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May, 2017:

Why Your Brain Craves Cigarettes When You Drink

You’re experiencing the weird effect nicotine has on memory.

You know the feeling. You’re two, maybe three drinks in, and you suddenly get a special hunger. It’s like a void that you hadn’t noticed, and now you want to fill it with something hot. Something so hot and filthy that you’ll regret it when it’s over, but oh God I spend my whole life not doing things I’ll regret, just give me this one goddam thing. Please.

And the strangest part of all this is that you don’t smoke. Or rarely. In fact, you can go weeks without smoking. But then you mix in some alcohol, and all your nicotine circuits come online.

So what’s going on? Why is your brain doing this?

According to Dr. John Dani, a neuroscientist and expert on the mechanisms of addiction from the University of Pennsylvania, the urge to smoke is two-pronged. The first part results from the way nicotine affects memory, but the other is in how nicotine combines with alcohol to reduce dopamine levels. Together the two mechanisms make cigarettes seem delicious.

Let’s break that down a little more. Firstly, with the effects on memory.

In 2009, Dr. Dani’s team published a study examining how nicotine supercharges the formation of memory pathways. What they did was run laboratory mice through two compartments in a pen. In one compartment, the mice received a dose of harmless saline, while in the other they received a dose of nicotine. Unsurprisingly the mice quickly learned to spend more time in the nicotine compartment. But what’s really interesting is the affect the nicotine had on their brains.

“Compared to injections of saline, nicotine strengthened neuronal connections, sometimes up to 200 percent,” explained Dr. Dani. “And this strengthening of connections underlies new memory formation. We found that nicotine could strengthen neuronal synaptic connections only when the so-called reward centers sent a dopamine signal. And that was the critical process in creating the memory associations.”

So on the one hand, the study just underlined something we already knew: Feel-good activities make us want to do them again. But on the other, it showed on a neurological level how our memories of smoking cigarettes get hardwired into the brain. And more important, how all these associated memories—such as drinking and hanging with friends—all get bundled into these same, nicotine-reinforced memory pathways.

“I remember recently finishing an experiment with a colleague, and we went to a bar,” explained Dr. Dani. “I had known him for many years and never knew he smoked, but then he admitted he could really go for a cigarette. He said he hadn’t smoked in 20 years, not since high school. But now he has a few drinks and feels the urge to smoke.”

So that’s one reason you want a cigarette with your beer, but there’s another. And again it involves Dr. Dani’s rodent experiments.

It’s been known for a long time that, taken separately, alcohol and nicotine bolster dopamine in the brain. Because of this, Dr. Dani and his team theorized that if nicotine and alcohol were consumed together levels of dopamine would rise even higher. But it turned out the opposite was true. While rats that had been dosed with nicotine were shown to consume more alcohol, their dopamine levels actually flatlined.

Surprised, Dr. Dani and his team repeated the entire experiment. But they got the same results. After a lot of head-scratching, they realized the combination of nicotine and alcohol was actually initiating a release of stress hormones that stopped the release of dopamine. Or in more simple terms: Drinks and cigarettes will make you happy if consumed separately. But together, they’ll make you less happy.

So the reason people keep smoking and drinking is to regain that happiness. Theoretically, it’s a cycle that starts when alcohol dredges up those positive memories of smoking. But then smoking a cigarette, after drinking, drops your levels of dopamine. So there’s again an urge to drink more to recuperate levels of happiness-inducing dopamine, and the cycle starts over.

According to Dr. Dani, this hypothesis is consistent with other observations around smoking and drinking. As he says, “I was inspired by some work from Norway that showed one of the biggest predictors if someone is going to be picked up drink-driving is whether or not they smoked when they were young.”

But none of this answers the biggest question of all—will having a cigarette with your beer kill you? As always the answer comes in some pretty uncertain probability stats. So instead Dr. Dani gave us some more facts about social smokers.

“What you’re describing is called a ‘chipper’—somebody who doesn’t smoke very often but will under certain circumstances,” he says. “And what I’d recommend is that you just don’t. Because it’s really, really common for that habit to slide into regular use. And then it’ll be really hard to give up.”

Smoking may cause bone degeneration, osteoporosis in youngsters

Smoking as a habit typically begins in high school or the college years, when bones are still developing. It also interferes with calcium and vitamin D absorption in the body.

Youngsters who smoke may be at risk of developing low bone density — a condition that may lead to an increased risk of developing osteoporosis, experts say.

“Smoking has a negative effect on the bones, causing loss of bone mass and, eventually, premature osteoporosis when young people take up smoking,” Raju Vaishya, senior orthopaedic surgeon, at Indraprastha Apollo Hospitals, said in a statement on Wednesday.

Smoking as a habit typically begins in high school or the college years, when bones are still developing. It also interferes with calcium and vitamin D absorption in the body.

Besides, in case of a bone injury, a person who smokes is more likely to have a longer period of recovery and greater risk of complication, doctors noted.

“Smoking during the years of bone-building puts you at risk of osteoporosis in later stage. Smoking after 30 will speed up loss of bone mass almost twice as faster,” Vaishya added.

Smoking kills over one million people in the India annually, according to The Global Adult Tobacco Survey (GATS) India report. The economic burden of tobacco consumption is around Rs 104,500 crore per annum.

In a study, recently published in the journal Annals of the American Thoracic Society, smoking was found to be an independent risk factors for low bone density among both men and women.

Each additional pack-year of smoking raised the odds of having low bone density by 0.4%. The participants with normal bone density had an average of 36.6 pack-year of smoking, while those with low bone density had an average of 46.9 pack-years of smoking history.

How to Quit Smoking: 10 Easy Ways to Resist Tobacco Cravings

Smoking is not a disease and does not need medication. A smoker needs an ecosystem of support, guidance, mentoring and self-discipline to kick the butt. World No Tobacco Day is commemorated every year by the World Health Organisation on 31st May. According to their report, tobacco kills more than 7 million people every year around the world. The theme for World No Tobacco Day 2017 is “Tobacco – a threat to development.” It proposes measures that governments and the public can take to promote health and development by confronting this global crisis. But here’s what you can do – quit smoking and start today. These easy tips may prove very helpful in your efforts to quit smoking.

1. Drink plenty of liquids (fruit juice or water) during the first three days of quitting. It will help in flushing out nicotine faster. Milder forms of green tea are also very helpful. Avoid black tea and coffee for a few days.

2. Your body systems are going to work much better, including your senses for smell and digestion. Consider keeping some pre-cut vegetables handy, such as celery, carrots and fruits to beat sudden hunger pangs and avoid binging on candies and pastries.

3. For some smokers, ending a meal means lighting up, and the prospect of giving that up may appear daunting. Here’s a quick tip to deal with this situation. Replace that moment after a meal with something such as a piece of fruit, a (healthy) dessert, a piece of chocolate, and a stick of gum or simply suck on a straw.

4. Distract yourself. Do the dishes, turn on the TV, take a shower, or call a friend. The activity doesn’t matter as long as it gets your mind off smoking.

5. Reward yourself. Reinforce your victories. Whenever you triumph over a craving, give yourself a reward to keep yourself motivated.

6. Whenever the urge of smoking arises, brush your teeth. The just-brushed, clean feeling can help get rid of cigarette cravings. Keep other things around to pop in your mouth when cravings hit. Good choices include mint, celery sticks, gum, and sunflower seeds

7. Practice deep breathing on a daily basis, use it whenever you may get an unwarranted craving.

8. Add ginseng powder to your breakfast. Ginseng is an effective remedy to prevent the release of dopamine, one of the main components found in nicotine.

9. Snap your cravings away. Wear a rubber band around your wrist and snap it if you are considering giving in to a craving. The sting will distract you and give you a moment to remember all of the reasons why you are quitting.

10. Go for a quick work out. Whenever you feel the urge to smoke, take 5-10 push-ups. Your mind and body will be diverted quickly by engaging them in a new activity. A quick gaming session also keeps your mind off from nicotine.

Smoking cessation has definitive milestones which you should take note of. Key ones are 72 hours to reduce nicotine levels significantly, 14 days to recover from physical withdrawal, 48 days to recover from habituation and 3 months to go to sleep without thinking of smoking. Know and understand this journey to be able to quit smoking successfully. Remember that smoking is a one or all proposition. One single puff is sufficient to blow up all your efforts.


The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

Tobacco poison needs to go from shelves

Former associate health minister Dame Tariana Turia is disappointed she was not able to get the government to remove tobacco from sale in New Zealand.

It’s World Smokefree Day, and the Cancer Society and Maori public health organisation Hapai Te Hauora have launched the Dame Tariana Turia Award for tobacco control, which will go to someone working in tobacco control who has made an impact on indigenous smoking levels.

Dame Tariana says she is proud of what she was able to do as minister with the support of many others, but the New Zealand government still needs to say tobacco is a poisonous substance that should not be part of trade.

It showed it was able to act by stopping the sale of party pills and synthetic cannabis.

“They took the other off the shelves because of the incidents that were occurring through people taking them, yet for some reason tobacco has never been considered to be an unsafe substance,” she says.

Dame Tariana says dairy owners who want government protection against cigarette robberies should instead consider not selling them, following the lead of a Maori-owned dairy in Whanganui.

Meanwhile, the New Zealand Defence Force is taking steps to be the world’s first smokefree military by 2020, including banning the sale of cigarettes on camps and bases and making NZDF housing smokefree.

Mumbai: Over 40 NGOs, Tata Hospital join hands against tobacco

Mumbai: To mark ‘World No Tobacco Day’ which falls on May 31, more than 40 Non-Governmental Organisations, (NGOs) in collaboration with the Tata Memorial Hospital, Parel have formed a coalition to reduce the consumption of tobacco in India.

Dr. Pankaj Chaturvedi, professor and surgeon of Tata hospital, said that every third person in India consumes tobacco in different forms. He stated that the theme, ‘Tobacco- a threat to development’ specifically highlights the link between the use of tobacco products, tobacco control and sustainable development.

Dr. Chaturvedi further said that 33 per cent of tobacco users die a premature death due to cancer, heart attack, lung diseases, stroke etc. A smoker loses 8 years of his life due to this addiction.

“Tobacco is responsible for nearly 50 per cent cancers in India and 90 per cent of mouth cancers. Half of the mouth cancer patients die within 12 months of diagnosis,” said Dr. Chaturvedi.

Dr. Vijay Satbir Singh, additional chief secretary Public Health Department said that the main aim is to regulate the consumption of tobacco by implementing the Cigarettes and Other Tobacco Products Act (COTPA Act).

“The main challenge is to enforce traders to implement the warning signs and stop selling loose cigarettes. Stern action will be taken against those who are not following the law,” said Dr. Singh.

What is COTPA Act?

The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 was enacted in 2003 to prohibit advertisement of tobacco products and to regulate them in India.
The Act prohibits smoking of tobacco in public places, except in special smoking zones in hotels, restaurants and airports and open spaces.
Advertisement of tobacco products including cigarettes is prohibited.
Tobacco products cannot be sold to person below the age of 18 years, and in places within 100 metres radius from the outer boundary of an institution of education.
Tobacco products must be sold, supplied or distributed in a package which shall contain an appropriate pictorial warning, its nicotine and tar contents.

The Law on Labels

Noah Steinsapir, general counsel for Kretek International, offers a legal look at what the FDA’s new warning label requirements mean for manufacturers and retailers.

The FDA’s Deeming Regulations are now in full swing, and several deadlines have come and gone since its implementation on August 8, 2016. Currently, the tobacco industry is working hard to comply with the imminent deadlines in connection to the FDA’s new labeling requirements. Manufacturers/importers of cigars are required to submit a rotational warning plan in compliance with FDA regulations by May 10, 2017, and the new labels must be implemented and in commerce no later than May 10, 2018.

The material aspects of the new FDA warning plan are fairly straightforward. Manufacturers and importers of cigars must rotate six warnings:

  1. WARNING: Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale;
  2. WARNING: Cigar smoking can cause lung cancer and heart disease;
  3. WARNING: Cigars are not a safe alternative to cigarettes;
  4. WARNING: Tobacco smoke increases the risk of lung cancer and heart disease, even in nonsmokers;
  5. WARNING: Cigar use while pregnant can harm you and your baby; or SURGEON GENERAL WARNING: Tobacco Use Increases the Risk of Infertility, Stillbirth, and Low Birth Weight; and
  6. WARNING: This product contains nicotine. Nicotine is an addictive chemical.

These rotated warnings must be permanently affixed to the cigar packaging and advertisements. For packaging, the warning must encompass no less than 30 percent of the two principal display panels of the product’s packaging (a principal display panel being defined by the Deeming Regulations as the panels of the package that are most likely to be displayed, presented, shown or examined by the consumer) and no less than 20 percent of the total display area of the advertisement, with the caveat that the warning on advertisements appear in the upper portion of the advertisement within the trim area of the advertisement. The warnings have some other requirements such as font size, capitalization and color.

Although the rule is relatively straightforward, the industry still remains confused in connection with two looming issues: First, how will this warning coalesce with California’s current Proposition 65 warning requirements? Second, how will the timing of selling through products with older warnings on them work?

Prop 65 vs. FDA Warning

For Prop 65, certain industry groups are working to devise a plan. The purpose of California’s Proposition 65 is to warn the consumer and the public at large that tobacco products contain toxic chemicals. The new FDA warning plan achieves California’s objective and does so in a meaningful manner such that 30 percent of the principal display panels of the product’s packaging will notify the consumer of the health warnings of the tobacco product. In terms of size and visibility, the FDA’s rule goes above and beyond what is required by California’s Proposition 65. Therefore, a proposed and reasonable outcome is that California determines that the additional Prop 65 warning is unnecessary, duplicative and may cause customer confusion in light of the new federal guidelines that require such a clear and conspicuous warning. In either event, hopefully the State of California will provide clarity in connection with this issue.

Products Already in the Retail Pipeline
Another common concern is that the May 10, 2018 deadline for implementing the new warning scheme may create challenges in light of the fact that product can sit in a warehouse or on a retail shelf for extended periods of time. This may result in the sale of product without the adequate warning to the consumer after the May 10, 2018 deadline, which would not be the fault of the manufacturer/importer or the retailer. While the answer is not crystal clear yet, the Deeming Regulations appear to have considered this issue and provide a safe harbor to both the manufacturer/importer, as well as to the retailer. The manufacturer and importer appear to be allowed to introduce product without the current warning requirements into commerce up until May 10, 2018. They then have an additional 30 days after this deadline as a safe harbor to continue selling the last of the product.

In addition, retailers appear to be provided a safe harbor as long as the retailer purchased the product from a licensed manufacturer, the packaging contains some type of health warning, and the retailer has not altered the packaging. Both the FDA and the industry want to provide clear and conspicuous warnings so that consenting adults may make informed decisions. With time, the new FDA warning plan will be further clarified.

This story first appeared in the May/June 2017 issue of Tobacco Business magazine. Members of the tobacco industry are eligible for a complimentary subscription to our magazine. Click here for details.

On World No Tobacco Day, a pledge to free millions from the poverty trap called smoking

Shin Young-soo calls for stringent policies and taxation as deterrents to tobacco use, as the habit not only kills but keeps entire households in long-term ill health and poverty across Asia and the Pacific

In a small fishing village in Vietnam, 27-year-old Duong pockets US$2 from his weekly earnings of US$15 from fish sales, and looks forward to the pack of cigarettes he will buy with it.

His wife tells him she needs another US$2 to buy rice for the rest of the week. Duong stops to think, and then walks to the nearest store to buy his favourite pack.

We have long known tobacco use is bad for health. Less well known is how this hurts poor and vulnerable families. Millions of stories like Duong’s play out across Asia and the Pacific every day: meagre household resources are spent on tobacco, instead of food, shelter and education. For already impoverished families, even a small diversion of resources from basic necessities can have a huge impact. And that is before the impact of tobacco-related illness, the costs of which can plunge poor families even further into poverty – or prevent them from escaping it.

The WHO Western Pacific region is home to nearly 400 million smokers, with some countries there having the highest male smoking rates in the world – at over 90 per cent. Most tobacco-related deaths in the world occur in low- and middle-income nations. In the Western Pacific, about three people die every minute from tobacco-related diseases.

In China, the world’s biggest producer and consumer of tobacco products, a WHO-commissioned study found the death of a head of household, or “breadwinner”, from tobacco-related illness results in significant average yearly loss of household income – and the effect is long term. Households do not start to recover financially until at least 10 years after such a death.

Contrary to the tobacco industry’s claims that sales are good for the economy, tobacco use hurts economies and hampers their growth – through the microeconomic costs imposed on households and macroeconomic costs including the health costs of treating tobacco-related illness. There is also lost productivity and participation in the workforce as most tobacco-related deaths occur among working-age adults.

The good news is that we know what to do. Strong policies to reduce tobacco use work. The single most effective intervention is to use tobacco taxation to increase prices – and, in doing so, discourage consumption. Tobacco tax increases also deliver more revenue to governments: it’s a win-win situation.

The theme for this year’s World No Tobacco Day, on May 31, is “Tobacco is a threat to development”. Tobacco use traps the poor in a vicious cycle of poor health and poverty. The sustainable development agenda has no room for a product that kills half of its users, with a particularly devastating impact on the poor.

Dr Shin Young-soo is the WHO regional director for the Western Pacific

Support World No Tobacco Day – say “no” to tobacco

To support the World No Tobacco Day 2017, the Department of Health (DH) today (May 31) held a sharing session to remind the public again of the hazards of smoking and to urge smokers to quit smoking as early as possible.

Speaking at the sharing session, the Director of Health, Dr Constance Chan, said that the World Health Organization (WHO) has marked May 31 as World No Tobacco Day annually. The theme for World No Tobacco Day 2017 is “Tobacco – a threat to development”, with the aim of demonstrating the threats posed by tobacco to the world’s sustainable development, including public health and the economy. Dr Chan strongly urged members of the public to say “no” to tobacco and to continue supporting the Government’s efforts in tobacco control.

“With the collaborative efforts of the Government and various sectors over the years, the work on tobacco control in Hong Kong has attained pleasing results, with a drop in overall smoking prevalence from 23.3 per cent in the 1980s to 10.5 per cent in 2015. Nonetheless, casualties and economic loss directly and indirectly caused by tobacco remain tremendous. Local studies revealed that tobacco-related fatalities reach nearly 7 000 people annually and the economic loss resulting from tobacco-related health problems is estimated to be about 5.5 billion every year,” Dr Chan said.

“Smoking is a causative agent of many cancers as well as cardiovascular and respiratory diseases. Smoking causes harm not only to the smoker but also to their family members and friends due to the secondhand smoke induced, which increases their risk of cancer and many other chronic diseases as well as the chance of children developing respiratory symptoms,” Dr Chan added.

Sharing the research findings on local smoking-related mortality and morbidity conducted by the University of Hong Kong (HKU), the Chair Professor of the School of Public Health of the HKU, Professor Lam Tai-hing, pointed out that at least one out of every two elderly smokers died of tobacco-related diseases. He said that the Government must continue to adopt various tobacco control measures to encourage smokers to quit the habit.

The Head of the Tobacco Control Office of the DH, Dr Lee Pui-man, introduced in the sharing session 12 new pictorial health warnings on cigarette packets, which better inform the public about the specific hazards of tobacco use to smokers and their families. Experience and evidence from the WHO and around the globe also demonstrate that pictorial health warnings are an effective intervention, and increasing the size of pictorial health warnings on cigarette packets is now an international trend.

“The graphics and designs of health warnings should be updated regularly so as to maintain their salience and enhance the impact. The Government updates pictorial health warnings coupled with multiple tobacco control measures to discourage members of the public from smoking and encourage smokers to quit,” Dr Lee said.

Smokers who intend to quit smoking can call the DH’s Integrated Smoking Cessation Hotline on 1833 183, where registered nurses provide professional counselling services on smoking cessation and will also refer service users to suitable social service agencies for follow-up when necessary. To enhance smoking cessation services to smokers, the DH will launch a pilot public-private partnership programme this year to trial a new mode of smoking cessation service supported by family physicians.

In addition, the DH will collaborate with a renowned medical institution, Mayo Clinic, in the United States to organise an online training programme on tobacco dependence treatment, which will be rolled out within this year. Family physicians joining the programme will acquire skills and knowledge on smoking cessation via e-learning, and their capacity in providing smoking cessation services will be further enhanced through training and assessment. The programme aims to ensure that they can provide quitters with effective evidence-based treatment.

In addition, two patient representatives shared their experience of smoking at the sharing session, ranging from smoking-related diseases to successfully quitting the habit. They urged other smokers to quit smoking as early as possible and to seek help on smoking cessation if necessary.

Where smoking is the leading cause of death and ill health

Rich countries are hit the hardest but poor ones may soon follow


TODAY is World No Tobacco Day. Although in most countries the proportion of people who smoke continues to fall, campaigners see the glass as half full. In 24 countries smoking causes the largest share of the overall burden of disease, measured in years lost to ill health and premature death. In another 37 countries it ranks second. Most of these 61 countries are rich. Although their smoking rates are falling, much of the decline is because fewer young people are picking up the habit, rather than because older smokers are quitting. The harms from smoking affect people most seriously after middle age, so countries where smoking became popular a generation or more ago are worst affected—for now.

In poor countries, smoking is still a less important cause of death and disability than several other things, such as dirty water and malnutrition. Few African and Asian women light up—smoking is often socially acceptable only for men. In many of the poorest countries, smoking is still uncommon—though in some it is on the rise. As developing countries grow less poor, other harms will dwindle and smoking will start to look deadlier by comparison.

World No Tobacco Day: Poor almost three times more likely to smoke

360,000 NI residents still estimated to smoke, with men more likely to light up

People in the most deprived areas of Northern Ireland are almost three times more likely to smoke than their better off counterparts according to the Public Health Authority NI.

Considered by the World Health Organisation to be a blight on health, the environment and household income, the international health organisation also revealed today – on World No Tobacco Day – that globally, there are 226million adult tobacco users living in poverty.

And in low income countries over 10% of a smoker’s budget can be spent on tobacco products, meaning less money for food, education and health care.

“Tobacco use hits the poorest people the hardest and exacerbates poverty,” said Dr Margaret Chan, Director General of WHO.

“Spending on tobacco products often represents more than 10% of total household income.

“(It) is a deadly product that kills more than 7million people every year, and costs the global economy more than $1.4trillion annually in healthcare expenditure and lost productivity.”

“In addition to posing a serious threat to health,” she added, “tobacco use also threatens development in every country on every level and across many sectors – economic growth, health, education, poverty and the environment – with women and children bearing the brunt of the consequences.”

Closer to home, the Public Health Authority said it is currently estimated that around 320,000 people aged 16 and over smoke in Northern Ireland, with men (23%) slightly more likely to light up than women (21%).

But, in line with global trends, they said there is also a strong link between smoking prevalence and deprivation here, while those in manual occupations are three times more likely to smoke than professionals.

The 2015/16 Health Survey NI found that 36% of respondents in the most deprived areas used tobacco, but this figure is just 13% among the more well off.

And while the number of smokers is falling, with 80% of those who still do forgoing the addiction in their homes and cars, there is still more work to be done.

“Protecting people from tobacco smoke is a key objective set out in the Ten Year Tobacco Strategy for Northern Ireland,” said Colette Rogers, Head of Health and Social Wellbeing Improvement from the Public Health Agency.

“Therefore, the Public Health Agency would welcome a ban on smoking in cars as a means of protecting young people from exposure to second-hand smoke, improving people’s health and helping to reduce the uptake of smoking in Northern Ireland.

“Smoking remains the single greatest cause of preventable illness and premature death in Northern Ireland so we urge smokers to quit by seeking the help of their local stop smoking service.

“In Northern Ireland there are more than 650 free PHA-funded stop smoking services which are run by specially-trained staff who can advise on the best way to stop smoking.

“Services are offered in many community pharmacies, GP practices, HSC Trust premises, and community and voluntary organisations, and can be set up in workplaces.”