Despite the well-known health risks of tobacco products and of smoking in particular, almost 40 percent of construction laborers still smoke or chew tobacco. Many Laborers and their family members would like to quit smoking but find this extremely addictive habit hard to break.

A key ingredient in tobacco is the highly addictive chemical, nicotine. Though it does not, itself, cause cancer – that task is handled by other chemicals in tobacco products – nicotine keeps the user coming back to the poison (see sidebar). Nicotine does its job by attaching to receptors in the brain that then send a message to another part of the brain to release dopamine, a pleasure chemical. However, the effect is not long-lasting, and the urge for nicotine quickly returns.

Common Misunderstandings

Most people – 72 percent of women and 60 percent of men – think nicotine causes cancer, but that is not true.

Similar percentages of men and women smoke “light” – reduced tar and nicotine – cigarettes because they believe them to be less harmful. In fact, most “light” smokers smoke more of them and suck harder to get the nicotine they need to fend off withdrawal symptoms.

Another study showed that many smokers avoid nicotine replacement products because they believe they are harmful. In fact, using these products eliminates exposure to the cancer-causing chemicals in tobacco. And, while the nicotine in them is no less addictive than the nicotine in tobacco, for those who are trying to break the habit, it can be more easily managed and systematically reduced.

Quitting tobacco use is difficult because the body goes through withdrawal. Without their nicotine fix, tobacco users can become irritable, impatient, anxious and even hostile. Some become depressed, restless and have difficulty concentrating. They often experience increased appetite and weight gain which may lead them back to tobacco. The craving for nicotine gradually subsides in most quitters, but it is often months before it can be readily ignored.

Though many users quit “cold turkey,” a number of cessation medications can help. However, because most medications have side effects and potential risks, tobacco users should consult with their doctor before using these drugs.

The newest is Chantix, a prescription medication being heavily advertised on television and radio. Its generic name is varenicline. The medication coats the nicotine receptors in the brain, blocking or reducing the effect of nicotine. With Chantix, when a tobacco user smokes or chews, he or she experiences no pleasure sensation and is less inclined to continue or renew the habit. However, the withdrawal symptoms are still present, and the user must be committed to a sustained quit effort; otherwise, he or she may decide to abandon the medication and return to tobacco use.

A different approach to quitting, nicotine replacement therapy, is supported by chewing gums, inhalers, nasal sprays, patches or lozenges that contain nicotine. Some of these require prescriptions while others are over-the-counter. Users of these medications do not experience withdrawal because they continue to receive nicotine, but these medications sustain dependency on nicotine. They do, however, avoid the cancer-causing chemicals that are in tobacco and, thereby, reduce the user’s long-term health risk. In addition, the nicotine dosage in these medications can gradually be reduced, allowing users to ease themselves off nicotine by managing the associated cravings.

The third medication sometimes prescribed for tobacco cessation is the generic drug bupropion, known more commonly by its brand names, Wellbutrin SR and Zyban. When patients using the anti-depressant Wellbutrin noticed that they also lost some of their desire to smoke, the manufacturer, GlaxoSmithKline, conducted further tests and then repackaged the drug as the tobacco cessation aid, Zyban. It assists some tobacco users by reducing key symptoms of nicotine withdrawal.

Even with medical help, quitting tobacco use is a difficult and protracted task – and setbacks are not uncommon. No one quits without strong self-motivation. Understanding both the personal risks and the second-hand smoke dangers for family and friends can provide motivation. Appreciating the poor example set for one’s children and the life-long effect of a parent’s premature death may also help. Enlisting the support of loved ones and friends can also be provide important help for this difficult but important endeavor.

The American Cancer Society offers advice for quitting, as do a variety of other sites (Google search under “smoking cessation”), and the LHSFNA publishes a number of tobacco awareness materials. For more information, contact the LHSFNA Health Promotion Division at 202-628-5465.

[Steve Clark]