Janice Milliman, Quit Coach, Service Delivery:

Most people say quitting tobacco is one of the hardest things they've ever done. There are so many factors going against those who want to quit. Many feel like their canoeing upstream without a paddle (against a strong head wind too).

Along with nicotine addiction and the habitual and emotional triggers, tobacco users face additional challenges. Many are not given assistance to obtain the medications often necessary to help them quit. It's discouraging, to say the least.

Here are two of the most common (and quite unfortunate) scenarios heard daily by Free & Clear Quit Coaches like myself:

Scenario 1: A man who smoked a pack a day is hospitalized for 7 days. While hospitalized he is provided the nicotine patch which helps minimize the withdrawal symptoms. After 7 days of not smoking he's excitedly off to a great start because he's been wanting to quit. The hospital gives him written prescriptions for the necessary medications at discharge. At the pharmacy, all medication are covered by his employer's health plan, except the nicotine patch. He tries to stay quit without the patch, but in a short period of time the withdrawal symptoms become unmanageable, and he asks someone for a cigarette.

Scenario 2: A woman and her two children receive Medicaid benefits which cover health care costs and most prescriptions. Mom wants to quit smoking to improve her health and the health of her children. Unmanageable withdrawal symptoms made it impossible when she tried to quit cold turkey before. Using the nicotine gum will help to minimize the withdrawal symptoms like irritability, fatigue, or difficulty concentrating (as a mom myself, I know it's hard to be anything less than fully functional when caring for children). In many states, Medicaid doesn't cover tobacco cessation medications, over the counter or prescription. Without such benefits from Medicaid or a state tobacco cessation program, the woman will have to pay out of pocket for the nicotine gum. Undoubtedly she will continue smoking, unsuccessfully try quitting cold turkey again, or significantly delay attempting to quit.

The American Lung Association's 2009 comprehensive report on tobacco cessation coverage sends this crystal clear message: "Tobacco dependence is a medical condition just like any other addiction, and its treatment should be covered by insurance plans...Medicaid coverage of smoking cessation treatments targets essential help to people disproportionately affected by tobacco use. People who receive Medicaid benefits smoke at higher rates than the general population (36.6 percent versus 22.6 percent for ages 18-65). These Medicaid enrollees also, by definition, have low incomes and are less able to pay out-of-pocket for any cessation treatments."

Think of it this way: If a diabetic is discharged from the hospital but cannot get the medication necessary to keep their blood sugar under control, what is going to keep them from being hospitalized again? It is unreasonable to expect a diabetic to fight the disease without medication when pharmaceutical intervention is warranted.

Tobacco addiction is a medical condition. So why do we send tobacco users upstream without a paddle?