Case study- Quit Smoking

A young adult man met his primary care physician for the first time, during which his prior military history came to light. The young man recalled the anxiety he experienced when he received his military orders for deployment to Iraq. Prior to the notice of deployment, he smoked cigarettes only occasionally, maybe 1 or 2 cigarettes a day. As the time for deployment approached, he started smoking more cigarettes and by the time he arrived in Iraq was up to a full pack a day. Throughout the 12-month deployment, he steadily increased his smoking with peak consumption of nearly 40 cigarettes a day. The soldier suffered several significant combat-related traumas resulting in mild physical injuries.

Upon return to
• Verify successful cessation by measuring cotinine or carbon monoxide levels.
A cigarette delivers 1.2-2.9 mg of nicotine, and the typical one pack-per-day smoker absorbs 20-40 mg of nicotine each day, raising the plasma concentrations to between 23-35 ng/mL. Nicotine produces increased expression of brain nicotine receptors, changes in regional brain glucose metabolism, the release of catecholamines, tolerance, and physiologic dependence. Nicotine addiction results from positive reinforcement (with the administration of nicotine) and withdrawal symptoms that start within a few hours of the last cigarette. The time to first cigarette and total cigarettes per day are the two strongest predictors of nicotine addiction. The nicotine dependence and nicotine withdrawal could be treated by the following:[13, 14]

• Other forms of nicotine delivery
• Drugs that selectively target one or more of the underlying mechanisms
• Behavioral treatments, acupuncture, and other therapies

Nicotine replacement therapy

Nicotine replacement therapy works by making it easier to abstain from tobacco by partially replacing the nicotine previously obtained from tobacco.[15] At least 3 mechanisms by which NRT could be effective include (1) reducing either general withdrawal symptoms, thus allowing people to learn without cigarettes, (2) reducing the reinforcing effects of tobacco-delivered nicotine, and (3) providing some psychological effects on mood and attention states.

Nicotine