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How to
quit
Nicotine
is addictive, and quitting is hard work. There is no way to succeed
without really trying. But if you set your mind to it, you can
quit.
There
are four basic strategies for quitting. Look them over and decide
which is best for you. Most smokers start by trying to quit on
their own, but many end up needing several methods and several
attempts before they kick the habit. And even after you quit,
it's important to keep your guard up. Just as an alcoholic can
fall off the wagon after a single drink, just one cigarette can
fire up your nicotine craving even after years of abstinence.
Kicking
the habit: Do it yourself
Don't
kid yourself by trying to cut down; nearly everyone who tries
slides back up to their usual dose of nicotine. Cold turkey is
the way to go, but it takes preparation. And even without professional
help, cooperation from family and friends can be important. Here
are some tips:
Make
a list of reasons to quit and another list of people who have
kicked the habit. The first list will remind you why quitting
is important, and the second will show you that folks who are
no stronger or smarter than you have succeeded. Keep your lists
handy and refer to them whenever you begin to waver.
Pick a quitting date and stick to
it. Plan to quit on a special day, such as a birthday or the American
Cancer Society's Great American Smokeout event on the third Thursday
of each November. Steer clear of stressful periods, and avoid
holidays if you are likely to be invited to smoke-filled parties.
Try to get other smokers in your
household or circle of friends to join you in quitting. A 2008
study found that smoking behavior spreads through both close and
distant social ties; your resolve and success can help your friends
and, ultimately, your community.
As your quit date approaches, throw
out your ashtrays, clean your house, car, and clothes, and clean
your teeth. Once you're away from it, you'll realize how much
smoking stinks.
Anticipate withdrawal symptoms such
as grumpiness, restlessness, irritability, hunger, headache, anxiety,
and drowsiness or insomnia. The discomfort usually peaks one to
three weeks after you quit, and then it gradually diminishes.
To get through the rough patches, stock up on low-calorie snacks
and sugarless gum or candy to keep your mouth busy. Plan enjoyable
diversions to keep your mind busy. Think of ways to keep your
hands busy.
If you feel tense, try meditation,
deep breathing, or yoga.
Begin an exercise program. It will
relieve tension, promote good sleep, and help control weight gain.
Walking for 30 minutes a day can really help.
Eat a healthy diet.
Stay away from secondhand smoke.
Don't even think about smoking "just one"—even
a single puff will set you back.
Reward yourself. Put your tobacco
money aside in a kitty, and then spend it on a special treat.
Think positively—you can quit.
Take it one day at a time. And if you slip, try, try again—either
on your own or with one or more of the other strategies for quitting.
Kicking
the habit: Behavioral support
Quitting
is your responsibility; it may be hard, but it doesn't have to
be lonely. Many employers, health plans, and hospitals offer individual
or group counseling. Your doctor or your local chapter of the
American Lung Association or American Cancer Society can refer
you to a program in your area. Telephone support can also help;
you can try it for yourself by calling the National Smoking Cessation
Hotline at 800-QUIT-NOW. Hypnosis is another alternative that
has helped some smokers break free.
Kicking
the habit: Nicotine-replacement therapy
Cigarette
smoke contains thousands of chemicals. Many are harmful, but nicotine
is the most addicting. Like other addicting substances, it acts
on receptors in the brain's "reward center," creating
a sensation of pleasure and a craving for more nicotine. The craving
has made billions of dollars for Big Tobacco, but it has cost
the public much more, in health and money. Nicotine-replacement
therapy can short-circuit the craving without introducing the
other disease-producing chemicals.
Nicotine
replacement is safe. You'll get less nicotine than from cigarettes,
and you won't get any of the tar, carbon monoxide, and other damaging
substances in tobacco. Plan to start nicotine-replacement therapy
on the day you quit smoking. If you are a heavy smoker, you'll
need higher doses. Estimate how much nicotine you need based on
an average of 1 to 2 milligrams (mg) of nicotine per cigarette.
Start with the full dose, then gradually taper down over several
months. Under-dosing is more common than overdosing, but you should
not smoke while using nicotine-replacement therapy.
Five
types of nicotine replacement are available in the United States.
Nicotine patches deliver a steady dose of nicotine throughout
the day, providing round-the-clock protection from craving. The
other products deliver a higher dose of nicotine faster, but protection
also declines faster. The short-acting products can be used on
demand to counter a sudden nicotine craving. If you wear a patch,
you can also use short-acting nicotine products to suppress breakthrough
craving.
Here is
a quick review of the options for nicotine-replacement therapy:
Nicotine
patches are available over the counter. One popular 24-hour patch
(NicoDerm CQ) comes in three strengths: 21 mg, 14 mg, and 7 mg.
Place a new patch on clean, unbroken, hairless skin each day;
you can leave it in place all day. Most smokers should start with
the 21 mg dose, but if you weigh less than 100 pounds or smoke
fewer than 10 cigarettes a day, you should start with the 14 mg
strength. You can reduce the dose every one to two months as your
nicotine addiction resolves. If you have bad dreams while wearing
a patch at night, you can use a 16-hour patch that you remove
at bedtime. Mild skin irritation is the most common side effect.
Store and discard your patches with care to keep them way from
young children.
Nicotine gum (Nicorette) is available
over the counter. If you smoke more than 25 cigarettes a day,
you should use gum that provides 4 mg of nicotine per piece; if
you smoke less, use the 2 mg dose. Chew a piece of the gum whenever
the smoking urge surges, up to 30 pieces a day. Aim to wean off
the gum in about three months if possible. Chewing replaces the
oral stimulation of smoking, which can be an advantage, but some
people find the taste unpleasant, and some develop hiccups or
indigestion. Coffee, tea, beer, and soft drinks may interfere
with nicotine absorption.
Nicotine lozenges (Commit)are available
without prescription. If you usually light up within 30 minutes
of waking, you should use the 4 mg strength, while others can
use the 2-mg lozenges. A typical schedule calls for one lozenge
every one to two hours for six weeks, then every two to four hours
for two weeks, and then every four to eight hours for the final
two weeks. Don't eat or drink while using a lozenge, and as with
nicotine gum, you should avoid acidic beverages for at least 15
minutes before use. Nicotine lozenges are safe for use with dentures.
Side effects may include an unpleasant taste, nausea, indigestion,
or mouth tingling.
Nicotine inhalers (Nicotrol inhaler)
are available by prescription. Each cartridge delivers a "puff"
of vapor containing 4 mg of nicotine. The cartridge is placed
in a device that resembles a plastic cigarette holder, which may
help satisfy a smoker's oral urge. The average dose is six to
16 cartridges a day for up to 12 weeks, followed by a gradual
reduction in dose over the next 12 weeks. Most of the nicotine
is absorbed from the mouth, not the lungs. Side effects may include
mouth or throat irritation and cough.
Nicotine nasal sprays (Nicotrol
NS) are available by prescription. Each spray delivers 0.5 mg
of nicotine. Use one spray in each nostril whenever you feel the
urge to smoke, up to a maximum of 10 sprays an hour or 80 a day
for three months. Side effects may include nasal irritation, sneezing,
tearing, and cough.
Individual
smokers may prefer one form of nicotine replacement over the others.
Experiment with various types and talk to your doctor about the
prescription forms. Remember, too, that nicotine replacement works
best when combined with behavioral support, prescription drugs,
or both. And smoking cessation always requires a good dose of
willpower.
Kicking
the habit: Prescription drugs
Bupropion
(Wellbutrin, Zyban) was initially approved to treat depression
and was then approved for smoking cessation. It does not contain
nicotine and can be used in combination with nicotine-replacement
therapy. Start taking bupropion one to two weeks before your quit
date. The usual dose is 150 mg once a day for the first three
days, then 150 mg twice a day for eight to 12 weeks, or longer
if needed. Bupropion can reduce weight gain after quitting. Possible
side effects may include dry mouth and insomnia; seizures are
very rare.
Varenicline (Chantix) is the newest
drug approved for smoking cessation; although experience is still
limited, it also promises to be the most effective. It blocks
nicotine receptors in the brain while also partially stimulating
these receptors to reduce nicotine withdrawal symptoms. The usual
dose is 0.5 mg once a day for the first three days, then 0.5 mg
twice a day for four days, followed by the full dose of 1 mg twice
a day for 12 weeks or longer. The dose should be lowered in patients
with severe kidney disease. Nausea is common, and bad dreams may
occur. Mood disturbances and behavioral problems have developed,
particularly in smokers with psychiatric problems, but it's not
clear that these are caused by the medication. Reports of accidents
and visual abnormalities are also being investigated by the FDA.
More research is needed.
Top priority
Smoking
is considered by many people to be Public Health Enemy Number
One—so if you smoke, quitting should be your top priority.
It will take willpower and hard work, but lots of help is available.
You may gain a few pounds, you may go through a rough spell as
your body adjusts to life without tobacco, and you may have to
try several times before you finally kick the habit. Don't be
discouraged. Over 45 million Americans have quit smoking, and
you can, too.
Resources:
American Cancer Society - 800-ACS-2345 - www.cancer.org
American Lung Association - 800-LUNG-USA - www.ffsonline.org
Centers for Disease Control and Prevention - 800-CDC-1311 - www.cdc.gov/tobacco
National Smoking Cessation Hotline - 800-QUIT-NOW
Try to Stop Tobacco Resource Center - 800-TRY-TO-STOP - www.trytostop.org
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