Veterans Quit Smoking with the help of the Tobacco Treatment Clinic

Plus, cigarettes are designed to rapidly deliver nicotine and/or menthol to the brain. These Veterans, who are in the process of quitting tobacco with the help of Mindy Conklin and the Tobacco Treatment Clinic she runs at the Baltimore VA Medical Center, share how they kicked the habit. 

Kelton Mullen, a 65-year- old Air Force Veteran, began smoking at age 13. “My parents smoked. It was normal to me to smoke,” he said, though he does concede that if his parents had known he’d pilfered cigarettes from them, he’d been in trouble. The five decades of smoking has wreaked havoc on his body, causing severe COPD. “I use oxygen now and have shortness of breath,” he said. Six months ago, he decided time has come for him to start listening to his doctor and now has been smoke-free for the past three months—a major victory in quitting tobacco.

Similarly, Edward “Antonio” Kelly, who served 26 years in the military as a Marine and in the National Guard, also picked up smoking when he was 13 years old. Through the years, he tried to quit several times but invariably returned to the habit.  Now 68 years old, Kelly hopes that this time with help from the Tobacco Treatment Clinic will be his final time trying to quit.  “I’ve been hard on my body. My body has been good to me, and I haven’t been good to it,” he said. He recognizes that quitting is a process and with help from medications, he was able to taper his tobacco use gradually over a year and a half. Now he’s happy to say he’s been smoke-free for nearly half a year. “I always kept strict notes about smoking on a calendar, and now I’m at the point where I don’t think about cigarettes or smoking until I’m marking zero cigarettes on the calendar. Maybe it’s time to stop marking the calendar,” he said.

Marine Veteran Joseph Zubey, 61, began smoking in Infantry School when he was 18 years old. “All the guys were smoking. I wasn’t smoking every day, but within six months, I was,” he said.  He started with regular cigarettes and then moved to menthol about 15 years ago. “I enjoyed smoking. Back when I started smoking, cigarettes were 15 cents a pack and now they’re $15 a pack,” he said. With help from the Tobacco Treatment Clinic, Zubey decided to try quitting 16 months ago and noticed that he started breathing a little easier. “I’d like to live a few more years,” he said.  

“While counseling is important, that alone does not effectively treat Tobacco Use Disorder. The American Thoracic Society/European Respiratory Society/American College of Chest Physicians guidelines all discuss the fact that pharmacotherapy is a crucial component for treatment of Tobacco Use Disorder. It is important to combine these and approach tobacco use as a disease framework, similar to treating Opiate addiction with Methadone and as needed Narcan for overdose,” said Dr. Janaki Deepak, director of the Lung Mass Clinic at the VA Maryland Health Care System and a pulmonary critical care physician who along with Conklin created the Tobacco Treatment Clinic. “Nicotine and menthol are addictive substances that allow people to be fully functional despite. They do not cause immediate acute intoxication that impairs motor skills or cognitive function as do opioids or alcohol. But make no mistake, tobacco causes a lot of damage to the body, including high blood pressure, damaging blood vessels and making them more prone to form clots. Smoking is [also] a risk for stroke.”

The Tobacco Treatment Clinic started in 2023 with a full clinic of Veterans referred to it by the Lung Mass Clinic.  “The clinic has grown fast.  I see an estimate of more than 1,000 plus Veterans and the clinic has a 60% self- reported quit rate,” said Conklin.  

Conklin likes to explain to her patients how cigarettes contain about 600 ingredients, which create more than 7,000 chemicals when burned. Of those burned compounds nearly 70 can cause cancer, including nicotine, carbon monoxide, tar, formaldehyde and benzene, arsenic and hydrogen cyanide to name a few.  This heavy chemical load in a single cigarette affects every organ in the body upon inhalation. 

“Even a single cigarette exposes your body to addictive nicotine and toxic chemicals. Smoking one cigarette can lead to nicotine dependence and can contribute to harmful effects on your heart, lungs, and overall health,” said Conklin who deploys an array of tools to help Veterans quit tobacco.

“We don’t require that the Veterans quit right away. Quitting tobacco is an individual journey—it’s very different for each person—so we see every patient individually, one on one,” said Conklin. “We follow Veterans in our clinic for three years. Sometimes Veterans who say they aren’t ready to quit will come back three months later, ready to quit.”

A plethora of medicines are now available to help those who want to quit smoking. They include nicotine patches, gum and lozenges and prescription pills, medicines that can safely ease withdrawal symptoms and diminish the urge to smoke. 

“VA offers Veterans a comprehensive approach with a combination of personal treatment plans, counseling, education, and medicines to help individuals who want to quit achieve their goals,” said Conklin. 

For the Veterans on the quit-tobacco-journey, many wish they had sought help earlier. “I wish I had quit years ago,” said Mullen. 

To participate in the Tabacco Treatment Clinic, Veterans need to ask their VA providers for a referral.