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Capes On the Couch - Where Comics Get Counseling

The One Fact that Gets You to Stop Smoking. Jameson Hates It!

Jan 29, 2019

As the clickbait title says, smoking is bad for you.

Thank you, I hope you have appreciated this helpful medical hint. Subscribe to Capes On the Couch today!





Oh, I need to say more? Well then, allow me to expound on what the heck to do once you've started smoking tobacco. J Jonah Jameson probably would not listen to this advice, and you are under no obligation to do so, either. Smoking is legal (above a certain age and in certain areas according your local laws). I am not your doctor, or loved one, or friend, or coworker, or get the point. This is not meant to shame you. Quitting is hard. Let's reframe it a bit. Finding an alternative for your hard-earned cash savings is hard. Not gaining weight once your taste buds come alive again is hard. Daring to exercise more because your respiratory and cardiovascular systems can take it is hard. Having people comment on how you smell better is...well, that's actually nice (or creepy if it comes from a stranger). Anxiety and irritability are potential deal breakers. You had a routine, and it's gone for good, I hope. Let's see how we can keep it that way.


What is your system to smoke? You know what I mean. Do you chain 'em just outside the lobby or in the parking lot at work? Extra bathroom break? A dedicated room in your house? Unfortunately, most accounts indicate Jonah smokes wherever he wants. That's too loose of a system; he can't compartmentalize. The good news, if you do have a set time and/or location, then you can make an immediate change through avoidance. Of course, that's a temporary transition. If you're using chew in the bathroom (don't think I forgot bout you folks, right?) I can't say use the toilet somewhere else. Nope, you're still in for a fight.


It doesn't have to be “cold turkey.” Jameson might take to that idea because gravitates to sensationalism. If you're in that line, then good for you! There are no guarantees though. Count how many cigs you smoke in day. Cut it back by one. No, not one pack. One cigarette. Write it down. Keep a ledger about how many cigarettes you avoided each day (this puts a more positive spin). Periodically cut back a bit more. Had an off day? Then recognize it for the small hiccup it was and keep going. You might have to change your social circle a bit. Find another way to connect with those that haven't made the decision to quit smoking yet. Plus, you probably need to do something with your hands. Ever hold a pen or pencil like it was a cigarette? Just don't put it in your mouth; we're trying to create positive habits here. When you're ready, apply a gentle nudge in your psyche by declaring your intentions to others. Announcing that you're going to do something can provide good motivation to get it done (even for a podcasting doctor).


This is all just peachy, but what about some extra tools? Have no fear. I'm a trained allopathic doctor, so you know I wouldn't leave you without discussing some form of medical intervention, but only if necessary. Please talk with YOUR providers about any and all of these topics if you truly want to do this the right way for your personal situation:

-Varenicline is the one that got all of the commercials and a bit of backlash about side effects. The way it works is attaching to the nicotine receptors in the nervous system, thus blocking nicotine itself. I typically do not prescribe this in the ER setting, because it's imperative for the patient to have close follow-up with their own providers. Overwhelmingly, patients do not come to the ER for nicotine addiction. It's a misuse of resources. I have seen some patients in the ER after side effects from this medication, thankfully none of which had lasting impact. So far the most common thing I've seen is sleep disturbance. Plenty of colleagues have discussed successful cases, and I don't want to sound negative about it. My experience is purely a product of selection bias. Larger randomized controlled trials showed that the risk of any psychiatric side effects is about the same with ll of he other treatment options.

-Buproprion is a medication that is commonly used for depression and anxiety specifically by the increased release of dopamine and noradrenaline , but gasp it actually was observed to consistently have a correlated reduction in cigarette smoking and prolonged smoking cessation. See folks, side effects are not all bad! The main risk here is that it lowers seizure threshold, so tell your doctor if you have a history of epilepsy, or have been drinking alcohol, using benzodiazepines and/or barbiturates.

-Nicotine substitution is...well, nicotine substitution. My apologies for failing to make this sound more complicated. There's a long lasting patch that you replace once per day, as well as nicotine gum and nicotine lozenges. Usually you have the patch to take the edge off, and the gum/lozenge to really hit the breakthrough cravings. If you're using these products, please try to stay away from tobacco itself. Oh, and take the patch off before you go to bed because it can lead to some strange vivid dreams.

-E-cigs/vaping may be a boon to the alternative smoking industry, and I think it has the potential to be a well adjusted system to give up nicotine products as a whole, but only if the user comes at it with the proper mindset. Only the individual knows for sure; don't fool yourself.


If you expected me to say something besides “a combination of counseling and pharmacotherapy are usually more effective than either alone,” then you don't hang around many healthcare professionals. Then again, I may be the one healthcare professional that says something in a style that promotes action. If I am, then call 1-800-QUIT-NOW for help in the United States, or the local smoking resource number in your area. If you are like JJJ, then stop focusing on Spider-Man and notice the concordant decline in your cigar use. Either way, I hope you reach your goal.


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