Tobacco Use Disorder (Nursing)

00:00 Now let's take a look at another substance that is legal, but that can be abused and can result in a substance use disorder. Let's look at tobacco. Now, it's not the tobacco that a person becomes dependent on. It is the nicotine that is found in those products. So dependence on nicotine and tobacco products is why tobacco has its own substance use disorder category. 15.5% of Americans, which is 38 million Americans, over the age of 18 smoke tobacco products. And the CDC follows this. We assess high school students, middle school students to find out how many people and what ages they are beginning to use tobacco. Tobacco, even though it's legal, is also lethal. It causes almost half a million deaths a year. And it is noticeably the most preventable cause of death in the United States. Tobacco affects every single human organ as well as the growth of a fetus and the development of a fetus. Tobacco withdrawal is terrible. People who stop smoking will tell you that how difficult it is. It is physically hard, they start having headaches, stomachaches. Tobacco, cigarettes, or chew tobacco, cigars have become their primary relationship and so now they have been separated from that primary relationship so there is an emotional loss. And the withdrawal itself causes a mental fussiness. So they are unable to be able to focus on what they want to get done. It's important to understand that nicotine, that product nicotine, is a CNS stimulant. And so the withdrawal from nicotine is very uncomfortable and it starts soon. This is a drug that attacks and holds you and after 2 hours of smoking if you've just finished a cigarette and you go out and you don't have one for 2 hours you will begin to feel the effects of withdrawal.

02:58 Tobacco cessation is very difficult because at least until recently people smoke everywhere. Fortunately, in the United States there are now rules and regulations so tobacco use has been seen as a public health threat because second-hand tobacco is also so terrible. So now at least if you are a smoker you must go outside, you must be at least a certain number of feet from any public building that is owned by the federal government, the local governments, hospitals. But for many of our patients who have mental health disorders, tobacco and that nicotine help to calm their brain and so we have to be able to find a way to help our patients who now when they go inpatient are unable to smoke and we want to make sure that we keep them from going through withdrawal. And part of the way we do that is medication assisted. So, what do we have? We have medications that you can actually take like bupropion and that's known as Chantix, Zyban, varenicline, and Wellbutrin. There's also nicotine gum. Right now, most people are able to even get nicotine gum as over-the-counter, it's no longer requiring a prescription. There are inhalers, lozenges, nasal spray, and what we normally use in the hospital is the patch which also provides a certain amount of nicotine. Because remember with tobacco it is the nicotine that is the addictive substance. Now, the other pieces of wanting to have the accoutrements that go along with smoking, people have their favorite lighter or they'll have something to hold a pack of cigarettes and these are things that help them to stay focused on the substance and normalize the use of the substance so we want to remove those things as well. It is a very difficult, difficult addiction to break from. Once the person is able to get through 3 months, 6 months and has a supportive community, we find that that recovery can be forever. The trick is that first week, 3 weeks, 3 months, 6 months, a year.