|Smoking & Drinking
The immediate and long-term damaging effects
of smoking are generally well recognised.
Some 14 million people in the UK smoke;
around 10 million of these would like to
stop and around 4 million are attempting
to stop at any given time.
Cigarettes are the most popular form of
smoking in the UK. Laboratory and clinical
research has shown that cigarettes contain
about 4,000 chemicals, some of which are
highly toxic. Nicotine, a major constituent
of tobacco smoke, is highly addictive and
largely responsible for the pleasurable
effects of smoking as it has mood enhancing
and anxiety relieving effects. It takes
7 seconds for nicotine to reach the brain
Medically, nicotine is an addictive drug.
Physical dependence occurs because the body
develops a tolerance to nicotine, so that
increasing amounts are needed to produce
the same 'pleasurable' effects. The smoker
must inhale more deeply or smoke more cigarettes
to get he desired effect. Psychological
dependence on tobacco occurs because smoking
becomes a habit that is pleasurable and
Smoking is viewed by the health profession
as the most preventable cause of death in
the modern world. More than 100,000 people
die each year in the UK from smoking-related
Many pharmacies offer non-judgemental support
as part of a smoking-cessation programme.
of nicotine withdrawal reach a peak
in the first 1-2 days after stopping
smoking but generally lessen after 3-4
weeks. These symptoms include depression,
irritability, frustration, anger, anxiety,
restlessness, insomnia, difficulty concentrating,
decreased heart rate and an increased
Nicotine Replacement Therapy:
Several OTC nicotine-replacement
products are available in the form
- Chewing gums
- Sublingual tablets
- Transdermal patches
- Sprays and inhalers.
All these products treat nicotine
dependence as a step to help you stop
smoking. When you use these products
properly you’ll gradually reduce the
dose of nicotine you have over several
weeks, help easing withdrawal symptoms
and ultimately breaking the physical
It is usual for a treatment course
of 3 months to be recommended and
it’s important not to smoke any cigarettes
during this time.
Nicotine replacement is not recommended
for pregnant or breastfeeding women
and should not be given to children.
Those with cardiovascular disease
should consult a GP.
Side effects of nicotine therapy include
exacerbation of the symptoms of peptic
ulceration and gastritis.
Nicotine Transdermal patches: These
are small, self-adhesive patches that
deliver nicotine into the bloodstream
through the skin, over the course
of several hours. Depending on the
type used, a fresh patch is applied
daily for 16 or 24 hours over a period
of 3 months.
The patches come in different strengths
and nicotine intake is reduced by
progressively switching to lower-strength
patches over a treatment period.
Although the patches produce lower
levels of nicotine than a cigarette,
blood levels are sufficient to overcome
cravings and withdrawal symptoms such
as restlessness and anxiety.
Local irritation can occur where the
patch is on the skin, so try to apply
the patch to different areas of skin.
Nicotine Gum: Nicotine is released
from the gum as it is chewed; it is
absorbed through the lining of the
mouth. Nicotine gum should be chewed
correctly for maximum effectiveness
and fewer side effects. It should
be chewed when there is an urge to
smoke. Once a strong taste is experienced,
the gum should be placed between the
gum and cheek until the taste has
gone. The gum should be chewed again
until the taste subsides. This is
repeated over a 30-minute period.Nicotine
gum is available in 2mg and 4mg strengths.
The stronger gum is recommended for
those who smoke more than 20 cigarettes
per day and are therefore more highly
dependent on nicotine.
Adverse effects associated with chewing
gum include: jaw pain; tooth trouble;
throat irritation and mouth ulcers.
Nicotine lozenges and sublingual
tablets: Oral nicotine replacement
therapy is now also available as a
lozenge (containing 1mg of nicotine)
and sublingual tablet (containing
Lozenges should be sucked every 1-2
hours when you feel the urge to smoke,
usually. 8-12 lozenges per day. The
recommended dose for sublingual tablets
is one tablet per hour (8-12 tablets
per day) for those smoking less than
20 cigarettes a day, and 2 tablets
per hour (16-24 tablets per day) for
those smoking more than 20 cigarettes
Adverse effects include tooth trouble,
throat irritation and mouth ulcers.
Nicotine Inhaler: A nicotine
inhaler comprises a mouthpiece containing
a replaceable cartridge with 10mg
of nicotine. This type of cessation
therapy helps to overcome the behavioural
dependence on cigarettes and, in particular,
the habitual hand-to-mouth activity.
This product is therefore most suitable
for people who have a high behavioural
dependenceAnd who smoke less than
20 cigarettes a day.
The nicotine from the inhalation device
is absorbed through the lining of
the mouth. An inhaler produces approximately
one-third of the nicotine levels achieved
from cigarette smoking, which is adequate
to suppress withdrawal symptoms. The
nicotine vapour is inhaled by shallow
puffing or deeply inhaling, but the
amount absorbed is similar whichever
technique is used.
To make sure enough nicotine is inhaled
to depress the withdrawal symptoms,
6-12 cartridges should be used each
day for the first 8 weeks. The number
of cartridges is then halved over
the next two weeks and then halved
daily until none are used by week
Side effects diminish with use and
include cough, hiccups, sinusitis,
irritation in the mouth and a sore
For OTC products, read Smoking
There are several steps you can take
to help yourself control psychological
dependence on – and physical craving
for – cigarettes:
Take one day at a time: Stopping
smoking is hard. Aim to get through
Keep a positive attitude: Remain
determined and remind yourself
why you want to stop smoking
Keep busy: Physical activity
will take your mind off the craving
Change Routine: Do something
you don’t normally do; something
you won’t associate with smoking.
Avoid temptation: Don’t
allow yourself to get into difficult
situations where you might be tempted
to smoke; just one cigarette can
upset all your efforts
Eat the right food: If you
feel more hungry than usual try
to eat more raw fruit and vegetables
and avoid snacking on high-calorie
Ask for help if you need it: Visit
your pharmacy or GP – or use a
help-line for extra support. Join
a support group, or talk to a friend
who has succeeded.
Get a buddy: Stopping along
with someone else can help provide
motivation. Tell your friends you
have stopped as well as they will
try to help you.
At low doses nicotine acts like a
stimulant, can ‘sharpen’ the senses
and improve the ability to concentrate.
However, higher doses can cause a calming
and soothing effect. Habitual smokers
can readily adjust their nicotine dose
to achieve the desired effect: e.g.
when anxious the smoker will draw heavily
o a cigarette to get the higher dose
needed to feel calmer.
In addition to its central affects on the brain, nicotine has other
effects on the body:
- Relaxation of the gut
- Relaxation of skeletal muscles, sometimes causing tremor
- Increased secretion of certain hormones
- Increased heart rate and raised blood pressure
- Reduction in blood-flow, causing poor circulation.
Regular smokers become physically and psychologically dependent
on nicotine. Physical dependence arises because the body develops
a tolerance to nicotine so that increasing amounts are needed to
produce the same pleasurable effects. The smoker must inhale must
inhale more deeply, or smoke more cigarettes to get the desired
effect. Psychological dependence on tobacco occurs because smoking
becomes a habit and it becomes sociable and pleasurable.
Cigarette smoke: the ingredients Dangerous
ingredients – apart from nicotine – of
cigarette smoke include:
Carbon monoxide: prevents
oxygen from binding to red blood
cells, damages blood cells
Hydrogen cyanide: affects
respiration and other body functions,
damages blood vessels
Formaldehyde: irritant to
membranes, is carcinogenic
Hydrocarbons and nitrosamines: carcinogenic,
particularly in lung tissue
Amines: carcinogenic (casually
associated with bladder cancer
- Heavy metals (arsenic, cadmium, lead, nickel) are all poisons.
Health effects of smoking
- Increases risk of certain types of cancer (lung, mouth, throat,
oesophagus, stomach, bladder, kidney, pancreas and cervix)
- The risk of dying from lung cancer is 22 times higher for male
smokers and 12 times higher for female smokers – compared with
- The risk of developing lung cancer increases with the number
of cigarettes smoked daily
- Smoking causes a 5-fold increase in the risk of dying from lung
problems such as chronic bronchitis or emphysema
- Smoking causes a 2-4-fold increase in risk of death from diseases
of the heart and coronary arteries; more smokers die from coronary
heart disease than from lung cancer.
- The risk of stroke is increased by about 50% in 20-a-day smokers
- Smokers are more likely to get duodenal ulcers – and these are
more likely to take longer than normal to heal
- Can cause premature and underweight babies to be born to pregnant
women who smoke. Can also cause miscarriage and foetal malformation.
THE GOOD NEWS IS THAT STUDIES
IN EX-SMOKERS SHOW THAT THEIR RISK
OF DYING FROM SMOKING-RELATED DISEASE
DECREASES WITH EACH YEAR OF ABSTINENCE:
- After 3 years of not smoking, the risk of having a heart attack
is reduced to that of a life-long non-smoker
- After 10 cigarette-free years the risk of lung-cancer is halved
- 15 years after stopping smoking, the risk of developing almost
any smoking-related disease is reduced to little more than that
of a life-long non-smoker
all the symptoms below are suffered
by everybody with a hangover, and
the intensity increases with the
amount of alcohol consumed.
- Throbbing headache
- Increased sensitivity to light
- Redness of the eyes
- Muscle aches
- Sleep disturbance
- Dizziness, and a feeling of the
room spinning round
- Depression, anxiety, irritability
- Palpitations, tremor and sweating
Paracetamol will help for headache
and some of the other symptoms. Alka-Seltzer
XS (Bayer Consumer), Andrews Plus
Powders (GlaxoSmithKline Consumer
Healthcare) and Resolve (SSL International)
contain parcetamol and are formulated
with antacid ingredients to treat
headache with upset stomach.
- Aspirin. As for paracetamol. Alka-Seltzer
(Bayer Consumer) is formulated with
an antacid to treat headache with
upset stomach. Ordinary aspirin tablets
should not be taken as these might
irritate an already upset stomach.
- Ibuprofen. As for paracetamol and
aspirin. Soluble forms should be
taken as ordinary tablets might irritate
- Do not drink on an empty stomach.
Have a meal before you start a
drinking session and try to eat
snacks with the drinks. Food slows
down the absorption of alcohol
and gives the body time to deal
- Avoid dehydration by drinking
plenty of water along with the
alcohol, a glassful with every
- Drink steadily. The body can
cope with one unit of alcohol (half-a-pint
of lager or beer, a glass of wine
or a single measure of spirits)
- Try to eat the next morning and
have a light breakfast. Fruit juice,
cereal and toast with jam or marmalade
will help raise the blood sugar
level back to normal.
a directory of medicines and food supplements
that are available 'over the counter'
(OTC) from your pharmacist. The links
below will take you to pages detailing
products which may help treat or relieve
the following symptoms:
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