Who Smokes and For How Long?
Most of my patients here in Nashville use nicotine, by vaping or traditional cigarettes. (Here’s a fact sheet from the State of Tennessee on smoking in the state). When I bring up the quitting, I sense their discomfort. There is a pause-a soft shift in the room, a glance away, a quiet confession waiting behind polite eyes. I feel what nicotine means to them: calm, control, companionship, habit, identity, In that moment, I wish to embrace each of them, demonstrating my acceptance of their worth and acknowledging their dignity.
My name is William Conway, MD. I am a general internist with a subspecialty in addiction medicine. I have practiced addiction medicine since 2012. My current addiction treatment practice is Suboxone+Primary Care™, in Nashville. My current practice of general internal medicine is Nashville Concierge Medicines.
In America, we are quick to judge the smoker, but slow to understand the comfort that tobacco brings. No one chooses cigarettes to die. Everyone chooses them to feel alive, to belong to breathe through pain. For many of my patients, tobacco has been a quiet companion, a ritual that knows their loneliness
Yes, cigarette cause suffering and shorten lives. But my patients deserve compassion more than condemnation. Nicotine dependence must be met not with scolding, but with the prolonged patience driving understanding.
In this essay, I want to help you see nicotine for what is -a clever, enduring presence which begins early, persists for a long time, and is not responsive to punishment. The reduction of your risk is important to me, Dr. William Conway.
Executive Summary
- Approximately two-thirds of Americans have chosen to never smoke. One third of Americans are current smokers or former smokers
- Persistent smokers smoke for more than 25 years, often for a lifetime
- Former smokers quit after any period of smoking, from months to over 40 years
- Patients living with addictions frequently remain smokers even with treatment.
- The interaction of nicotine with human biology sustains its hold.
The Choice to Smoke and the Choice to Continue to Smoke
Many of my patients on suboxone still smoke. They are thoughtful, resilient people overcome hardship. They know the statistics-two of out three Americans never smoke_ but the statistics do not ease their cravings. Nicotine is an essential part of them, weaving itself through stress, habit, and identity
Approximately two of three Americans choose to never smoke tobacco. The rest smoke for a variable period from months to years to forever. Despite ever increasing prices of cigarettes and the ever-increasing social stigma, large number of Americans are nicotine dependent.
Persistent Smokers smoke over 25 years.
I remember my beginning days at doctor, on the wards (hospital wing), where my days and nights were filled caring for patients who smoked too and drank too much alcohol. Both smoking and alcohol are legal. Everyone is permitted to smoke as much and drink as much as they want. Working thirty six hours shifts every third night, the ravages of smoking and drinking were permanently itched into my mind with pictures of suffering of adults whose lives had been changed by cigarettes and booze.
Later, in my training, I cared for patients who went through long disfiguring head and neck surgery due to their cancers, cancers which were caused by smoking tobacco. I watched in amazement as they often smoked through their surgical holes in the necks( tracheostomies). With all that they had gone through with their cancer, smoking remained central in their life.
For those Americans who choose to smoke, over half smoke for over 25 years. Nicotine dependence can have a profound permanence. History should provide us the wisdom to understand that smoking tobacco is often persistent or even forever, despite it all.
Former Smokers may stop early, but most smoke for many decades before quitting
Americans do choose to quit smoking, but if often takes years to decades before that decision is fully implemented.
Patients with Addictions continue to smoke
Most of my patients who are prescribed buprenorphine continue to be nicotine dependent, to continue to smoke. My patients are intelligent. My patients are aware of the risks they bear from smoking. I speak with them on a monthly basis to encourage them to quit. With patients, in my limited experience, we have treatments which now work well for those who choose to quit. These treatments reduce or eliminate the pain of withdrawal from nicotine.
The fact that my patients continue to smoke or vape shows the power of nicotine.
Why is nicotine so Difficult to Quit
Smoking give an almost immediate response in the brain, a calming pleasure or a calming reduction of withdrawal. However, the blood level of nicotine drops very rapidly, within one to two hours. This stimulates several times a day a craving, which is relieved by smoking.
The discomfort of withdrawal throughout the day is not understood by the person who is not nicotine dependent. The suffering of patients who are nicotine dependent in the hospital with forced withdrawal is often disregarded and sometimes under-recognized in their treatment.
Conclusion
The choice for Nicotine often begins early. It provides daily benefits. The absence of nicotine in a nicotine dependent patient quickly turns into suffering. Nicotine use on a persistent basis continues for decades to a lifetime in patients whose genes predispose them to addictions. Predisposition to addiction to widespread and common. Those with these predisposition is wise to never begin. For those at risk, prevention is especially important. For those who begin and persist, their course is more complicated. Please call Dr. Conway at Suboxone+Primary Care ™
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