Ending the Disease of Tobacco Addiction

Charl Els, Addiction Psychiatrist

0.1 CEcredit

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This webinar provides empirical evidence for safe and effective treatment for the condition of addiction to nicotine, or Tobacco Use Disorder (DSM-5), also referred to as Nicotine Dependence (DSM-IV-TR).

The cigarette has been identified as the deadliest artifact in the history of human civilization. Most tobacco users know the power of addiction and want to quit. Tobacco is the leading preventable cause of death and disease globally, and contributes to 6 of the 8 leading non-communicable diseases. Evidence tells a vivid and chilling story of the dire and urgent need to support smoking cessation. Pharmacists and pharmacy technicians are ideally and uniquely placed to assess, and treat tobacco addiction and its impact on oral health, thereby saving lives and reducing the excess healthcare burden of tobacco.

Additional Resources:

Learning Objectives

  • Explain the impact of tobacco use on oral health.
  • Identify techniques pharmacists and pharmacy technicians may use in screening for, and assessing the extent of, tobacco addiction.
  • Describe methods for providing safe and effective oral care, based on Clinical Practice Guidelines.

Learning Objectives

  • Explain the impact of tobacco use on oral health.
  • Identify techniques pharmacy technicians may use in screening for, and assessing the extent of, tobacco addiction.
  • Describe methods for providing safe and effective oral care, based on Clinical Practice Guidelines.

Language: English

Release date: Friday, July 1, 2016
Expiration date: Monday, July 1, 2019

Contact Information   |   Hardware, software and Internet requirements.

Live Webinar Q&A

  • Shuet Loke

    is it because tobacco users need something to do with their hands... that's why they resort to smoking?

    Charl ElsAddiction Psychiatrist

    No. Tobacco addiction is a bona fide relapsing medical disorder, and not simply a "fiddle factor" issue.

  • Christine Nga Tran

    Is nicotine addiction more of a psychological or physiological nature?

    Charl ElsAddiction Psychiatrist

    It is a biopsychosocial condition that involves robust physiological and psychological factors in the predisposition and modulation of expression of the condition of addiction.

  • Jennifer Davis

    Where can we find printed pamphlets to give patients about smoking cessation that no only covers the negative effects on the body but specifically on the effects on oral health?

    Charl ElsAddiction Psychiatrist

    The ADA has a wonderful resource link to this:http://www.ada.org/en/member-center/oral-health-topics/smoking-and-tobacco-cessation

  • brandi faul

    Do you recommend Chantix?

    Charl ElsAddiction Psychiatrist

    Yes. The safety and efficacy evidence for varenicline is robust, and we consider this medication a first-line option for smoking cessation

  • Drg. Iman Syahfik, Sp.Ort

    Based on the news, is it true that the filters of a cigarets containing a pig blood ?

    Charl ElsAddiction Psychiatrist

    I have not heard this, but with the tobacco industry's track record, who knows?

  • Michelle Bauman

    What drugs actually help?

    Charl ElsAddiction Psychiatrist

    First line options are varenicline, bupropion, and nicotine replacement therapy. See bullet #6 under: http://www.ncbi.nlm.nih.gov/books/NBK63952/

  • Cecilia

    Chantix I believe hasissues withthose with HBP

    Charl ElsAddiction Psychiatrist

    Smoking increases blood pressure, and some of the medications may temporarily do the same. Careful monitoring is recommended.

  • Shuet Loke

    recently there's a controversy in banning vaping due to abuses... do you think it's a safe alternative to tobacco?

    Charl ElsAddiction Psychiatrist

    At this time, the evidence does not yet support the e-cigarette (vaping) as a reasonable alternative to smoking cessation. The best evidence is summarized in the form of a Cochrane review: McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub2.

  • Mandana Baradaran

    offering medication doese not sound good to me, dont you think they might get addicted to a new drug instead of tobacco?

    Charl ElsAddiction Psychiatrist

    The available medications like varenicline and bupropion is not associated with addiction or abuse, and the nicotine products have a very low abuse potential.

  • Tina (christina) Kellen

    acupuncture for smoking cessation?

    Charl ElsAddiction Psychiatrist

    This may be useful for some, but the empirical evidence in support of such is very limited. It is not recommended as a sole option for cessation.

  • swastika nepal

    how can we motivate someone not to smoke , although they know the adverse effect ?

    Charl ElsAddiction Psychiatrist

    The USDHHS Guidelines contain sections that describe how to deal with the smoker who is not ready to quit. This can be accessed on the surgeon general's website. Motivational enhancement therapy is usually the foundation of moving persons along the stages of change.

  • Heidi Pittman

    Are there any more natural ways to help with quitting, ie essential oils, vitamin regimens, high dose vitamin C etc.

    Charl ElsAddiction Psychiatrist

    None of these options enjoy the support of the empirical evidence-base. Healthy lifestyle choices in terms of diet and exercise are important, but for cessation we recommend pharmacotherapy plus counseling.

  • Janelle

    How do you propose approaching a teenage patient who admits to using tobacco and/or is suspected of using tobacco? Should parents be informed?

    Charl ElsAddiction Psychiatrist

    The question whether parents can / should be informed depends on the age and the specific laws in the jurisdiction. E.g. in some instances, if emancipated, the parents cannot be informed. The USDHHS guidelines summarize the approach to adolescent smokers. In some cases, we do consider pharmacotherapy, but this is done with the necessary oversight as the RCTs usually do not provide information for those under 18.

  • Monika Klerkx

    howdo you deal with a smoker who is in denial---"cancer will never happen to me"?

    Charl ElsAddiction Psychiatrist

    The 5-R approach helps with this; it appears in the text by Miller and Rollnick, but can also be seen in many other publications. Here is one example: http://www.acog.org/About-ACOG/ACOG-Districts/District-II/Smoking-Cessation-The-5-Rs

  • Michael Carey

    How long must a smoker cease smoking to be considered "safe" from resuming the habit?

    Charl ElsAddiction Psychiatrist

    There is no time when a person will be completely immune to the risk of relapse.

  • E

    yes! tina! HOW about hypnotherapy for smoking cessation?

    Charl ElsAddiction Psychiatrist

    Hypnotherapy offers a very limited scope of evidence for cessation. We do not endorse hypnotherapy as a solo intervention for cessation. The empirical evidence is lacking in support of its robustness as a safe and effective measure.

  • Luiza Bauta

    how to help a preagnant woman in quitting ciggarettes without drugs?

    Charl ElsAddiction Psychiatrist

    Psychosocial interventions are summarized in a Cochrane review: Chamberlain C1, O'Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J.Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2013 Oct 23;10:CD001055. doi: 10.1002/14651858.CD001055.pub4. See: http://www.ncbi.nlm.nih.gov/pubmed/24154953

  • Ravneetinder

    Is sudden tobacoo quitting have some health hazards?

    Charl ElsAddiction Psychiatrist

    The most problematic is that of nicotine withdrawal. This is not life-threatening and is easily managed with pharmaceutical nicotine. In psychiatrically ill patients who are involuntarily abstinent, it may be associated with disorganized behavior.

  • Han Na Na

    how can dentists approach smoking pts about nicotine replacement therapy most effectively in a short amount of time?

    Charl ElsAddiction Psychiatrist

    The 5-A approach is likely the best approach, specifically using the 4th A, i.e. Assist. The USDHHS guidelines provide direct guidance on such.

  • Denise Schoeb

    is it true Welbutron helps to stop smoking?

    Charl ElsAddiction Psychiatrist

    Yes. Wellbutrin contains the same ingredient as Zyban, i.e. bupropion. It roughly doubles success rates for quitting smoking.

  • Jennifer Engle

    Do you think Vapor smoking is a good replacement to cancer causing tobacco?

    Charl ElsAddiction Psychiatrist

    When the appropriate dose of nicotine in the e-cigarette has been determined and the necessary clinical trials have been completed, it may become a viable option. At this time it is a promising prospect, but we need more evidence in support of this option.

  • Surabhi Labh

    How bad is smoking only one cigerette a day? or 3-4 cigerrettes a week

    Charl ElsAddiction Psychiatrist

    There is no safe level of exposure to tobacco smoke. Even intermittent low dose exposure could lead to adverse health consequences. Hence, the answer is that is it not safe.

  • Vasiliki Everekyan

    Is the tobacco or the added chemicals in cigarettes that is the real problem?

    Charl ElsAddiction Psychiatrist

    Yes, specifically the tobacco-specific nitrosamines that form during the curing process of tobacco preparation. Other than being highly addictive, Nicotine is relatively harmless.

  • omair

    i used to smoke to increase my concentration while studying, but now i have just quitted and now i am facing difficulty concentrating on studies , what should i do? help!!

    Charl ElsAddiction Psychiatrist

    This is not an uncommon problem! Please talk to your primary care provider to screen if there is a possible attention deficit, which may be treatable with either medication, CBT, or MBSR.

  • Janice Digon

    Isn't it true just 1 cigarette paralyses the cillia in our lungs/respirtory system?

    Charl ElsAddiction Psychiatrist


  • Michael Carey

    Is smoking reduction a reasonable and worthwhile approach?

    Charl ElsAddiction Psychiatrist

    Yes, provided there is the option of replacing nicotine when the patient reaches a certain point. Reduction seems to work only up to a particular threshold, at which point the person just smokes more "efficiently".

  • Blossom Barrientes

    Are the effects of tobacco worse smoked vs chewing?

    Charl ElsAddiction Psychiatrist

    Each of these routes of administration is associated with real and foreseeable health hazards.

  • Jennifer Davis

    What are your thoughts on e cigerettes and how it effects the body? I have a few patients that tell me they are using them to wean off traditional cigarettes.

    Charl ElsAddiction Psychiatrist

    This may become a reasonable option when adequately studied in future. At this time, it is not yet part of what we can reasonably endorse or recommend for our patients. The problem is that some people may become dual users.

  • Chu

    How effective of using hypnotherapy in smoking cessation?

    Charl ElsAddiction Psychiatrist

    Not very effective at all, and hence not endorsed.

  • Vasiliki Everekyan

    do cessation techniques work for tobacco dip as well?

    Charl ElsAddiction Psychiatrist

    To a limited degree, but it has not been adquately studied.

  • Manmeet Hundal

    How effective is the lasers for quitting smoking

    Charl ElsAddiction Psychiatrist

    Not proven to work throught RCTs, hence not endorsed as an option.

  • LeTesa Baity

    what would you tell a patient about the use of chantix and the risk of suicide

    Charl ElsAddiction Psychiatrist

    The risk of suicide is increased with smoking. Quitting smoking may increase risk further. There is no proven causal link between medication use and suicide risk, and we need to adequately monitor anyone with a history of mood disturbance.

  • Luiza Bauta

    true or myth? some patients claim that smoking tobaco lowers their tooth pain?

    Charl ElsAddiction Psychiatrist

    Not aware that this is supported by empirical evidence.

  • Ashantae

    are the chemicals in ecigs harmful per secondary smoking

    Charl ElsAddiction Psychiatrist

    Yes, especially formaldehyde.

  • Lesley O'Neal

    I thought you can titrate the nicotine in e-cigs, to help quit

    Charl ElsAddiction Psychiatrist

    Not yet proven to be the case; might be a promising approach to research.

  • Sowmya Vanteru

    Are dentists allowed to prescribe the medicines for tobacco addiction?

    Charl ElsAddiction Psychiatrist

    It depends on the jurisdiction. In Canada, yes!

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Charl Els Addiction Psychiatrist, Addiction Psychiatrist, Medical Review Officer

Charl Els is a Fellowship-trained addiction psychiatrist and Medical Review Officer in clinical practice in Edmonton, Canada. He serves on the University of Alberta’s Health Ethics Research Board, and is involved with the Edmonton Police Service as a Hostage Negotiator. Els serves on the Executive of the Canadian Society of Medical Evaluators and holds several research grants. Els served as co-author and editor of the Health Canada funded textbook: Disease Interrupted. He published his work in a number of journals, including the BMJ, the Journal of Occupational and Environmental Medicine, and the Lancet.

Conflict of interests:

Dr. Els reports no conflicts of interest associated with this course.

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Universal Activity Number (UAN)

Home Study: 0589-0000-16-007-H01-P

Pharmacy Technicians:

Home Study:0589-0000-16-007-H01-T

Type of Activity: Knowledge

Target Audience: Pharmacy Technicians, Pharmacists

Topic Designator: 01 - Disease State Management/Drug therapy

Format: H - Home study and other mediated activities

ACPE CE Credits: 0.1 CEU

“Ending the Disease of Tobacco Addiction” is financially supported by Colgate Palmolive. Tribune Group GmbH is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.