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劝奥巴马戒烟(转载)

已有 4231 次阅读 2009-1-27 13:08 |个人分类:游学感想|系统分类:生活其它| 大众健康

亲爱的奥巴马总统:

你接手的是一个烂摊子,加沙那边冲突不断,国内经济日益衰退。有些会耍嘴皮子的人建议,你这位新的“自由世界领袖”不应该戒烟。但我不同意这种说法,换新工作,又搬新家,正是改变老习惯的绝好时机。

你在自己一天抽多少支烟的问题上一直讳莫如深。上个月,你对NBC晚间节目主持人汤姆.布罗考(Tom Brokaw)说:“有时候,我会烟瘾复发。”这可能意味着你在漫长的竞选演讲路途中偶尔抽上一两支解解乏,也可能意味着每天都要偷偷来上几根。也许你还不知道,2005年挪威的一项大型研究发现,每天抽1到4支烟的人,死于心脏病的几率是正常水平的三倍。

迄今已有4,700万美国人戒了烟,抽烟的人占总人口比例去年也首次降至20%以下

像你这么聪明和自律的人,居然不能完全戒烟,这证明香烟的确太容易上瘾了。在美国,有4000多万人跟你在同一条船上。

尼古丁能让人缓和“战或逃”的原始反应,有助于集中注意力,促使身体释放出多巴胺,让人变得更愉悦;但中止尼古丁摄入后,人会变得难以静下心来思考,经常走神,记忆力衰退,易怒,爱冲动,而且咄咄逼人。(针对这些你可能需要添加额外的防护。)尼古丁替代治疗─使用口香糖、锭剂、贴片或吸入器─能缓和这些因戒烟产生的综合症,前提是用的份量足够多。

你已经嚼戒烟口香糖好几个月了,但有研究发现,一些戒烟者需要更多的尼古丁替代治疗才能控制烟瘾。如果每天只抽五支烟,但每支都抽得非常狠,这样摄入的尼古丁数量跟以普通方式抽整整一包烟摄入的一样多,这是北卡罗来纳州Durham市的杜克大学尼古丁及吸烟戒除中心(Duke University's Center for Nicotine and Smoking Cessation)主任杰德.罗斯(Jed Rose)说的。

罗斯教授是尼古丁贴片的开发者之一,他说只要去戒烟诊所做一个简单的呼吸测试,就能检测出你吸入了多少一氧化碳,需要多少尼古丁替代治疗。罗斯教授说,如果加大替代剂量,或使用另一种替代方式,或者双管齐下,那么戒烟可能会更容易一些。

加大尼古丁替代剂量也许会让你觉得恶心,头重脚轻,心跳加快,但应该不会导致癌症,致癌的罪魁祸首是烟草里的焦油和各种添加剂。如果你接见外国元首时嘴里还粘着大块戒烟口香糖,我想他们也是会理解的。

在一些临床实验中,戒烟药Chantix的作用非常明显,但有些人警告说,服这种药会有很低的几率让人产生自杀的想法。同样,它让人昏昏欲睡,这对一位新总统来说也可能不太合适。

你之所以抽烟,也许更多的是出于一种行为上的习惯,而不是对化学物质上瘾。即使如此,戒起烟来也同样困难,但也有办法可以对付。

首先要尽可能少接触到香烟,不要随身携带,把私藏的全部储备都扔掉,别让自己的秘书、随从、便衣探员和保镖帮你带着。对你来说,偷偷溜出去买包烟不那么容易,而且白宫内部禁止吸烟。(但电视剧《白宫群英》(The West Wing)中没有这种限制,扮演总统的杰德.巴特莱特(Jed Bartlett)在遇到烦心事的时候偶尔会在院子里抽两口。)

其次要做个心理记录,每次烟瘾上来的时候,就写下时间和想抽烟的原因。抽烟是为了集中注意力?是想镇定下来,免得发火?是每天的某个特定时候就想抽,还是跟某个人在一起的时候容易犯瘾?尝试分析一下抽烟想达到的效果,然后找到替代方法。

曼哈顿一位专门帮人戒烟的心理学家丹尼尔.赛德曼(Daniel F. Seidman)说:“发挥你意识的作用,用不同的方式来处理问题。不要做出下意识的反应。”

我不打算列出戒烟给健康带来的所有好处。你曾参与起草了一项参议院议案,把每包香烟的联邦税费提高一美元,用于资助儿童健康项目。要记住,如果你继续抽烟,即使只抽一点,全美国的下一代都会觉得抽烟是件很酷的事,那么美国在未来就会产生更高的医疗费支出。

很多最终戒了烟的老烟民是这样说的:烟瘾会慢慢消失。对于你来说,要考虑的事情太多了,根本腾不出空来思念香烟,很快你就会忘掉自己曾经还是个烟民。

你能做到。对,你能做到。

英文原稿:

Letter to Our New President: It's Time to Break the Habit

Dear President Obama,

A world of woe has just landed in your lap, including a conflagration in Gaza and a deepening recession at home. Some wags have suggested that the new Leader of the Free World shouldn't try to quit smoking, too. But I disagree. Starting a new job and moving to a new home is a great time to break old habits.

You've been very cagey about how much you do smoke. Telling Tom Brokaw last month, "There are times when I have fallen off the wagon," could mean once or twice in the long campaign, or several furtive butts a day. In case you didn't see it, a big study in Norway in 2005 found that smoking just one to four cigarettes a day can triple the risk of dying of heart disease.

The fact that somebody as smart and self-disciplined as you are hasn't been able to quit completely is a testament to the addictive power of cigarettes. More than 40 million other Americans are in the same boat.

Nicotine soothes the primitive fight-or-flight response while focusing attention, and it releases dopamine like a pleasurable reward. Nicotine withdrawal can make it harder to think, concentrate and remember, as well as causing irritability, impulsiveness and aggressiveness. (You might want to put an extra layer of security on those launch codes.) Nicotine-replacement therapy -- with gum, lozenges, a patch or an inhaler -- can alleviate those withdrawal symptoms, provided you're getting enough.

You've been chewing nicotine gum for months now, but researchers have found that some smokers need more nicotine replacement than others to stop their cravings. Puffing intensively on just five cigarettes a day can deliver as much nicotine as an entire pack, says Jed Rose, director of Duke University's Center for Nicotine and Smoking Cessation in Durham, N.C.

Dr. Rose, a co-developer of the nicotine patch, says a simple breath test, available at some smoking-cessation clinics, can measure how much carbon monoxide you've inhaled and how much nicotine replacement you need. You might be more successful with a higher dose, another kind of nicotine therapy or a combination, says Dr. Rose.

Overdosing on nicotine replacement can make you feel nauseous and light headed and raise your heart rate, but it doesn't appear to cause cancer; it's the tar and various additives in tobacco that do that. And even foreign dignitaries would understand if you had a big wad of nicotine gum "parked" in your jaw when they came to visit.

The stop-smoking drug Chantix has been very effective in some studies, but there are those warnings that it can cause thoughts of suicide in rare cases. Hypnosis might not be such a great idea for a new president, either.

It's possible that you're smoking more out of a behavioral habit than a chemical addiction, and that can be just as hard to shake. But there are things you can do about that, too.

One is to make cigarettes as inaccessible as possible. Don't carry any with you. Throw away any private stashes you might have. Don't let your secretaries or aides or Secret Service agents or Marine guards carry them for you. Slipping out to buy a pack won't be easy -- and smoking is banned inside the White House (but that didn't stop Jed Bartlett from occasionally puffing on the patio when the going got tough on "The West Wing").

Also keep mental notes -- or a written log -- of when you feel the urge to smoke and why. Do you need a cigarette to concentrate? Does it calm you down when you'd otherwise get angry? Do you want to smoke at a certain time of day or when you're with a particular person? Try to assess what it's doing for you and come up with another means of coping.

"Use your awareness as a tool to deal with the situation differently. Don't let it be automatic," says Daniel F. Seidman, a Manhattan psychologist who specializes in smoking cessation.

I'm not going to list all the health reasons for quitting. You co-sponsored a Senate bill to raise the federal cigarette tax to $1 per pack to fund children's health programs. Just remember that if you do continue to smoke, even a little bit, another generation of American kids will think it's cool, and the nation will have even higher health-care bills in the future.

Take it from people who smoked cigarettes for a long time and finally quit: The urge disappears. You'll have so much else to worry about that you won't have time to miss them, and you'll forget you ever smoked at all.

You can do it. Yes, you can.

 (原载华尔街日报 2009年1月20日)



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