Smoking is the most common addiction and the one that produces the highest mortality. It is the main avoidable risk factor for serious and fatal diseases such as heart attack, stroke, pulmonary emphysema, COPD and many cancers (lung, bladder). It is estimated that about 50,000 deaths per year in Spain are attributable to smoking.

If it is so bad for health, why is it so difficult to quit smoking? The nicotine from tobacco is immediately absorbed in the lungs, goes to the bloodstream, reaches the brain and causes it to release dopamine, the "feel-good" neurotransmitter. Between one and two hours later, the nicotine level decreases and irritability and nervousness appear. These are the withdrawal symptoms. The craving, the urgency to smoke another cigarette is to maintain a high level of dopamine in the brain to relieve that nervousness and feel good again. It is highly addictive.

When attending to someone who wants to quit smoking, we will ask them the following questions to assess how serious their tobacco addiction is:

• How many years have you been smoking?
• How many cigarettes/day? (<20 is mild, >20 is severe)
• Which brand? (some are stronger than others)
• Is it very difficult for you to be in places where you cannot smoke? (for example long plane trips, hospitals...)
• Do you continue smoking when you are ill?
• How long after waking up in the morning do you smoke your first cigarette of the day?

Stages of Smoking Cessation

1. Precontemplation: prefers to smoke, does not want to quit.
2. Contemplation: considers quitting smoking in the coming months.
3. Preparation: seriously considers quitting smoking in the next month. Is able to set a day.
4. Action: The first 6 months without smoking. There is a higher risk of relapse.
5. Maintenance: After 6 months without smoking. There is a lower risk of relapse.

Slips and Relapses

A ''''slip'''' is an isolated consumption of tobacco after abstinence. It can happen due to a stressful situation in which the desire to consume becomes uncontrollable or quite the opposite, an event in which one lets their guard down and "one puff won't hurt". It is considered a slip if within less than a week they have managed to quit tobacco completely again. If, on the contrary, they resume the habit and continue smoking for more than a week, it is considered a ''''relapse''''. Some people find it very difficult to quit smoking and upon having a relapse they internalize a feeling of shame and failure that discourages them greatly from trying again because their experience tells them they will not succeed. They believe they cannot live without smoking. They can perpetuate their smoking habit for years with the consequent damage to their health.

Acupuncture treatment for smoking cessation

Tobacco consumption from the TCM perspective is understood to mainly affect two organs:

1. Heart: shen. Dependence. When quitting smoking, shen is altered. Nervousness, irritability, anxiety, difficulty concentrating, insomnia, headache.
2. Lungs: smoke dries the lungs, leading to Lung-Qi and Lung-Yin deficiency. By hindering descent and diffusion it produces cough and phlegm (tan). Tiredness, dry mouth, thirst.

Normally about 4 sessions are agreed upon. The person has to ''''set a specific day on which they quit smoking''''. The first session is usually done before that day. The day before they have to reduce their consumption by half. After the first session they must have quit tobacco.

• The first week: 2 sessions.
• The following week: 1 session.
• The next session: 2 weeks later.
• A reinforcement session is recommended after one month, 3 months, 6 months and 1 year, to help them not relapse. The risk of relapse decreases as time passes without consuming.

In cases of more severe addiction, more reinforcement sessions are done if considered necessary. The person may be receiving treatment with medications prescribed by their pulmonologist, using nicotine gum and gradual reduction of consumption. Acupuncture can help complement those tools. Other techniques that can help are hypnosis, yoga, coaching or psychological support.

Points

The treatment principle is to calm shen, eliminate Tan, nourish Yin. Clearing the nose and helping recover the taste are factors that help reinforce the person feeling good and benefited from being a non-smoker. Help sustain the discomfort of withdrawal.

• GB-8: good point for addictions.
• Bi Tong: clears the nose. Also called Shang Ying Xian, which means "above LI-20". Anti-smoking point.
• Tian Mei: Recovers taste. Located between LI-5 and LU-7.
• GV-20, HT-7: calms shen
• LU-5: Tonifies Lung Yin
• ST-40: Eliminates Tan (phlegm)

Depending on how the person is doing, the following can be added:

• If choking, chest oppression and lots of phlegm: CV-17
• Dry throat, with itching: LU-7, KI-6
• Nervousness: PC-6, PC-7, LR-2 or LR-3
• Tiredness: ST-36

Auriculotherapy works very well for treating addictions because since they wear the stimulus (in the form of needle, seed or magnet) on the ear all the time, it is more constant.

• Auriculotherapy points: Mouth, trachea, internal nose, lung, heart, liver, sympathetic nerve, subcortex, Shen Men.

Electro-stimulation can be practiced on auriculotherapy points or on the body. It is recommended to disperse.