According to recent studies, it has been observed that approximately 21% of adults in the United States are regular smokers. However, a more concerning aspect related to this issue has been identified in the smoking habits among clients enrolled in community drug abuse treatment programs. In fact, the prevalence of smoking habits among these clients has been found to be 3 to 4 times higher than the average smoking rates of the rest of the population. But that’s not all. An even more worrying scenario comes from the smoking habits that surround these programs’ staff, which have been identified to have a smoking prevalence that is about twice that of the general population. These findings suggest the need for focused interventions to help staff and clients alike to quit smoking and embrace healthier habits that can offer long-term benefits in managing their overall health.
Smoking cessation is an essential intervention for people undergoing drug treatment, as per the national clinical care standards. However, it comes to light that smoking cessation services are often overlooked or provided inconsistently in drug abuse treatment programs. At INSynergy, we recognize the need to integrate smoking cessation into drug abuse treatment at the individual level. We strive to address this need by providing effective pharmacotherapy approaches that support smoking cessation.
It is paramount to note that smoking remains the leading preventable cause of morbidity and mortality throughout the nation. Regrettably, the progress made in reducing smoking prevalence over the past four decades is still not satisfactory. Therefore, it is critical to treat both drug addiction and smoking simultaneously to guarantee a more effective and lasting recovery. At INSynergy, we are committed to combating this issue and ensuring that our patients receive the comprehensive care they need to achieve and maintain a healthy, smoke-free life.
A variety of formulations of nicotine replacement therapies now exist, including the transdermal nicotine patch, nicotine spray, nicotine gum, and nicotine lozenges. Because nicotine is the main addictive ingredient in tobacco, the rationale for NRT is that stable low levels of nicotine will prevent withdrawal symptoms – which often drive continued tobacco use – and help keep people motivated to quit.
Bupropion was originally marketed as an antidepressant (Wellbutrin). It has mild stimulant effects through blockade of the reuptake of catecholamines, especially norepinephrine and dopamine. A serendipitous observation among depressed patients was the medication’s efficacy in suppressing tobacco craving, promoting cessation without concomitant weight gain. Although bupropion’s exact mechanisms of action in facilitating smoking cessation are unclear, it has FDA approval as a smoking cessation treatment.
Varenicline is the most recently FDA-approved medication for smoking cessation. It acts on a subset of nicotinic receptors (alpha-4 beta-2) thought to be involved in the rewarding effects of nicotine. Varenicline acts as a partial agonist/antagonist at these receptors – this means that it mildly stimulates the nicotine receptor, but not sufficiently to allow the release
of dopamine, which is important for the rewarding effects of nicotine. As an antagonist, varenicline also blocks the ability of nicotine to activate dopamine, interfering with the reinforcing effects of smoking, thereby reducing craving.
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