Campus Chronicle

Issue date: 8/20/07 Section: Pulse

Dr. Ralph

Q: What's the best way to quit smoking?

A: As an ex-smoker, I consider myself an expert on this topic. In fact, I quit several times! The last time was five years ago this past Thanksgiving. I'm not cocky enough to say that it is my last time, although I sure hope it is. I know myself well enough to know that I can never have one cigarette again without planning on starting a pack a day habit. Some people can handle an occasional cigarette. The huge addiction problem to nicotine is a testament to the fact that many people are, like me, prone to addiction.

I don't know that you would reach a consensus on any one best method for quitting, but I can tell you what worked for me and some of my patients. It's a process that takes a while, but one doesn't learn how to be a smoker the first time you puff on a cigarette. It took repeated attempts to smoke before the addiction took hold. It will take repeated efforts to "unlearn" the behavior.

I advise tapering off of nicotine by using progressively lower nicotine cigarettes, about every two weeks moving to a lower brand. At first you may find you smoke more to compensate, but within a few days resume the previous habits and approximate number of cigarettes. Smoking becomes less enjoyable and you start to unlearn the benefits of smoking.

In addition, daily aerobic exercises ? jogging, walking, swimming, biking, etc. ? will give frequent reinforcement for the positive changes going on with your health. You will note with every lighter cigarette that you feel you have more energy and stamina. This is a good time to mentally prepare yourself for the challenges ahead. Of course, you will have days of anger, frustration, arguments with your wife, your boss, etc. There will be plenty of excuses to give up your quest due to stress. You need to figure out a strategy. I think the bottom line is that you have to be quitting for yourself, because eventually you will become angry with everyone else.

If at some point you take a puff of one of the cigarettes you were smoking before changing to the milder ones, you will cough and you'll be surprised that it doesn't taste good. It tastes too strong and going back to the milder ones seems better. Eventually, you need to set a day when you just put them away and stop. I didn't tell anyone, fearful that I would fail. Some people like quitting with a buddy. Many people pick a memorable occasion like New Years Day, your birthday, or National Smokeout Day. The American Lung Association supplies a help line 24/7 and will supply a packet of info free of charge to help you in your mission.

Nicotine replacement can be done with patches, gum, nasal sprays and inhalers. I have found these to be helpful, although not as much so as a drug called Zyban or Welbutrin. This antidepressant was serendipitously found to reduce the urge for cigarettes, although the psychological addiction still needs to be addressed. Zyban and nicotine replacement are such complex, potentially dangerous therapies that you really need to have a doctor familiar with them to assist you.
At $7 a pack, the financial investment to quit will be made back quickly, so don't hesitate to spend the money (if your insurance doesn't cover it anyway) if needed. Next, the multitude of triggers one has learned to associate with smoking need to be unlearned through repetition. Finally, the one day at a time attitude is necessary. For a smoker to look at no cigarettes for the rest of his or her life looks unbearable. The best you can hope for is to have no cigarettes for the next hour, then the rest of the day, then the next day, etc.

Dr. George

Q : Why do you feel more hung-over when mixing alcohol (like wine and beer or gin and vodka) than when drinking only one kind?

A: Way back in medical school, in between the neuroanatomy of the cranial nerves and the microbiology of syphilis, I learned the important laws that applied to this particular clinical scenario: "Beer on top of whiskey, pretty risky…Whiskey on top of beer, you're in the clear," and "Beer before liquor, never been sicker... Liquor before beer, never fear."

The truth was that I, myself, had a pretty low tolerance for alcohol. I eventually came to the conclusion that the memories of the hangovers stuck with me for so long, that it wasn't worth the party. One memorable morning, changing my kid's stool-filled diaper with a rocky stomach after a long night was the final straw. Not a pretty picture.

Hangovers are thought to result from three factors: First, too much alcohol in too short a time period (as Homer would say "D'oh!") then can be metabolized by the liver. Second, dehydration, since alcohol is a diuretic ? it actually causes one to urinate more fluids than the volume of the drinks that was consumed. Third, the levels of congeners, or impurities after fermentation and distillation; congeners are various substances left over from making the spirit and are what give the spirit its dark color. Clear liquor: little congeners. Dark liquor: lots of congeners. Different kinds of liquor: different kinds of congeners. We have nothing to base this on, but presume that "impurities" should make you sick. It has also been speculated that mixing drinks hits the liver with different congeners and therefore makes a bad situation worse. Pure speculation. Probably theorized after a couple of drinks.

There is sparse science to support the contention that hangovers are dependent on the kind of alcohol that is ingested, but lots of anecdotes do just that. Many of us can't look at a particular kind of alcohol years later because on an association with an exceptionally severe episode of porcelain worship. From the anecdotal pool, there is a bias against darkly colored liquors. Tequila holds a prominent place in many of our memories that end in a night of retching. Many of our yarns suggest that the darker the spirit, the worse the hangover. That would make a vodka martini a better choice than red wine. It has also been observed, objectively, that when one is mixing several kinds of drinks, the overall amount of alcohol ingested in one sitting is greater than when sticking with one kind of drink.

The same would hold true with sweet drinks. Those strawberry daiquiris can hide an awful lot of rum with all the sugar and strawberry flavoring. With a shot of straight bourbon, you know you're drinking a considerable amount of alcohol. You can hide quite a bit more with some tasty mixers.

What is probably the major culprit in hangovers is a somewhat toxic substance called acetaldehyde. Alcohol is metabolized to acetaldehyde during mild or moderate drinking and then onto acetate. When the consumption from any source ? a fuzzy navel to a shot and a beer ? exceeds the liver's ability to break down the acetaldehyde, it builds up and causes the symptoms we associate with a hangover. Once you have overloaded the liver, time is necessary to catch up.

A "hair of the dog that bit you" might help alcohol withdrawal symptoms, but does nothing to make a hangover better. There are marked genetic differences in individuals' rate of breakdown of acetaldehyde, which at least partially explains some peoples tolerance of, and others sensitivity to, ingested alcohol. Cheers.

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Dr. Ralph and Dr. George are Emergency Room physicians with the University of Illinois at Chicago's Medical Center.

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As with all medical advice, consult your physician before beginning any regimen or if symptoms persist for more than five days

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Send your anonymous questions to pulse@chicagoflame.com.

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