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Addressing Addiction

157731476_47Tobacco and alcohol use contribute to over 85 percent of head and neck cancers.1 Smoking in cancer care (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.cancer.gov/cancertopics/pdq/supportivecare/smokingcessation/HealthProfessional/page2. People who use both tobacco and alcohol are at greater risk of developing head and neck cancer than people who use either tobacco or alcohol alone.1 Smoking in cancer care (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.cancer.gov/cancertopics/pdq/supportivecare/smokingcessation/HealthProfessional/page2. Moreover, continuing using tobacco during radiation therapy creates significantly worse side effects and treatment outcomes.1 Smoking in cancer care (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.cancer.gov/cancertopics/pdq/supportivecare/smokingcessation/HealthProfessional/page2. Continuing tobacco use and heavy alcohol consumption after head and neck cancer treatment increases the risk of cancer recurrence or new primary tumors by almost double, to about 28 percent.2, Day GL, Blot WJ, Shore RE, et al. Second cancers following oral and pharyngeal cancers: role of tobacco and alcohol. J Natl Cancer Inst. 1994;86(2):131-137.3 Do KA, Johnson MM, Doherty DA, et al. Second primary tumors in patients with upper aerodigestive tract cancers: joint effects of smoking and alcohol (United States). Cancer Causes Control. 2003;14(2):131-138.

If you wish to achieve the best possible treatment outcome for your head and neck cancer, it is very important to stop smoking after your diagnosis and during treatment. Alcohol is also not recommended during cancer treatment as it can interact with certain cancer treatment drugs and can worsen mucositis caused by radiation treatments.4 Rugg T, Saunders MI, Dische S. Smoking and mucosal reactions to radiotherapy. Br J Radiol. 1990;63(751):554-556. Your care team can provide advice regarding alcohol and your specific cancer treatment.

Depression and addictions

People who are clinically depressed are more likely to suffer from addictions, and they often have a harder time quitting the substances to which they are addicted.5 Gierisch JM, Bastian LA, Calhoun PS, et al. Comparative effectiveness of smoking cessation treatments for patients with depression: a systematic review and meta-analysis of the evidence. Washington (DC):Department of Veterans Affairs; 2010 Nov. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009502/#executivesummary.s1. For example, 45 percent of people with depression are smokers, while just 22 percent of people without depression smoke.5 Gierisch JM, Bastian LA, Calhoun PS, et al. Comparative effectiveness of smoking cessation treatments for patients with depression: a systematic review and meta-analysis of the evidence. Washington (DC):Department of Veterans Affairs; 2010 Nov. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009502/#executivesummary.s1. The negative mood symptoms of depression make it much more difficult to stop smoking successfully. If you are a smoker and have depression, getting treatment for your depression can also help you to quit smoking. This is true for addictions to other substances as well.

Quitting smoking and drinking

Ask your care team for advice about smoking cessation treatment. Nicotine-replacement therapy (NRT), such as nicotine gum or patches, has been shown to improve the success of quitting.6 Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. (3): CD000146, 2004. Counseling or behavioral therapy helps as well.7 Lemmens V, Oenema A, Knut IK, et al. Effectiveness of smoking cessation interventions among adults: a systematic review of reviews. Eur J Cancer Prev. 2008;17(6):535-544.

A variety of resources on quitting smoking can be found on BeTobaccoFree.gov, a website created by the U.S. Department of Health and Human Services, or SmokeFree.gov, a site from the National Institutes of Health.

If you have been a heavy alcohol drinker, note that stopping suddenly can be harmful. Sudden withdrawal can even be life threatening. If you are dependent on alcohol, it is best to get professional help to quit.8 Self-help strategies for quitting drinking. Rethinking Drinking: Alcohol and Your Health. National Institute on Alcohol Abuse and Alcoholism. http://rethinkingdrinking.niaaa.nih.gov/default.asp. Ask your care team for advice and a referral to a clinic or rehabilitation facility that can assist you with your withdrawal. Once you are in the process of quitting, try these self-help strategies: find new activities to fill your time or lift your mood, avoid the circumstances that trigger your desire to drink, make a plan to handle urges to drink, and practice a polite and convincing “no” for when you are offered drinks.8 Self-help strategies for quitting drinking. Rethinking Drinking: Alcohol and Your Health. National Institute on Alcohol Abuse and Alcoholism. http://rethinkingdrinking.niaaa.nih.gov/default.asp.

Information on stopping drinking alcohol can be found on the Rethinking Drinking website, a resource developed by the U.S. National Institute on Alcohol Abuse and Alcoholism, or MedlinePlus, a resource of the U.S. National Library of Medicine.

Avoiding relapses

Former addicts know that the danger of relapse is always there, even years after they have quit. You must remain vigilant, maintain your coping strategies, reduce stress and other triggers and seek out support to remain successful long-term. Counseling and support groups, such as Alcoholics Anonymous or Nicotine Anonymous, can help you to stay successful. Remind yourself that the dangers of addiction relapse are far greater for a cancer survivor than for others since relapse brings with it much higher risk for cancer recurrence as well.


References

1 Smoking in cancer care (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.cancer.gov/cancertopics/pdq/supportivecare/smokingcessation/HealthProfessional/page2.

2 Day GL, Blot WJ, Shore RE, et al. Second cancers following oral and pharyngeal cancers: role of tobacco and alcohol. J Natl Cancer Inst. 1994;86(2):131-137.

3 Do KA, Johnson MM, Doherty DA, et al. Second primary tumors in patients with upper aerodigestive tract cancers: joint effects of smoking and alcohol (United States). Cancer Causes Control. 2003;14(2):131-138.

4 Rugg T, Saunders MI, Dische S. Smoking and mucosal reactions to radiotherapy. Br J Radiol. 1990;63(751):554-556.

5 Gierisch JM, Bastian LA, Calhoun PS, et al. Comparative effectiveness of smoking cessation treatments for patients with depression: a systematic review and meta-analysis of the evidence. Washington (DC):Department of Veterans Affairs; 2010 Nov. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009502/#executivesummary.s1.

6 Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. (3): CD000146, 2004.

7 Lemmens V, Oenema A, Knut IK, et al. Effectiveness of smoking cessation interventions among adults: a systematic review of reviews. Eur J Cancer Prev. 2008;17(6):535-544.

8 Self-help strategies for quitting drinking. Rethinking Drinking: Alcohol and Your Health. National Institute on Alcohol Abuse and Alcoholism. http://rethinkingdrinking.niaaa.nih.gov/default.asp.