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Your Good Health: Why no rehabs for cigarette smokers?

In-patient rehab is a very expensive, time-consuming intervention that few can afford. It is used when the immediate threat of physical harm from drugs and alcohol is extremely high.
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Dr. Keith Roach

Dear Dr. Roach: How come there aren’t any rehabs for people addicted to cigarettes? I heard trying to quit smoking is much harder and more difficult than quitting heroin. Any ideas?

C.A.M.

Tobacco smoking is incredibly difficult to quit. Many tobacco users have physical dependence to nicotine, meaning they will experience symptoms of withdrawal. Many will also show psychological signs of addiction, which is characterized by compulsive drug-seeking and use, even in the face of negative health consequences.

In-patient rehabilitation can be a very effective way of dealing with addiction. Among those who spent six months in inpatient rehab for drug or alcohol addiction, the success rate (as measured by abstinence) is about 70%. Shorter rehab times mean lower effectiveness.

I think you can probably see the reason in-patient rehab is not used for tobacco smoking: It is a very expensive, very time-consuming intervention that few can afford. It is used when the threat of physical harm from drugs and alcohol is extremely high.

Cigarette smoking DOES have a high potential for harm. On average, a smoker lives eight to 12 fewer years than a nonsmoker. Quitting smoking successfully is one of the most powerful things a person can do for their health, as most of that difference in life expectancy can come back, and the sooner a person quits, the better. Quitting, even after many years, results in improved function and longevity.

Short of in-patient rehab, there are proven techniques to help a person quit. The combination of behavioural interventions (such as stop-smoking clinics or group classes) and pharmacologic interventions (such as nicotine replacement, bupropion or varenicline) is best. A person’s regular doctor is the first place to start, but there are experts who can help with tobacco use disorder. In B.C., a free counselling and support for people who want to quit tobacco can be accessed through the QuitNow program at quitnow.ca or 1-877-455-2233

Dear Dr. Roach: I recently heard about a study done by The Cleveland Clinic on Alzheimer’s prevention. The results were good: 69% prevention of people who might have developed Alzheimer’s. The drug that gave these results was Viagra. I mentioned this to some of my friends and they brushed it off or didn’t take it seriously. I would take it if it would prevent this horrible condition. Some of my relatives have developed dementia in their later years, but I’m not sure if the drug prevents other forms of dementia. Do you know if it will be offered to the people who might be at risk?

G.H.

A study published in December 2021 by The Cleveland Clinic group looked at prescription records against insurance claims data, and found that those who took sildenafil (Viagra) do have a decreased risk of insurance claims for Alzheimer’s disease. The group also identified a potential mechanism of action — improved growth of brain cells and decreased formation of an abnormal protein (tau) — by which Viagra might plausibly help prevent Alzheimer’s.

However interesting, this is a long, long way from proving that Viagra reduces Alzheimer’s risk, which will require a clinical trial. I do not recommend sildenafil or medicines like it solely to reduce the risk of Alzheimer’s (or other forms of dementia).

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu