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There are five areas that the MediQuit Stop Program addresses:
The medication that MediQuit utilizes are not just to deal with
withdrawal symptoms; the majority of withdrawal symptoms are handled
rather easily by the nicotine patch. However, in the first six weeks
hunger and cravings, hostility, anger and mood swings are not controlled
by nicotine patch. Research has shown that antidepressants help
with the depression, hunger and cravings. Some medications are more
effective with women and some are more effective with men. Based
on the evaluation, which consists of personal interviews and several
screening instruments, (the Blue Mood Screening Questionnaire, the
Self Confidence Questionnaire and the Stress and Anxiety Questionnaire)
the MediQuit counseling team in consultation with a physician and
medical staff will make a decision of which medications will be
most effective for you.
It is important to realize that medications that we are using
that deal primarily with the cravings are different from the nicotine
patch and nicotine gum. Nicotine patch and nicotine gum are primarily
blocking agents that are known as nicotine agonists. The medications
that are used to help with mood swings (depression, anxiety, irritability
hostility and anger) are serotonin uptake inhibitors. If these medications
are not effective in controlling hunger and cravings then we use
central acting nicotine blockading agents which are technically
referred to as antagonists. They counteract the action of nicotine.
These drugs attach to certain receptors in the brain that keep nicotine
from acting and prevents you from becoming dependent. It is important
to realize in the initial stages if you take these nicotine blockage
drugs that during the first few weeks you may increase smoking.
Nicotine patch and gum are ineffective with the symptoms of hunger
and cravings and mood swings.
The success rate of quitting cold turkey or with a nicotine patch
is only and using the nicotine patch and/or gum is 5-10%. With the
medication it is 40-70%. Counseling allows you to increase the odds
even more. Research shows that dealing with the bad habits that
have driven out the good habits and a healthy lifestyle need to
be identified and reinstituted. This involves goal-setting, identifying
high risk situations, developing support from your partners and
at the workplace, focusing on reinstituting healthy habits such
as exercise and modifying your diet and developing self-control.
A special diet that MediQuit has developed also is quite effective
in raising the brain chemistry to begin to control hungers and stress.
If you agree on a regular basis and in crisis situations to use
the Quit Smoking hotline and the telephone support your long-term
success will be improved. One of the most important aspects of long-term
success is being able to make contact with a MediQuit Counselor
and acknowledge a slip has occurred. This is valuable because 75%
of people fail because of the guilt and depression that follows.
This starts a vicious cycle that leads to demoralization and relapse
through the use of cigarettes. Thus it is important to restart an
intensive program if you have a slip. The intensive program involves
workbooks and self help material. Depending on your choice of programs,
it will involve a minimum of three individual sessions and then
weekly support groups or telephone counseling based on your availability
and commitment. The complete program consists of four phases:
First Phase
The initial evaluation phase which involves a physical examination
and completion of a health history, an EKG if indicated (based on
your health history) and laboratory and completion of other program
material. If it is necessary to do more in-depth evaluation of your
medical or stress coping skills, then more in-depth tests will be
undertaken, which may involve an additional cost.
After completing this initial phase, which takes approximately
1-2 hours, you will then begin on medication which will be individualized
based on your situation and the pattern of your moods in coping
with withdrawal symptoms and stress.
At that point you will sign a contract and pick a date for quitting.
Our recommendation is to quit completely; less than 5% of people
who use the fading technique are successful. During that week you
will read a guide that gives an overview for smoking cessation.
Second Phase
The second phase begins after you return in 5-14 days. If your
brain and body have adjusted well to the medication, then you will
be started on the nicotine patch. We recommend the 24 hour patch,
because it is most effective with the cravings (especially in the
morning) that occur after quitting smoking. Some individuals may
not be able to use a 24 hour patch or may require lower strength
because the patch may be too strong. It is recommended that you
remain on the patch for a minimum of 6 weeks. However, in special
situations that patch is continued for as long as 12 weeks. It is
important not to smoke while you are using the patch; symptoms of
nicotine toxicity will occur (such as a rapid heart rate and nausea).
The second phase of the program involves restructuring your life
and coping with the withdrawal and a new lifestyle. During this
time, you will be asked to keep a diary as well as to practice the
skills that you have to deal with the temptation to start smoking
again. In addition, if you so choose you will also then contract
with individuals who can help you with your efforts.
If the antiaxiety or the antidepressants are not appropriate for
you then consideration will be given to using the hunger and cravings
medication. The most difficult part of withdrawal from nicotine
is the first four weeks. Approximately 25% of people fail during
the first week and another 25% fail during weeks two through four
of abstinence. This is a time that it is most important for you
to have intensive counseling as well as support and be in touch
for a telephone call to the Quit Smoking Crisis line.
In addition to this, it is important to have a positive attitude
and begin to reward yourself positively and begin to establish new
habits such as exercise and other positive things. It is important
you keep us informed of significant changes in your life or work.
It is important to reward yourself periodically with positive activities.
One of the biggest concerns during this phase is weight gain.
We attempt to try and deal with this through diet and the weight
gain is usually about three pounds for women and eight pounds for
men. 10-20% of people gain more than twenty pounds. If you are already
overweight then once you achieve mastery of the Quit Smoking program,
we will consider a weight loss program. However, if you are significantly
overweight (about approximately 40-50 pounds, a BMI of 35-40) consideration
should be given to possibly going on a weight loss program first
rather than quitting smoking first. It is also important to know
that the medications that are available for weight loss are also
quite effective in helping decrease smoking and possibly achieving
abstinence without the MediQuit regular program.
Third Phase
The third phase of the program is maintenance, beginning in the
third month. During this phase, individuals are monitored for withdrawal
symptoms on at least a monthly basis through a personal consultation
and a weekly basis through telephone consultation. In addition,
those individuals who have chosen the basic short term program (6
weeks) will be contacted to keep in touch with them to monitor their
program but also will be asked to inform us via mail on a regular
basis about any withdrawal symptoms as well as other questions which
can help individuals monitor their progress.
For those individuals who have agreed to go on the long-term program
the medications will be stopped based on relief of symptoms. However,
this may occur after twelve weeks. At this time if an individual
has gained weight consideration will be given to beginning the appetite
control medications. If an individual is more than twenty pounds
overweight they will be encouraged to begin a diet to lose weight,
however if they need a professional weight loss program they will
be able to enroll in the MD Weight Care weight loss programs at
a 20% discount. It is important to realize that smoking sometimes
is not just a stress reliever but it is one of the things that gives
people pleasure and makes them feel good. Consequently, when they
stop smoking people tend to eat more to feel good or to deal with
the mood swings. If this is the case, the individual will have to
consider long-term stabilization on the medication for 6-12 months.
In addition to this, if individuals have a history of depression
or excessive stress then individuals may need individual or group
psychotherapy. If individuals prefer consideration may be given
to behavioral therapy or hypnosis.
Fourth Phase
The fourth phase. The relapse program continues until the end
of thirty-six weeks. At this point we will make every effort to
reinforce those techniques that have been successful and also examine
the support network that you. This is particularly important for
long-term abstinence beyond the six-to-twelve month period. At this
point more consideration can be given to your cardiac and cardiovascular
condition and cholesterol levels. Emphasis at this point should
be on exercise and continued support.
If individuals have begun the premium program, they will be called
on a monthly basis (or more frequently if they desire) to be reassured
of their progress as well as to discuss any relapses that have occurred
and discuss restart if necessary. If an individual has chosen the
personalized program, they will be called at least once a month.
These individuals will be eligible for restart for up to a year
of the start date. If individuals want continued personalized counseling,
that also is available based on their utilization of individual
sessions. In addition, group sessions are available at no charge
for those who want to drop in periodically to let other know of
their success as well as to give reinforcement and give information
to others of difficult periods that occur.
If an individual relapses, then the focus will be to restart the
programs and make use of the causes of the relapse in order to try
and avoid them. What is important to know is that individuals who
have quit smoking at least five times or have the most severe smoking
habit usually have the most success in the long-term.
In addition, it is important to realize for whatever reasons that
women have more difficulty with withdrawal than men. Along those
lines that is particularly important why women need to be available
much more for individual counseling as well as group support. Also
in view of the weight gain it is important in the relapse phase
to maintain diet and exercise. In this phase we have natural remedies
that can assist with withdrawal as well as diet supplements that
are quite helpful.
If individuals during this period of relapse prevention realize
that there are stress issues that are independent of those that
they experience during the withdrawal or weight loss phase, then
there are opportunities for structured stress management and motivation
techniques which will help them focus on the coping strategies that
work well for them that are underutilized. During the maintenance
stage of abstinence consideration will be given to use of nicotine
gum, however, lifestyle changes should be emphasized since most
of the withdrawal symptoms are relieved in 8 weeks and the symptom
that individuals might be experiencing that they think may be related
to withdrawal are really related to stress and anxiety. The use
of gun should be limited since dependency has en reported in 10-20%
of those who use nicotine gum.
In summary:
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Weeks 1-2: the initial evaluation phase and medication adjustment
for moods and cravings.
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Weeks 3-6: the withdrawal phase using the nicotine patch and
counseling.
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Weeks 6-10: maintenance phase dealing with life after smoking.
At the end one begins to develop a relapse prevention program.
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Week 10-20: relapse prevention. During this phase the focus
is on improving your life as well make changes that you have
avoided. The severity of your smoking and the length as well
as the amount of support you are getting and the satisfaction
you are getting from your life will determine the frequency
and the number of individual and group sessions that you should
attend as well as the amount of telephone support and contact
you should maintain. It is during this phase that individuals
should begin to work on their weight gain as well as making
other changes in their life.
If an individual experiences a crisis or major disruptions in their
life they should return to the MediQuit for support as well as medication.
It is important to realize that there may be consideration to using
nicotine gum in this phase. Although it does not have the negative
impact of cigarettes most research shows that most individuals who
use gum after abstinence return to smoking. Thus, other methods
should be used to deal with whatever stress and temptations there
are to go back to smoking. At this point, individuals should increase
their stress management techniques such as exercise and contact
with individuals who have given them the most support. It is when
individuals are under more stress that they should be doing those
things that help them rather than do less of them.
RELATED ARTICLES FOR THE GENERAL PUBLIC
Fear of Weight Gain is Preventing Smokers
From Quitting Habit - from Marilyn Chase
A Complete Guide - Why Should I Quit? -
from the Helios Health Team
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