Dear Doctor: Why is there no inpatient rehab for tobacco addiction?

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DEAR DR. ROACH: I have a question regarding people who are addicted to cigarettes. How come there are no detox centers for cigarette addicts? I’ve heard that quitting smoking is much harder than quitting heroin. Ideas? –CAM

ANSWER: Quitting smoking is incredibly difficult. Many smokers are physically addicted to tobacco, which means they will experience withdrawal symptoms. Many will also show psychological signs of addiction, which is characterized by compulsive drug seeking and use, even in the face of negative health consequences.

Inpatient rehabilitation can be a very effective way to cope with addiction. Among those who have spent six months in rehab for drug or alcohol addiction, the success rate (measured by abstinence) is around 70%. Shorter rehabilitation times mean less efficiency.

I think you can probably see the reason hospital-based rehab isn’t used for smoking: it’s a very expensive and time-consuming intervention that few people can afford. It is used when the threat of physical harm from drugs and alcohol is extremely high.

Smoking has a high potential for harm. On average, a smoker lives eight to twelve years less than a non-smoker. Quitting smoking successfully is one of the most powerful things a person can do for their health, because most of that difference in life expectancy can come back, and the sooner a person quits, the better. Quitting smoking, even after many years, improves function and longevity.

Short of inpatient rehabilitation, there are proven techniques to help a person quit smoking. The combination of behavioral interventions (such as smoking cessation clinics or group classes) and pharmacological interventions (such as nicotine replacement therapy, bupropion, or varenicline) is best. A person’s regular doctor is the first place to start, but there are experts who can help with smoking-related disorder. In the United States, ongoing counseling and support is available through a nationwide program at 1-800-QUIT-NOW

DEAR DR. ROACH: I recently heard about a study done by the Cleveland Clinic on the prevention of Alzheimer’s disease. The results were good: 69% prevention of people who could have developed Alzheimer’s disease. The drug that gave these results was Viagra. I told some of my friends about it and they brushed it off or didn’t take it seriously. I would take it if it prevented this horrible condition. Some members of my family developed dementia in their later years, but I don’t know if the drug prevents other forms of dementia. Do you know if it will be offered to people who may be at risk? –GH

ANSWER: A study published in December 2021 by The Cleveland Clinic group looked at prescribing records against insurance claims data and found that those taking sildenafil (Viagra) had a reduced risk of drug claims. insurance for Alzheimer’s disease. The group also identified a potential mechanism of action – enhancing brain cell growth and decreasing the formation of an abnormal protein (tau) – by which Viagra could likely help prevent Alzheimer’s disease.

As interesting as it is, it is far, very far from proving that Viagra reduces the risk of Alzheimer’s, which will require a clinical trial. I don’t recommend sildenafil or similar drugs just to reduce the risk of Alzheimer’s disease (or other forms of dementia).

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

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