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Doctor's Diagnosis: Quitting smoking

This file image shows a woman smoking a

This file image shows a woman smoking a Blu electronic cigarette in a studio in Melville. (Sept. 5, 2013) (Credit: Newsday / Audrey C. Tiernan)

Since smoking at the beach club is prohibited, my pal Jim has to sneak out to the parking lot when he feels the urge for a cigarette. He knows that due to his smoking he is at high risk for heart and lung disease, stroke and many types of cancer. So why doesn’t he quit? In short: nicotine.

Nicotine is one of thousands of chemicals inhaled when smoking tobacco. It is absorbed into the blood and then transported to the brain in a matter of seconds, where it triggers feelings of intense pleasure. But the effects wear off very quickly, and without more nicotine, smokers will soon start experiencing withdrawal symptoms. It is this immediate feeling of pleasure when smoking and rapid onset of withdrawal symptoms when not smoking that makes nicotine so addictive.

Some people are able to break this vicious cycle on their own, but most need help quitting. Many patients find nicotine replacement therapy to be helpful. Nicotine is supplied in such a way that the immediate euphoria is lessened, and the amount of nicotine used can be gradually decreased and eventually eliminated.

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Currently, Nicotine is available in many forms such as patches, lozenges, nasal sprays and gums.

Various types of counseling and behavioral therapies are also available. Additionally, there are some non-nicotine medications that have been shown to be helpful for those who want to quit.

The controversial new electronic cigarettes are are battery-powered devices that might look like regular cigarettes but do not that heat up. Instead, nicotine, a solvent and sometimes flavorings into a vapor to be inhaled. (Hence the term “vaping.”)

Proponents claim that, like other nicotine replacement products, e-cigarettes can helping patients quit smoking.

Opponents are afraid that this is an attempt to once again make smoking in public socially acceptable. They also worry that e-cigarettes will entice many people who have never smoked to begin the nicotine habit, eventually leading them to smoke tobacco. Also, the long-term health effects of inhaling the vapor and the e-cigarettes’ effectiveness in helping patients quit smoking are unknown. There is also concern that available flavorings such as bubble gum show they are being specifically marketed to teenagers.

So far I’ve gotten nowhere in my attempts to get Jim to quit smoking. I haven’t given up yet; there’s too much at stake.

Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at

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