental changes that occur
following interruption or termination of
drug use
• Normally temporary
• A product of physical or psychological
adaptation to long-term drug use requiring
a period of re-adjustment when drug is no
longer ingested
Which effects are nicotine
‘withdrawal symptoms’?
• Irritability
• Restlessness
• Increased appetite (not caused by need for oral
substitute)
• Increased depression
• Increased anxiety
• Difficulty concentrating
• Sleep disturbance
• Urges to smoke
Link between cessation effects
and relapse
• More severe cravings and increased
depression are associated with greater
risk of relapse
• Anecdotal reports of smokers relapsing
because of weight gain but on average
those who gain more weight are more
likely to remain abstinent
Treatment of withdrawal
symptoms
 Smokers should be provided with realistic
picture of what to expect
 Most common treatment is nicotine
replacement, bupropion or varenicline
 Varenicline reduces urges to smoke more than
bupropion
 No clear evidence that one form of nicotine
replacement is more effective than others
 Oral glucose acutely reduces desire to smoke
 Exercise acutely reduces desire to smoke and
other withdrawal symptoms
Conclusions
•
•
•
Stopping smoking leads to a temporary nicotine
withdrawal syndrome of mood disturbance, hunger and
some physical symptoms
The main permanent change is weight gain
The mood disturbance, craving, hunger and physical
symptoms can be managed by
–
–
–
–
•
preparing people in advance
presenting them with a coherent model of their symptoms
recommending exercise and
prescribing medication
A minority of smokers experience adverse health effects
–
–
–
increased blood pressure
respiratory symptoms
clinicians need to be vigilant for these and monitor patients at
risk
Quiz: answers
Stopping smoking ...
causes a lasting drop in blood pressure
False
causes a temporary increase in adrenaline output
False
causes a temporary increase in heart rate
False
causes a temporary increase in coughing as the lungs start to recover False
causes a temporary increase in weight gain
False
reduces healthcare costs within the first year
False
causes a temporary increase in tremor
False
increases hunger because of smokers’ need for an ‘oral substitute’
False
causes a temporary increase in headaches
False
causes a temporary increase in alcohol consumption
False
Additional reading
• West R and Shiffman S (2007) Smoking
Cessation. Healthcare Press, Oxford