Clients are asking...

Breakthrough

Fall 2005

How can I deal with nicotine cravings?

Q: "Since CAMH implemented the smoke-free policy in September, I can't get out to smoke as much as I used to. How can I deal with the cravings I have?"

Kristen Cleary, Addiction Therapist with the Nicotine Dependence Clinic responds:

For many clients who receive treatment at CAMH, the change in our facility going smoke-free has been a big adjustment. Here are some tips for how to cope with not smoking as much as you are used to.

For many people, when they do not smoke their regular number of cigarettes they can experience a number of different side effects. These can include: headache, nausea, shakiness, restlessness, strong desire for cigarettes, sweats, trouble sleeping, and increased eating.

There are effective medications that can be taken to help reduce these withdrawal symptoms so you are much more comfortable. Nicotine Replacement Therapy (NRT) includes the nicotine patch, Nicorette gum or inhaler. When used properly NRT doubles one's chances of quitting smoking. The key is to make sure that you are using the proper dose of NRT and to stay on it for a long enough period of time. The doctors or nurses on your unit or in the Nicotine Dependence Clinic can give you more information on NRT.

Besides physical withdrawal from nicotine, people can also experience behavioural or emotional cravings for cigarettes. Do you feel like smoking after a meal, when you are stressed out, or when you are with certain friends or at certain places? Chances are that part of your smoking is habitual. You are used to smoking during certain activities, and to do these activities without cigarettes may feel very uncomfortable.

There are certain coping strategies that you can practice so you can get used to going places and doing things without cigarettes. Here are just a few ideas:

1. Smoke only half of the cigarette.
2. Smoke outside and make your car, office, or house smoke-free.
3. Enlist the support of your family, friends, and health care providers - tell them that you are quitting so they won't offer you cigarettes or smoke in front of you.
4. Buy a brand of cigarettes that you dislike.
5. When you are craving a cigarette, try to wait 15 minutes before smoking.
6. Chew sugarless gum or crunchy foods (e.g. carrot sticks).
7. Keep yourself busy and your hands occupied (e.g. knitting, crafts, play music).
8. Avoid coffee, alcohol and any other triggers that you link with smoking.
9. Change your routine (e.g. go for a walk immediately after meals, eat breakfast in another room).
10. Use the four D's - Distract yourself, Delay the cigarette, Drink Fluids, and take a Deep Breath.

If you are interested in joining the Nicotine Dependence Clinic, we offer individual and group support to help you reduce or quit smoking. We also offer access to a doctor or nurse so you can receive NRT at a subsidized rate. The clinic can be reached at 416 535-8501 ext. 6662.

What is harm reduction?

Q: "I have been hearing a lot about the 'harm reduction approach' in the news lately. What is this?"

Dr. Peter Selby, Clinical Director of the Addictions Program responds:

You may have heard of the harm reduction approach through a number of stories covered recently by the media in regards to the release of the Toronto Drug Strategy.

The Toronto Drug Strategy is based upon a broad and integrated approach to tackling alcohol and other drug issues in the city, with a focus on the areas of prevention, harm reduction, treatment and enforcement. This comprehensive approach was taken because research shows that bringing together the energies of the health, social services, housing, education, employment and criminal justice systems has the greatest impact on drug problems and their effects on a community.

Although the Toronto Drug Strategy includes 66 recommendations, there are three that have generated the most interest:

• the decriminalization of small amounts of cannabis
• a study of whether supervised drug consumption sites are needed and/or feasible, and,
• the distribution of safe crack kits and cookers.

These recommendations are examples of strategies with a harm reduction approach.

A harm reduction approach to treatment looks at trying to reduce the harm for people who use substances, as well as for families and communities who may be affected by that use. Harm reduction outreach strategies - like the very successful needle exchange programs - are also about connecting people with supports and services that can improve and sometimes save their lives.

People who use services such as needle exchange programs or safe consumption sites often go on to use addiction treatment programs, like the ones CAMH provides. One of our biggest challenges in treating people who have alcohol or substance use issues is the stigma they face from people in the community.

At CAMH we have a harm reduction approach that makes use of strategies utilized throughout the world to reduce the negative health and social consequences of drug use. Harm reduction accepts that total abstinence from all drug use is not a realistic goal for some people, particularly in the short term. Rather than demanding that people commit to complete withdrawal from all drugs as a precondition to treatment, CAMH works with clients to establish personal goals that can range from total abstinence to a "moderate" use of the drug.

More information on harm reduction can be found on www.camh.net.

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Breakthrough will help you get the answer. Please contact: Public Affairs at CAMH.

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