Wellness Wednesday – About triggers and cravings

On the morning of March 12, Sue Pope — a two-pack-a-day smoker for 38 years — decided to see what it was like to drive to work without a cigarette.

Not so bad.

Then Pope – an academic affairs program coordinator in the College of Medicine — wondered what it would be like to make it through lunch without a smoke.

Pretty good.

Then came the ride home, then dinner, and the next thing you know, Pope had made it through a whole day without a cigarette

Tips from Dr. Klingemann We ran these last week but figured it wouldn’t hurt to throw them out there again, so here are some tips from Dr. Klingemann to help get through nicotine cravings: Cravings generally last from three to five minutes — so try to focus on something else for a few minutes and the worst part of the craving should be gone. Wear a rubberband on your wrist and snap it a couple of times when a craving starts — this refocuses your thought. Focus on the negative outcomes that are awaiting you if you continue the addiction. Think about how your health-related illnesses will impact your family. Chew a piece of sugarless gum or candy. Stick a toothpick, drinking straw or pencil in your mouth for a couple of minutes. Call a friend or counselor for immediate help. Go for a walk. Go in an empty room and scream for a couple of seconds. And, most importantly, think about why the craving is affecting you so strongly at that stitch-in-time. What triggered it? How can you solve that particular problem? Can you reduce the frequency or intensity of that “trigger”? Apply what you have learned to the rest of your quit attempt. Don’t give up. Look at these cravings as learning experiences. People who succeed at quitting solve their problems as they go along.

“I was so proud of myself, I thought, let’s see if I can do it again tomorrow,” Pope said.

And so she did. Two days then became a week, which became a month and now, nearly six months later, she has yet to have another cigarette.

Trapdoors in the routine

But like many who use tobacco, for Pope, routine acts such as the drive to work or meals, were intrinsically tied to her addiction.

To many, such acts generate strong reactions in the mind – known as triggers – that basically cause tobacco users to automatically reach for cigarettes or snuff cans, said Tom Klingemann, Pharm.D., an adjunct professor in the College of Pharmacy who also is an expert on tobacco cessation

“It’s kind of a magnetic force – it just drags you and your body along,” Dr. Klingemann said.

Three phases of addiction

Nicotine addiction typically sets in in three basic phases, Dr. Klingemann said.

The first usually comes when a young user first tries tobacco, often in an attempt to “act older.”

“They continue using after the first try often because they get the reward of feeling like an adult,” Dr. Klingemann said.

Secondly – users become physically addicted to the dopamine surge in the brain’s reward center that is created by the intake of nicotine. Dopamine creates a sense of peace and well being and continued tobacco use actually causes the body to increase the number of dopamine receptors in the brain, which increases the demand for dopamine and conversely, nicotine.

Other stories Below is a schedule of stories in this series on tobacco cessation. Week 1 — Going tobacco free Week 2 — Quitting strategies Week 3 — Cravings and triggers Week 4 — Support systems and medicine Week 5 — Relapse Week 6 –Weight gain and the oral fixation Week 7 — Benefits of non-smoking

The third phase of addiction usually comes as people form their life routines, often with a cigarette in hand.

In this stage, Dr. Klingeman said, tobacco use becomes part of activities such as driving to work, eating, drinking coffee, etc.

“In the mind of the user, tobacco use and these activities are one activity because they often have never done them without using tobacco,” he said.

Triggering the urge

So when one engages in such an activity, it trips the trigger in the brain that causes the call for nicotine. These triggers create strong urges to use that are temporarily satiated when tobacco is used.

“But when users get to their pockets and there’s no tobacco — then anxiety sets in,” Dr. Klingemann said.

And these urges seem to grow stronger the longer nicotine is withheld from the body.

Many people who try to quit relapse during these moments, Dr. Klingemann said.

Don’t scratch the itch

But, while they are certainly uncomfortable, these trigger moments are not impossible to get through.

Unlike drugs such as heroin or alcohol, there is not a painful physical withdrawal from nicotine and some strategy and planning to handle the trigger moments can make quitting more manageable, Dr. Klingemann said.

“Essentially it’s like an itch that demands to be scratched, but the truth is, you’re not going to die if you don’t scratch it,” he said. “In fact, you may die if you do.”

It will pass

These moments and cravings will pass — most often within a few minutes — and sometimes quicker if people redirect their attention and engage in another activity, he said.

“It is important to understand that such moments will come and that there are things that can be done to get through them,” Dr. Klingemann said.

What trips the trigger?

It also helps to realize what activities trigger such thoughts and replace them with new ones that don’t trigger the urge to use, he said.

In his cessation classes and counseling session, Dr. Klingemann has patients journal their smoking to see how it is tied to their activities.

“This addiction runs pretty deep and it often helps people if they can see how tied their addiction is to their lives,” he said. “This knowledge can make the quitting process a whole lot easier.”