Ken Wassum, Associate Director, Clinical Development & Support

It is well known that smokers have much higher risk of all types of cancer, but smoking-related lung, head, and neck cancer were in the news this week. Two recent studies have shown dramatically higher rates of these cancers for smoker who have their first cigarette within the first hour after waking in the morning.  So while delaying that first cigarette in the morning is a good thing, making that one change is unlikely to reduce a person's chances of smoking-related lung, head, and neck cancer.

Here is the full story. One of the most reliable ways to measure a smoker’s dependence on nicotine is to assess how soon after waking the person smokes. Those who smoke within the first 30 minutes tend to be very addicted to nicotine, those who smoke within the first hour but not within 30 minutes a little less addicted, while those who smoke longer than one hour after waking are much less addicted.

The reason this measure is so accurate is that time spent sleeping is the longest time most smokers go without a cigarette. After 6 – 8 hours without a cigarette, nicotine receptors in the brain are screaming for that first smoke. This is why those who are highly dependent on nicotine smoke very soon after waking; their bodies are in early stages of nicotine withdrawal.

Here is how the nicotine cycle works. When you have a cigarette, smoke particles (tar) carry the nicotine into the lungs, where it is rapidly absorbed. The nicotine then enters the blood and moves quickly (within seconds) from the lungs to the brain, where it binds to nicotine receptors. When nicotine binds to receptors it stimulates the brain to release dopamine, a powerful brain chemical. Dopamine is the same brain chemical that is released when other drugs are used, like cocaine, and it makes the user feel good. When a smoker goes for an extended period of time without smoking, these receptors cannot release dopamine, and the smoker feels anxious, cranky, and restless. These are all signs of nicotine withdrawal.

Those who smoke within the first hour after waking are typically heavy smokers, and heavier smokers are more likely to develop smoking related diseases than lighter smokers. It should be noted that there is no safe level of smoking and that any smoking increases your risk of cancers, heart disease, stroke and emphysema. So while cutting down on the number of cigarettes smoked per day is good, the only way to truly reduce your risk of cancer is to quit completely.
Every person who enrolls in the Quit For Life® Program is assessed for nicotine dependence. Heavier smokers, including those who smoke within the first hour after waking, are strongly encouraged to use a FDA approved quit medication. Quit Coaches help program participants put together a personalized plan to become smoke free and offer callers education and decision support regarding quit medications.

Participants learn that there are 7 medications available, 5 of which contain nicotine: nicotine patch, nicotine gum, nicotine lozenge, nicotine inhaler, nicotine nasal spray. The two medications that do not contain nicotine are bupropion SR (Zyban) and varenicline (Chantix). Heavier smokers choosing to use a nicotine medication are encouraged to use two at the same time. One of these is the patch and the other is a short-acting form like the gum or lozenge. When used together these medications provide better relief from nicotine withdrawal after quitting.

According to the United States Public Health Service’s 2008 Clinical Practice Guideline update, Treating Tobacco Use and Dependence, the most effective, evidence-based method for treating tobacco dependence is a combination of counseling and medication. Does your tobacco cessation program provide this kind of education and support to your smoking population?