BREAKING THE HABIT: INSIGHTS INTO OVERCOMING NICOTINE ADDICTION. INTERVIEW WITH MARGJE DE ROOIJ, A RELAPSE PREVENTION SPECIALIST

Why is it so challenging to stop using nicotine?

It is very hard to quit nicotine because it is an addictive substance that has the same power of heroin or cocaine. So if you use it, it's quite easy to get addicted to it, to get physically addicted to it, and then, of course, over time, we also develop a psychological addiction. And that makes it really hard to stop.

How does nicotine impact the brain?

Nicotine affects the brain by really working on the dopamine receptors in the pleasure centres of our brain. And what that means is that when we smoke or vape or use other ways of consuming nicotine we experience mood altering effects, so we feel more pleasure or more enjoyment. We experience spikes in our concentration levels, or in our memory. So it has short term positive effects for a lot of people.

How does nicotine affect the human body and biochemistry?

Nicotine, and especially if we smoke it in the forms of cigarettes, it comes with a lot of other different compounds that can be very harmful for the body. Nicotine itself is very addictive, but, for example, it also contains compartments like tar or, or other chemicals that increase your risk of developing cancer. I think we are all aware of the correlation between smoking and the development of lung cancer, for example. What is maybe lesser known is that it also increases the risk of cardiovascular disease. Other effects that it has, it has effect on our dental health as well. You know, I think throat cancer is also correlated with smoking, for example, and our skin health as well.

Can nicotine addiction be overcome?

Like other addictions, nicotine addiction is treatable. With the right Intervention with the right medical support we can help and support people in their smoking cessation. BIO-R®, one of the pillars of The Kusnacht Practice, can help you, can help people, for example, by restoring the biochemistry. Our somatic health team can help you with certain medications to battle withdrawal symptoms. And our psychiatry teams, especially in the form of counselling, can really work with the individual to identify motivation for change as a sort of more psychological support to increase the chances of remaining abstinent from nicotine.

What is the The Kusnacht Practice approach to treating nicotine addiction?

Addiction treatment of nicotine, The Kusnacht Practice really embraces a holistic approach. We have three main pillars. Of course, we have somatic health. We have BIO-R®, which really looks at biochemistry of a person and restoring any disbalances, and we have our psychiatric team who works on a more underlying causes and maybe have a more, they explore more the psychological addiction part and the behaviour that is so difficult to change.

What is the average duration of treatment for nicotine addiction at The Kusnacht Practice?

The Kusnacht Practice would suggest a treatment length of 4 to 6 weeks. And during that time we can really battle the physical addiction side of nicotine dependency. And our different pillars, somatic health, BIO-R® and psychiatry can really provide enough scaffolding to help the client to battle withdrawal symptoms and make a start with the psychological addictive part as well. I would say that smoking cessation is a marathon. It will not be cured after four weeks, It will be a longer journey. And The Kusnacht Practice can provide continuous support as well through our continuing care programme.

What factors contribute to the difficulty of overcoming nicotine addiction?

Nicotine addiction is very difficult to overcome because of the psychological part to it. I think the physical dependency is quite easy to treat. The psychological addiction, on the other hand, is a much more difficult aspect. Behaviour is quite easily learned, but it is really difficult to unlearn. And especially with smoking, it is so ritualised. We, you know, we associate, if you ask people, when do you smoke a cigarette? They will say, the first thing in the morning with a cup of coffee, or they say, you know, when I need a little break and I need a boost in my energy at work, or people say, after sex. These are like the typical situations and rewards that people allow themselves during the day, also to stretch out the day a little bit and to make, and to give them a little bit of respite. And these things are so ingrained that you have to substitute that behaviour with other behaviour and that it takes really time to understand the motivation and the triggering events, and to identify alternatives that are meaningful enough for the person to replace the smoking.

What are the contributing risk factors to the development of nicotine addiction?

Exposure to nicotine from an early age onward, having certain role models in your life that's portrayed it, it can, it can be a risk factor, it can also have exactly the opposite effect, right? That if you have been exposed that you absolutely don't want to develop the same habits as you have been experiencing in your youth. Peer pressure, maybe as well, where sometimes in certain settings, in certain youth cultures, maybe smoking is considered cool and a sense of belonging that might trigger young people to start smoking.

What is the typical duration of treatment for nicotine addiction?

The physical aspect of nicotine addiction takes a few weeks, I would say, a week, a few weeks to sort of detox the body. The psychological addiction takes a much longer period to treat and can be an ongoing battle, like with other substance addictions, for example.

What advice would be offered to individuals grappling with nicotine addiction?

Thank you for that question. I think that's a very important one as well. How can we support people that decide to stop smoking? I think one of the things that might be very helpful is to listen and don't lecture. So what are the, what is the motivation of the person wanting to stop? And how can you support that person, Right? Having a discussion about it, asking open questions like, what made you decide now? How do you see your future without cigarettes? That will give you a little bit of an idea of how you can scaffold or support that person in their journey. That's one thing. Another thing how you can support, a person is by celebrating small successes, right? I mean, we all have relapses. Don't don't be too harsh. Just focus on the positives. Right? So a person has not been smoking a day, celebrate it, give them a compliment, acknowledge that positive behaviour change. Another way people can offer support is by offering distractions. Smoking is highly embedded into ritualised behaviour. So how can we change those behaviours? Right? Instead of getting a cigarette, what can we offer? We can go for a walk. We can watch some TV. We can, you know, even if you are in a relationship, offer physical touch. Right? These kind of little things that are rewarding and helpful instead of harmful.

What are the short-term and long-term benefits of quitting smoking?

When people stop smoking, quite rapidly you will see improvement in your physical health. It can already by the, your skin, for example, or your dental health. Hearing or vision will also improve when you stop smoking because smoking also has a negative impact on the senses. Then, of course, your internal organs. You will improve your cardiovascular health and your lungs will redevelop the cilia, so the, the little brush like membranes on the lungs that help you fight infections and cold symptoms. So these are only a few of the benefits of stopping smoking.

What are the potential distractions for individuals attempting to stop smoking?

When it comes to smoking cessation, what we want to do is we want to replace the smoking with something more helpful. For example, cooking or eating, of course within moderation and healthy. And not only are you building on more helpful and, maybe even social behaviours, especially if you do it with a partner or with friends, but it also has an additional benefit of having your tastebuds restored when you are stopping smoking. So experiencing greater pleasure in eating. Your smell will also improve. So also your olfactory sensation when cooking, for example, will also be more stimulated. So these are little rewards that you will, that you will notice quite soon after stopping.

How long does physical dependency on nicotine typically last?

The physical dependency on nicotine can be, the withdrawal takes maybe a week, two weeks. And then the physical aspect of the of the addiction comes till finishing. What follows is the, is the work on the psychological addiction which takes a considerably longer time.

What are the symptoms associated with nicotine withdrawal?

When people decide to stop smoking the short term effects will be quite imminently. When you smoke you are developing a spike in adrenaline and it goes alongside an increased heartbeat, for example, trembling, muscle tension. So there you can see some symptoms that are similar to anxiety. When you stop smoking you will have less energy because that's, that dopamine, that adrenaline will not be released, right? So you will not have experienced a peak in concentration level, in mood, but you will feel a little bit more down and you feel less energetic. On the other side, the psychological addictive part will create cravings and will create an inner tension of wanting to smoke, which can be very unpleasant. But I want people to know that over time that will balance out. Another withdrawal symptom can be coughing, so people will think automatically, oh, this is not helping, it is only getting worse and it will stop when I smoke. I want people to know that these withdrawal symptoms are really normal.

How can nicotine withdrawal symptoms be eased?

Apart from psychological support and the BIO-R®– the restore, the restoration of the biochemistry, we can also offer pharmaceutical or medical supplementation to help the client battle the withdrawal symptoms.