Reasons Why You Should Quit Smoking
Reasons Why You Should Quit Smoking by Charlene J. NubleSmoking can hook you because cigarettes contain nicotine which is highly addictive. But being hooked is not an excuse why you cannot quit smoking. Smoking has been proven by several researches to be great threat to one's health, that is why there is no reason why one who is already hooked to it should not quit smoking.It is tough to quit smoking. People try at least 2 to 3 times before they can finally quit smoking. It takes hard work and lots of effort but if you're really determined then you can quit smoking for good.Why quit smoking?There are at least five reasons why you should quit smoking.* First, if you quit smoking, you will definitely live longer and better.* Second, each time you smoke, you take about 5 to 20 minutes off your life. Your chance of getting lung cancer, stroke or heart attack increases if you don't quit smoking.* Third, the people you live with, especially the children, will be healthier only if you stop smoking. In fact, second hand smoke is more dangerous than the actual smoke users get from smoking.* Fourth, if you quit smoking, you will have extra money to spend on other things than cigarettes.* And lastly, if you're pregnant, chances of having a healthier baby is more likely if you quit smoking.So the next and most crucial question is "how do I quit smoking?"Here are five ways that can help you quit smoking:1. Get ready and prepare yourself to undetake your quit somking program? Set a quit smoking date. Change your environment by getting rid of all cigarettes in places you frequent and not allowing people to smoke near you or at your home.2. Get support and encouragement. Studies have shown that you'll have better chances in quitting smoking if you can get support from families, friends, and co-workers.3. Learn new skills and behavior. Always remember that your goal is to quit smoking, so distract yourself from urges of smoking. Change your routine in your first try of quit smoking program. Do something to reduce your stress such as taking a hot bath, exercise, or reading. Plan something to do enjoyable every day.4. Get medication and use it correctly. Medications can help you lessen the urge to smoke. Five approved medications that can help you to quit smoking are: Bupropion SR, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch.5. Be prepared for a relapse. If you quit smoking, chances of a relapse is high. Most relapses occur after 3 months of quitting, so watch out for situations that may trigger you get back to smoking such as alcohol, other smokers, weight gain and depression.Everyone can quit smoking so don't hesitate to at least try to quit smoking also.Quit smoking now and I guarantee you a healthier, better and longer life.------------------------- Note: This article may be freely reproduced as long as the resource box at the bottom of the article is included and and all links must be Active/Linkable with no syntax changes. -------------------------About the AuthorCharlene J. Nuble 2005. For updated links and information about quit smoking, please go to: http://quit-smoking.besthealthlink.net/ or for updated links and information on all health related topics, go to: http://www.besthealthlink.net/

factsheet for stop smoking plan

The desire to stop smoking
Many smokers continue smoking not through free choice but because they are addicted to the nicotine in cigarettes. A report by the Royal College of Physicians found that nicotine complied with the established criteria for defining an addictive substance. The report states: “On present evidence, it is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of nicotine self-administration.” [1]

Surveys have consistently shown that at least 70% of adult smokers would like to stop smoking and of those who express a desire to quit, more than a third are very keen to stop.[2] Almost nine out of ten (88%) of smokers state that they want to quit because of a health concern. After health reasons, the next most common reason given for wanting to give up is a financial one. 2 The most important element of the cessation process is the smoker's decision to quit, with the aid or method of secondary importance. However, those who use aids such as nicotine replacement therapy double their chances of successfully quitting. [3] Smokers wishing to quit may find it helpful to telephone the national helpline on 0800 169 0169. Pregnant women seeking help in stopping smoking should call 0800 169 9169 where specialist counsellors are available from 1pm to 9pm, 7 days a week, to give advice. QUIT also operates specialist advice lines in the main Asian languages and in Turkish and Kurdish.

Beneficial health changes when you stop smoking
Stop smoking and the body will begin to repair the damage done almost immediately, kick-starting a series of beneficial health changes that continue for years. [4]

Time since quitting
Beneficial health changes that take place
20 minutes
Blood pressure and pulse rate return to normal.
8 hours
Nicotine and carbon monoxide levels in blood reduce by half, oxygen levels return to normal.
24 hours
Carbon monoxide will be eliminated from the body.Lungs start to clear out mucus and other smoking debris.
48 hours
There is no nicotine left in the body.Ability to taste and smell is greatly improved.
72 hours
Breathing becomes easier.Bronchial tubes begin to relax and energy levels increase.
2 - 12 weeks
Circulation improves.
3 - 9 months
Coughs, wheezing and breathing problems improve as lung function is increased by up to 10%.
1 year
Risk of a heart attack falls to about half that of a smoker.
10 years
Risk of lung cancer falls to half that of a smoker.
15 years
Risk of heart attack falls to the same as someone who has never smoked.

Withdrawal symptoms
Withdrawal symptoms are the physical and mental changes that occur following interruption or termination of drug use. They are normally temporary and are a product of the physical or psychological adaptation to long-term drug use, requiring a period of re-adjustment when the drug is no longer ingested. In the case of smoking, some of these are: [5]

Withdrawal symptom
Duration
Proportion of those trying to quit who are affected
Irritability / aggression
Less than 4 weeks
50%
Depression
Less than 4 weeks
60%
Restlessness
Less than 4 weeks
60%
Poor concentration
Less than 2 weeks
60%
Increased appetite
Greater than 10 weeks
70%
Light-headedness
Less than 48 hours
10%
Night-time awakenings
Less than 1 week
25%
Craving
Greater than 2 weeks
70%

Weight gain
The possibility of weight gain is often of particular concern to those who want to give up smoking. More than 80% of smokers will gain weight once they quit smoking but the long-term weight gain is on average only 6-8lbs for each smoker who quits. [6] However, this is the weight gain made without recourse to any special attempts at dieting or exercise and it presents a minor health risk when compared to the risk of continued smoking. In addition, improved lung function and some of the other health benefits of giving up smoking are likely to make exercise both easier and more beneficial. See QUIT’s guide to stopping smoking without putting on weight for further advice.

Pipes & cigars
Some smokers switch to pipes or cigars in the belief that this is a less dangerous form of smoking. However, such smokers may incur the same risks and may even increase them, especially if they inhale the pipe or cigar smoke. [7]

Smoking cessation aids
There are two proven pharmaceutical aids to stopping smoking: nicotine replacement therapy and bupropion, known by its tradename, Zyban. Nicotine replacement therapies (NRT), such as chewing gum, skin patch, tablet, nasal spray or inhaler, are designed to help the smoker to break the habit while providing a reduced dose of nicotine to overcome withdrawal symptoms such as craving and mood changes. Studies have shown that NRT roughly doubles the chances of a smoker successfully quitting compared to someone using no therapy. [8]

Bupropion, (Zyban) works by de-sensitising the brain’s nicotine receptors and has similar success rates to NRT. The course of treatment lasts around 8 weeks. It is only available on prescription under medical supervision. Zyban is safe for most healthy adults but there are side effects, the most serious of which is the risk of seizures (fits). This risk is estimated to be less than 1 in 1000 but other less serious side effects such as insomnia, dry mouth and headaches are more common. An independent review by the Consumers’ Association concluded that “when used in a specialist setting and in conjunction with regular counselling, bupropion is at least twice as effective as placebo in helping patients to stop smoking”. [9]

Other cessation aids
Acupuncture and hypnosis. A review of alternative stop smoking aids found little evidence to support the effectiveness of either acupuncture or hypnosis as a means of stopping smoking but such methods may suit some smokers. [10]

Herbal cigarettes. These are not recommended as an aid to giving up smoking because they produce both tar and carbon monoxide. Some brands have a tar content equivalent to tobacco cigarettes. In addition, the use of herbal cigarettes reinforces the habit of smoking which smokers need to overcome.

Clinics and self-help groups. Smokers who are motivated to quit the habit may benefit from cessation clinics or self-help groups, although smokers should be cautious about claims of high success rates made by some private clinics. A review of smoking cessation products and services found that smokers are up to four times more likely to stop smoking by attending specialist smokers’ clinics than by using willpower alone. [11] Free stop smoking clinics are now available across the UK. Validated results for the English services show that around one third of those attending are able to quit after 4 weeks.[12]

New stop smoking medications. New medications are being developed to help people stop smoking. These include verenicline, a drug that stops nicotine reaching the nicotinic receptors in the brain, thereby removing the satisfaction that smokers get from smoking. Other drugs having a similar effect include rimonabant and a nicotine vaccine. It will be some years before these products are made available in the UK. [13]





References
[1] Nicotine Addiction in Britain. A report of the Royal College of Physicians, February 2000 [View report]
[2] Lader,D & Goddard,E. Smoking-related behaviour and attitudes, 2004. London, ONS, 2005
[3] Smoking cessation guidelines and their cost effectiveness.. Thorax 1998; vol 53: S5 (part 2) S11-S16 [Viewpdf]
[4] The Health Benefits of Smoking Cessation: A report of the Surgeon General. US DHHS, 1990.
[5] West, R. Tobacco withdrawal symptoms. St. George’s Hospital Medical School, 1996.
[6] West, R. Tobacco withdrawal symptoms. St. George’s Hospital Medical School, 1996
[7] Cigars: Health effects and trends. National Cancer Institute, 1998
[8] Nicotine replacement therapy for smoking cessation. The Cochrane Library, Issue 3, May 2001 [View abstract]
[9] Bupropion to aid smoking cessation. Drug and Therapeutics Bulletin. Vol 38 no.10 Oct. 2000
[10] Abstracts of the Cochrane review. The Cochrane Library, Issue 3, 2001 [View abstracts]
[11] West, R. Getting serious about stopping smoking - a review of products, services and techniques. 1997.
[12] Statistics on NHS stop smoking services in England, April 2004 to March 2005. NHS Health and Social Care Information Centre. Statistical Bulletin 2005/03/HSCIC October 2005. (View report)
[13] West, R and Shiffman, S. Smoking cessation. Fast Facts. Oxford, Health Press, 2004

Quitting Spit and Other Forms of Oral Tobacco

Quitting Spit and Other Forms of Oral Tobacco
Introduction
Spit and other forms of oral tobacco can cause cancer of the mouth and throat, as well as several other health problems. There are many terms used to describe spit tobacco, such as oral, smokeless, chewing, and snuff tobacco. The use of spit tobacco by any name is a significant health risk and it is not a safe substitute for smoking cigarettes.
This document is intended to describe spit tobacco and its use, to outline some of the health problems it can cause, and to provide information that can help you quit.

Contents:What Is Spit Tobacco?Can Using Spit Tobacco Harm You?Who Uses Spit Tobaccot?Why Quit?Setting a Quit Date and Deciding on a PlanDealing With WithdrawalStaying QuitStress
What Is Spit Tobacco?
Spit tobacco commonly comes in 2 different forms: snuff and chewing tobacco. Snuff, a fine ground tobacco, comes in cans or pouches. It can be dry or moist. Users take a "pinch," "dip," or "quid," and place it between the lower lip or cheek and gum and suck on it. It is also available in small, tea bag like pouches or sachets that can be placed between the cheek and gum; these are designed to be both “smoke-free” and “spit-free” and are thought to be easier and neater to use and throw away. Some people prefer to sniff or inhale snuff up their nose. Chewing tobacco comes in pouches in the form of long strands of loose leaves, plugs, or twists of tobacco that, when used, are commonly called "plugs," "wads," or "chew." Most spit tobacco users place the product in their cheek or between their gum and cheek. Users then suck on the tobacco and spit out the tobacco juices, which is why smokeless oral tobacco is often referred to as spit or spitting tobacco.
In light of the smoking bans being enforced across the United States, the tobacco industry is actively researching, advertising, and test marketing their various spit tobacco products. Free samples and coupons are being offered to encourage people to change their tobacco consumption practices rather than quit. New products that might have greater appeal are being introduced. For example, a Swedish product called “snus,” which is made of mainly air-cured tobaccos, water, salt, and flavor additives is now available in the United States. Another new product, called a “tobacco substitute,” is being test marketed. It is made of black tea and nicotine extract.
Who Uses Spit Tobacco?
Data from the US Centers for Disease Control and Prevention (CDC) showed that among adults aged 18 and older in 2004, about 3% of people (6% of men and 1% of women) were current users of spit tobacco.
Rates among young people, however, are higher. According to CDC's 2005 National Youth Risk Behavior Surveillance, about 14% of male high school students and 2% of female high school students were using spit tobacco. The CDC 2004 Tobacco Survey reported that 2.9% of middle school students reported using spit tobacco at least once in the 30 days before the survey. Regardless of race, male students were more likely to use spit tobacco than female students.
Certain factors appear to influence whether young people will use tobacco or not. They include:
peer pressure
local lifestyles and fashions
general attitudes toward authority
economic conditions
examples set by teachers and school staff
presence of gangs
use of illegal drugs and alcohol
In 2003, more than 1 in 3 major league baseball players used spit tobacco, primarily moist snuff. Athletes are also the largest marketing source for spit tobacco, and are often seen on TV using it during a game. They exert considerable influence as negative role models for youth.
A more recent influence on the use of spit tobacco is the newly enacted smoking bans many states are enforcing. In light of these bans, tobacco companies are putting new marketing emphasis on their spit tobacco products. Multiple new, spit tobacco products are being advertised as alternatives to cigarettes in places where smoking is prohibited. The tobacco industry is hopeful that smokers looking for an alternative may try substituting these products before trying to quit.
Can Using Spit Tobacco Harm You?
In 1986, the US Surgeon General concluded that the use of smokeless tobacco is not a safe substitute for smoking cigarettes or cigars because these products cause various cancers and non-cancerous conditions. They can also lead to nicotine addiction. In fact, research shows that teens who use spit tobacco are more likely to become smokers.
The most serious health effect of spit tobacco is an increased risk of cancer of the mouth and pharynx (throat). These cancers occur several times more often among snuff dippers compared with non-tobacco users.
Other harmful health effects of chewing tobacco and snuff include:
addiction to nicotine
leukoplakia (white sores in the mouth that can lead to cancer)
gum recession (peeling back of gums)
bone loss around the teeth
abrasion of teeth
staining of teeth
bad breath
Leukoplakia is a white sore or patch in the mouth that can become cancerous. Studies have consistently found high rates of leukoplakia at the place in the mouth where users place the "chew." One study found that almost พ of daily users of moist snuff and chewing tobacco had non-cancerous or pre-cancerous lesions (sores) in the mouth. The longer you use smokeless tobacco, the more likely you are to have leukoplakia.
Many regular spit tobacco users have gum recession and bone loss around the teeth. The surface of the tooth root may be exposed where gums have drawn back. Tobacco can irritate or destroy the tissue.
Spit tobacco may also play a role in heart disease and high blood pressure. Nicotine, the addictive substance in tobacco, enters the user’s bloodstream through the lining of the mouth and/or the digestive tract. Nicotine causes your heart to beat faster and your blood pressure to go up.
As mentioned above, the tobacco industry is hoping that the recent development of smoking bans will lead smokers to try spit tobacco products as alternatives to cigarettes before trying to quit. While some people have suggested that cigarette smokers should switch to spit tobacco as a safer option, most medical experts recommend quitting use of all tobacco products. Numerous clinical studies have shown that nicotine replacement therapy (such as nicotine patches, nicotine gum, etc.) can help people to quit smoking.
While using snuff and chewing tobacco may be less lethal than smoking, there is no evidence to support claims that these products are as safe and effective as nicotine replacement in helping smokers to quit.
Why Is It So Hard To Quit Using Spit Tobacco?
Tobacco Is Addictive
Nicotine is a drug found naturally in tobacco. It is highly addictive – as addictive as heroin or cocaine. Users become physically and psychologically dependent on nicotine, and studies have shown that they must overcome both of these dependencies to be successful at quitting and staying quit.
Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, your metabolism, and your brain. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.
Nicotine produces pleasurable feelings that make the tobacco user want to use more. It also acts as a kind of depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, tobacco users tend to increase the amount of tobacco they use, and hence the amount of nicotine in their blood. After a while, the tobacco user develops a tolerance to the drug, which leads to an increased use over time. Eventually, the tobacco user reaches a certain nicotine level and then keeps up the usage to maintain this level of nicotine.
Spit tobacco delivers a high dose of nicotine. An average dose for snuff is 3.6 milligrams (mg) and for chewing tobacco is 4.6 mg — compared to 1.8 mg for cigarettes. Spit tobacco consistently produces levels of nicotine higher than those seen with smoking and blood levels of nicotine throughout the day are similar among smokers and those who use spit tobacco.
Several different factors can affect how quickly the body gets rid of nicotine. In general, a regular smokeless tobacco user will probably have nicotine or its by-products present in the body for a few days after stopping.
Stopping spit tobacco use causes symptoms of nicotine withdrawal that are similar to those smokers get when they quit. In a study of Swedish oral snuff users, the participants reported having as much trouble giving up tobacco as did cigarette smokers trying to quit smoking. Evidence also suggests that when regular snuff users can't use snuff, they will smoke cigarettes to satisfy their need for nicotine.
Nicotine Withdrawal Symptoms
When spit tobacco users try to cut back or quit, the absence of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body is reacting to the absence of nicotine. Psychologically, the user is faced with giving up a habit, which is a major change in behavior. Both must be dealt with if quitting is to be successful.
Withdrawal symptoms can include any of the following:
dizziness
depression
feelings of frustration and anger
irritability
trouble sleeping
trouble concentrating
restlessness
headaches
tiredness
increased appetite
These uncomfortable feelings can lead you to start using tobacco again to boost blood levels of nicotine to stop symptoms. Withdrawal symptoms can last for a few days to several weeks. For information on coping with withdrawal, please see the section "How to Quit."
Why Quit?
There are many reasons to stick it out through withdrawal and quit using spit tobacco for good. Health reasons, as mentioned earlier, are the obvious ones. But consider the following as well.
Social acceptance: Chewing and dipping carry a heavy social stigma, especially with the opposite sex. Bad breath, gum disease, and discolored teeth are very unappealing. The spitting associated with oral smokeless tobacco use can be offensive and has a potential health risk as well.
Cost: A tobacco habit can be expensive. It isn't hard to figure out how much you spend on tobacco: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been using tobacco and that amount will probably astound you.
Multiply the cost per year by 10 (for the upcoming 10 years) and ask yourself what you would rather do with that much money. Do you really want to continue wasting your money with nothing to show for it except possible health problems?
Setting an example: If you have children, you want to set a good example for them. When asked, nearly all spit tobacco users say they don't want their children to chew or dip. You can become a good role model for them if you quit now.
Quitting Spit Tobacco
Surveys show that most people who use snuff or chew would like to quit. In 1 survey, more than half of the respondents said they would try to quit in the next year.
In many ways, quitting spit tobacco is a lot like quitting smoking. Both involve tobacco products that contain nicotine, and both involve the physical and psychological components of addiction. Many of the methods of handling the psychological hurdles of quitting are the same. There are 2 elements of quitting, however, that are unique for smokeless tobacco users:
There is often a stronger need for oral substitutes (having something in the mouth) to take the place of the chew, snuff, or pouch.
The disappearance of mouth sores and gum problems caused by the spit tobacco provides a readily visible benefit of quitting.
In This Section:Help with Psychological AddictionWhat About Medication? Nicotine Replacement Therapy Telephone-based Help Programs Support Other Unconventional Quitting Aids How to Quit Where Can I Go for Help?
Help With Psychological Addiction
Some people are able to quit on their own, without the help of others or the use of medicines. But for many tobacco users, it can be hard to break the social and emotional ties to chewing or dipping while getting over nicotine withdrawal symptoms at the same time. Fortunately, there are many sources of support out there – both formal and informal.
Telephone-based Help Programs
Most states run some type of free telephone-based quitting program, which links callers with trained counselors. These specialists help plan a quit method that fits each person's unique pattern of tobacco use. With guidance from a counselor, quitters can avoid common mistakes that may hurt a quit attempt.
Telephone counseling is also more convenient for many people than some other support programs. It doesn't require transportation or childcare, and it's available nights and weekends. Counselors may recommend a combination of methods including local classes, self-help brochures, medicines, and/or a network of family and friends.
Tobacco users can get help finding a program, such as the American Cancer Society’s Quitlineฎ tobacco cessation program, in their area by calling ACS at 1-800-ACS-2345.
Support of Family, Friends, and Quit Programs
Many former tobacco users say a support network of family and friends was very important during their quit attempt. Other people who may offer support and encouragement are coworkers, your family doctor, and members of support groups for quitters. You can check with your employer, health insurance company, or local hospital to find support groups; or call the ACS at 1-800-ACS-2345.
What to Look for in a Tobacco Cessation Group or Class
Tobacco cessation programs are designed to help users recognize and cope with problems that come up during quitting and to provide support and encouragement in staying quit. While many programs focus primarily on smokers, most are open to spit tobacco users as well.
Studies have shown that the best programs will include either individual or group counseling. There is a strong association between the intensity of counseling and the success rate. In general, the more intense the program, the greater the likelihood of success.
Intensity may be increased by having more or longer sessions or by increasing the number of weeks over which the sessions are given. So, when considering a program, look for one that has the following:
session length – at least 20 to 30 minutes per session
number of sessions – at least 4 to 7 sessions
number of weeks – at least 2 weeks
Be certain the leader of the group has training in tobacco cessation.
Some communities have a Nicotine Anonymous group that holds regular meetings. This group applies the principles of Alcoholics Anonymous to tobacco addiction. There is no fee to attend.
Often your local American Cancer Society or local health department will sponsor quitting classes. Call 1-800-ACS-2345 for more information.
There are some programs to be cautious about as well. Not all programs are ethical. Be very careful of programs that:
promise instant, easy success with no effort on your part;
use injections or pills with "secret" ingredients;
charge a very high fee – check with the Better Business Bureau if you have doubts; or
are not willing to provide references from people who have taken the class.
A Word About Success Rates
Before you sign up for a tobacco cessation class or program, you may wonder what its success rate is. That's a hard question to answer for several reasons. First, not all programs define “success” in the same way. Does success mean that a person is not using tobacco at the end of the program? after 3 months? 6 months? or a year? If a program you're considering claims a certain success rate, ask for more details on how success is defined and what kind of follow-up is done to verify the rate.
The truth is that while tobacco cessation programs may give you more of an edge than trying to quit on your own, they (like other programs that treat addictions) often have a fairly low overall success rate. But that does not mean they are not worthwhile, or that you should be discouraged. Your own success in quitting is what really counts, and that is under your control.
What About Medication?
Tobacco addiction has both a psychological and a physical component. Physical addiction can cause you to go through withdrawal symptoms if you try to quit, and for many people this is a difficult part of addiction to overcome.
Nicotine Replacement Therapy (NRT)
Nicotine replacements (nicotine substitutes) provide nicotine without the other harmful components of tobacco. For cigarette smokers, nicotine replacement therapy (NRT) has been proven to help reduce withdrawal symptoms. Together with counseling or other support, it doubles the chances that a smoker will quit.
The US Food and Drug Administration (FDA) has approved several NRT products as effective aids for helping people to quit smoking. These include:
nicotine gum
nicotine patch
nicotine lozenges
nicotine inhaler
nicotine nasal spray
(For more information on these products, see the American Cancer Society document, “ Guide to Quitting Smoking.")
However, none of these products has been FDA approved specifically to help people quit spit tobacco, as their effectiveness in this situation has not been proven. The results of several small studies have been mixed, and larger studies are needed. Still, nicotine replacement therapy may be useful in helping you quit, or at least in helping to reduce your cravings.
Nicotine gum, patches, and lozenges can be bought “over the counter” (without a prescription). Nicotine nasal spray and nasal inhalers are available only with a doctor’s prescription.
For spit tobacco users, some types of NRT may be more helpful than others. From a behavioral standpoint, nicotine gum and lozenges are oral substitutes that most closely resemble using spit tobacco. They also allow you to control your dosage to help keep cravings at bay. The nicotine inhaler may not be as useful for spit tobacco users, as it is designed to look and feel like a cigarette filter tip. The nicotine patch provides a steady dose of nicotine but may not help with strong cravings. It may be more useful for people who prefer once-a-day convenience.
No matter which type of NRT you choose, make sure to follow the package instructions and don't use any tobacco, including spit tobacco, when using nicotine replacement. You may want to talk with your doctor, dentist, or pharmacist before using any of these products.
Getting the most from nicotine replacement: Nicotine replacement therapy only deals with the physical aspects of addiction. These products are best used in combination with other quitting aids such as group sessions or counseling. They may reduce withdrawal symptoms, allowing you to concentrate on dealing with the psychological aspects of addiction.
If you choose to use it, the most effective time to start nicotine replacement is at the beginning of an attempt to quit. Often tobacco users attempt to quit first on their own, then decide to try nicotine replacement therapy. You should not use nicotine replacement if you plan to continue to use any tobacco product. The combined dose of nicotine can be dangerous to your health.
Tobacco users who are pregnant or have heart disease should consult with their doctor before using over the counter nicotine replacement.
Prescription Medicines
Bupropion (Zyban): Bupropion is a prescription antidepressant in an extended-release form that reduces symptoms of nicotine withdrawal. It is not a form of nicotine replacement. This drug affects chemicals in the brain that are related to nicotine craving. Bupropion is FDA approved as an aid in quitting smoking, but it is not clear if it is useful for spit tobacco users as well. Talk to your doctor to find out if it might be an option for you.
Bupropion can be used alone or together with nicotine replacement. It should not be taken if you have a history of seizures, anorexia, heavy alcohol use, or head trauma.
Varenicline (Chantix): Varenicline is taken as a pill twice a day. Once in the body, it works by interfering with nicotine receptors in the brain. This reduces the physical pleasure derived from taking in nicotine and helps lessen the symptoms of nicotine withdrawal. Studies have shown it to be at least as effective as bupropion (if not more so) in helping people quit smoking, at least in the short term. Its effects against spit tobacco have not been studied.
Substances Not Considered to Be “Drugs”
Some newer tobacco-related and nicotine-containing products have appeared in the past few years. Because they are not marketed to treat nicotine addiction, the FDA doesn’t consider them to be drugs and therefore doesn’t regulate them. While some may be helpful, none of these products has been proven effective.
Non-tobacco snuff products: These are sold in grocery and convenience stores or by mail order. They are packaged like moist snuff in a tin and come in different flavors. They are made from plant or herbal products such as tea, clover, mint leaves, or alfalfa, sometimes with added flavoring. They can be used alone or mixed with regular snuff in an attempt to "wean" off tobacco. They are generally considered safe, but are not reviewed by the FDA. No studies have been done to determine how effective they are as aids to quitting tobacco.
Tobacco lozenges and pouches: Lozenges containing tobacco (Ariva, Interval) and small, tobacco-containing pouches (Revel, Exalt) are now being marketed as alternative ways for smokers to get nicotine in places where smoking is not permitted, rather than as tobacco cessation aids. The FDA has ruled that these are types of spit tobacco, not smoking cessation aids; therefore, the FDA does not have authority over them. There is no reason to think these products would have fewer health risks than conventional spit tobacco.
Nicotine lollipops and lip balms: In the past, some pharmacies made a product called a "nicotine lollipop." These lollipops often contained a product called nicotine salicylate with a sugar sweetener. Nicotine salicylate is not approved for pharmacy use by the FDA. The FDA has warned several pharmacies to stop selling nicotine lollipops and lip balm, calling the products "illegal." The FDA also said "the candy-like products present a risk of accidental use by children."
Other similar smoking cessation products may not use nicotine salicylate, and therefore may be legal. However, they still pose a risk for children if they are not sufficiently labeled and stored safely.
Nicotine water and nicotine wafers: These products have been sold in recent years as ways to get nicotine in places where smoking is not permitted. They are not marketed as aids to quitting smoking, but questions about their safety and legality have been raised.
Other Unconventional Quitting Aids
Hypnosis: This might be useful for some people, although there is very little evidence to support its effectiveness. Ask your doctor if he or she can recommend a good hypnotist if you are interested in this.
Acupuncture: This has also been used for quitting tobacco, but as of yet there is no strong evidence to support its effectiveness. It involves inserting small needles into the skin, usually around the ears. For a list of local physician acupuncturists, contact the American Academy of Medical Acupuncture at 1-800-521-2262. Low-level laser therapy is a related technique, which also has very little evidence to support its effectiveness.
Tobacco deterrents: These include over-the-counter products that change the taste of tobacco, "quitting diets" that supposedly curb nicotine cravings, and combinations of vitamins. There is little scientific evidence to support their claims.
“Homeopathic” aids and herbal supplements: Because they are marketed as dietary supplements (as opposed to drugs), these products don’t need FDA approval to be sold. The manufacturers don’t have to prove they’re effective, or even safe. Be sure to look closely at the label of any product claiming it can help you quit tobacco. No dietary supplement has been proven effective in helping people quit.
How to Quit
Tobacco users often say, "Don't tell me why to quit, tell me how." There is no one right way to quit, but there are some key elements in quitting successfully. These 4 factors are crucial:
making the decision to quit
setting a quit date and choosing a quit plan
dealing with withdrawal
staying quit (maintenance)
Making the Decision to Quit
The decision to quit tobacco use is one that only you can make. Others may want you to quit, but in order for you to get through the first few weeks without tobacco, the real commitment must come from you.
Researchers have looked into how and why people stop tobacco use. They have some ideas, or models, of how this happens.
The Health Belief Model says that you will be more likely to stop tobacco use if you:
believe that you could get a tobacco-related disease and this worries you;
believe that you can make an honest attempt at quitting;
believe that the benefits of quitting outweigh the benefits of continuing tobacco use; or
know of someone who has had health problems as a result of their tobacco use
Do any of these apply to you?
The Stages of Change Model identifies the stages that you go through when you make a change in behavior. Here are the stages as they apply to quitting tobacco use:
Pre-contemplation: At this stage, the tobacco user is not thinking seriously about quitting right now.
Contemplation: The tobacco user is actively thinking about quitting but is not quite ready to make a serious attempt yet. This person may say, "Yes, I'm ready to quit, but the stress at work is too much, or I don't want to gain weight, or I'm not sure if I can do it."
Preparation: Tobacco users in the preparation stage seriously intend to quit in the next month and often have tried to quit in the past 12 months. They usually have a plan.
Action: This is the first 6 months when the user is actively quitting.
Maintenance: This is the period of 6 months to 5 years after quitting when the ex-user is aware of the danger of relapse and take steps to avoid it.
Where do you fit in this model? If you are thinking about quitting, setting a date and deciding on a plan will move you into the preparation stage, the best place to start.
Make a list of your reasons for quitting: Tobacco users have a variety of reasons for wanting to quit. We listed some of them above. But what motivates you to quit may not be the same as what motivates others. Think about making a list of the reasons you want to quit – one you can refer back to later if you’re feeling tempted. The list might include some or all of the following, but be sure to add your own reasons:
I want to be healthier.
I already have problems with my gums/teeth, and I don’t want them to get worse.
I don’t want to spend money on this.
I can’t chew/dip at work/school.
I want to be able to go to a movie/mall/ballgame without worrying about it.
I want to prove I can do it.
I don’t want it to control me.
The people I care about don’t like it, and want me to quit.
I want to set a good example for my kids.
Setting a Quit Date and Deciding on a Plan
Once you've made a decision to quit, you're ready to pick a quit date. This is a very important step. Pick a specific day within the next month as your “Quit Day.” Picking a date too far in the future allows you time to rationalize and change your mind. But do give yourself enough time to prepare and come up with a plan. You might choose a date that has a special meaning like a birthday or anniversary, or the date of the Great American Smokeout (the third Thursday in November each year). Or you may want to simply pick a random date. Circle the date on your calendar. Make a strong, personal commitment to quit on that day. There is no one right way to quit. Some tobacco users prefer to quit "cold turkey" – that is, abruptly and totally. They use tobacco until their Quit Day and then stop all at once, or they may cut down on tobacco for 1 or 2 weeks before their Quit Day. Another way involves cutting down on the number of times or the amount you dip or chew each day. With this method, you gradually reduce the amount of nicotine in your body.
There is no one right way to quit. Some tobacco users prefer to quit "cold turkey" – that is, abruptly and totally. They use tobacco until their Quit Day and then stop all at once, or they may cut down on tobacco for 1 or 2 weeks before their Quit Day. Another way is to cut down on the number of times or the amount you dip or chew each day. With this method, you gradually reduce the amount of nicotine in your body.
Quitting tobacco is a lot like losing weight; it takes a strong commitment over a long period of time. Users may wish there were a magic bullet – a pill or method that would make quitting painless and easy. But that is not the case. Nicotine substitutes can help reduce withdrawal symptoms, but they are most effective when used as part of a quitting plan that addresses both the physical and psychological components of quitting.
Here are some steps to help you prepare for your Quit Day:
Pick the date and mark it on your calendar.
Tell friends, family, and co-workers about your Quit Day, and let them know how they can help.
Stock up on oral substitutes – sunflower seeds, sugarless gum, carrot sticks, beef jerky, cinnamon sticks, and/or hard candy.
Decide on a plan. Will you use nicotine replacement therapy? Will you attend a class? If so, sign up now.
Consider seeing your doctor or dentist. Have them check your mouth, and discuss your plan for quitting with them.
Set up a support system. This could be a group class, Nicotine Anonymous, or a friend or family member who has quit and is willing to help you.
Make a list of your “triggers” – situations, places, or emotions that make you more likely to chew or dip. Being aware of these can help you avoid them or at least be ready for them.
Successful quitting is a matter of planning and commitment, not luck. Decide now on your own plan. Some possibilities include joining a tobacco cessation class, calling a Quitline, going to Nicotine Anonymous meetings, using nicotine replacement, or using self-help materials such as books and pamphlets. For the best chance of success, your plan should include 1 or more of these options.
On your Quit Day, follow these suggestions:
Don’t use tobacco.
Get rid of all snuff or chew and related products.
Keep active – try walking, exercising, or doing other activities or hobbies.
Keep oral substitutes handy.
Drink lots of water and juices.
Begin using nicotine replacement if that is your choice.
Call a Quitline, attend a tobacco cessation class, or start following a self-help plan.
Avoid situations where the urge to dip or chew is strong.
Reduce or avoid alcohol.
Dealing With Withdrawal
Withdrawal from nicotine has 2 parts – the physical and the psychological. The physical symptoms, while annoying, are not life threatening. If you choose to use nicotine replacement, it can help reduce many of these physical symptoms. But most users find that the bigger challenge is the psychological part of quitting.
If you have been using tobacco for any length of time, it has likely become linked with many of your activities – watching TV; attending sporting events; fishing, camping, or hunting; or driving your car. It will take time to "un-link" tobacco use from these activities. That’s why, even if you are using the patch or gum, you may still have strong urges to use tobacco.
One way to overcome these urges or cravings is to recognize rationalizations as they come up. A rationalization is a mistaken belief that seems to make sense at the time but is not based on facts. If you have tried to quit before, you’ll probably recognize some of these common rationalizations:
I’ll just use it to get through this rough spot.
Today is not a good day; I’ll quit tomorrow.
It's my only vice.
How bad is tobacco, really? Uncle Harry chewed all his life and he lived to be over 90.
You've got to die of something.
Life is no fun without chewing (or dipping).
You probably can add more to the list. As you go through the first few days without tobacco, write down any rationalizations as they come up and recognize them for what they are: messages that can trap you into going back to using tobacco. Use the ideas below to help you keep your commitment to quitting.
Avoid people and places where you are tempted to use tobacco. Later on you will be able to handle these with more confidence.
Alter your habits. For example, switch to juices or water instead of alcohol or coffee. Take a different route to work; take a brisk walk instead of a chew.
Alternatives. Use oral substitutes such as sunflower seeds, sugarless gum or hard candy, or raw vegetables such as carrot sticks.
Activities. Exercise or do hobbies that keep your hands busy (such as woodworking, puzzles, gardening) and can help distract you from the urge to use.
Deep breathing. When the urge to use strikes, breathe deeply and picture your lungs filling with fresh, clean air. Remind yourself of why you are quitting and the benefits you'll gain.
Delay. If you feel that you are on the verge of giving in, delay. Tell yourself you must wait at least 10 minutes. Often this simple trick will allow you to move beyond the immediate urge to use tobacco.
What you're doing is not easy, so you deserve a reward. Put the money you would have spent on tobacco in a jar every day and then buy yourself a weekly treat. Buy a magazine, go out to eat, call a friend long-distance. Or save the money for a major purchase. You can also reward yourself in ways that don't cost money: take time out to read, work on a hobby, or take a relaxing bath.
Staying Quit (Maintenance)
Staying quit is the final, and most important, stage of the process. You can use the same methods to stay quit as you did to help you through withdrawal. Plan ahead for those times when you may be tempted to use tobacco and think about alternatives and activities you can use to cope with these situations.
More dangerous, perhaps, are the unexpected strong desires to use tobacco that occur sometimes months (or even years) after you've quit. To get through these without relapse, try the following:
Review your reasons for quitting – look at your list and think of all the benefits to your health, your finances, and your family.
Remind yourself that there is no such thing as just one chew or dip.
Ride out the desire. It will go away, but do not fool yourself into thinking you can have just one.
What if you do use tobacco? The difference between a slip and a relapse is within your control. You can use the slip as an excuse to go back to using tobacco, or you can look at what went wrong and renew your commitment to staying off tobacco for good.
Even if you do relapse, try not to get too discouraged. Many people are not able to quit for good on the first attempt. In fact, it takes most people several attempts before quitting for good. What’s important is figuring out what helped you in your attempt to quit and what worked against you. You can then use this information to make a stronger attempt at quitting the next time.
Dealing with stress: Tobacco users often mention stress as one of the reasons for going back to using tobacco. Stress is a part of all of our lives. The difference is that tobacco users have come to use nicotine to help cope with stress. When quitting, you have to learn new ways of handling stress. This can be tough, especially during the first few days. It’s important to let those around you know what you’re going through and to ask them for their understanding.
Nicotine replacement can help to some extent, but for long-term success other strategies are needed.
Physical activity is a good stress reducer. It can also help with the temporary sense of depression that some tobacco users experience when they quit.
Stress-management classes and self-help books may also be helpful. Check your community newspaper, library, or bookstore.
Spiritual practices such as prayer and meditation have been used successfully with other addictions and are an integral part of 12-step recovery programs. These same principles can be applied to tobacco cessation and may help with stress reduction.
Where Can I Go for Help?
It’s hard to give up tobacco. But if you are a tobacco user you can quit! Many organizations offer information, counseling, and other services focusing on how to quit and where to go for help. Other good resources include your doctor, dentist, local hospital, or employer.
If you want to quit and need help, contact one of the following organizations.
American Cancer Society1-800-ACS-2345 (1-800-227-2345)Internet address: www.cancer.orgCenters for Disease Control and Prevention Office on Smoking and Health Telephone: 1-800-CDC-4636 (1-800-232-4636)Internet address: www.cdc.gov/tobacco/how2quit.htm
National Cancer Institute Cancer Information Service1-877-448-7848Internet address: www.cancer.gov
Nicotine Anonymous 1-877-TRY-NICA (1-877-879-6422) Internet address: www.nicotine-anonymous.org
Smokefree.gov (info on state telephone-based counseling programs) 1-800-QUITNOW (1-800-784-8669) Internet address: www.smokefree.gov
References
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American Cancer Society. Cancer Facts & Figures 2007. Atlanta, GA. 2007.
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Benowitz NL. Pharmacologic aspects of cigarette smoking and nicotine addiction. New Engl J Med. 1988;319:1318-1330.
Benowitz NL, Jacob P III, Yu L. Daily use of smokeless tobacco: Systemic effects. Ann Intern Med. 1989;111:112-116.
Centers for Disease Control and Prevention (CDC). Use of smokeless tobacco among adults, 1991. MMWR. 1993. 42;263-266. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/00020232.htm. Accessed October 18, 2005.
Centers for Disease Control and Prevention (CDC). Tobacco use, access, and exposure to tobacco in media among middle and high school students – United States, 2004. MMWR. 2005;54;297-301. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a1.htm. Accessed October 18, 2005.
Ebbert JO, Rowland LC, Montori V, et al. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev. 2004:CD004306.
Elder JP, Wildey M, de Moor C, et al. The long-term prevention of tobacco use among junior high school students: Classroom and telephone interventions. Am J Publ Health. 1993;83:1239-44.
Hatsukami KD, Gust SW, Keenan RM. Physiologic and subjective changes from smokeless tobacco withdrawal. Clinical Pharmacology and Therapeutics. 1987;41:103-107.
Henley SJ, Thun MJ, Connell C, et al. Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States). Cancer Causes Control. 2005;16:347-358.
Holm H, Jarvis MJ, Russwell MAH, Feyerabend C. Nicotine intake and dependence in Swedish snuff takers. Psychopharmacology. 1992;108:507-511.
National Institute of Dental and Craniofacial Research. Spit tobacco: A guide for quitting. May 2005. Available at: www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/SpitTobacco/QuittingGuide/. Accessed October 18, 2005.
Office of the US Surgeon General. Tobacco Use Among US Racial/Ethnic Minority Groups. A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1998. Available at: www.cdc.gov/tobacco/sgr/sgr_1998/index.htm. Accessed October 18, 2005.
Office of the US Surgeon General. The Health Consequences of Using Smokeless Tobacco: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1986. Available at: http://profiles.nlm.nih.gov/NN/B/B/F/C/. Accessed October 18, 2005.
Severson HH. Enough Snuff: A Guide for Quitting on Your Own. 6th edition. Eugene, Oregon: Applied Behavior Science Press. 2002.
Severson HH, Klein K, Lichtenstein E, et al. Smokeless tobacco use among professional baseball players: Survey results, 1998 to 2003. Tob Control. 2005;14:31-36.
Substance Abuse and Mental Health Services Administration. Results from the 2002 National Survey on Drug Use and Health. Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2003. Available at: http:/www.oas.samhsa.gov/nhsda/2k2nsduh/Sect2peTabs35to39.pdf. Accessed October 18, 2005.
The S.T.O.P. Guide: Smokeless Tobacco Cessation. Applied Behavioral Science Press. 2002.

Guide to Quitting Smoking

The US Surgeon General has stated, "Smoking cessation (stopping smoking) represents the single most important step that smokers can take to enhance the length and quality of their lives."
Quitting smoking is not easy, but it can be done. To have the best chance of quitting successfully, you need to know what you’re up against, what your options are, and where to go for help. This document will provide you with this information.
Why Is It So Hard to Quit Smoking?
Mark Twain said, "Quitting smoking is easy. I've done it a thousand times." Maybe you've tried to quit too. Why is quitting and staying quit hard for so many people? The answer is nicotine.
Nicotine
Nicotine is a drug found naturally in tobacco. It is highly addictive – as addictive as heroin or cocaine. Over time, the body becomes both physically and psychologically dependent on nicotine. Studies have shown that smokers must overcome both of these addictions to be successful at quitting and staying quit.
When smoke is inhaled, nicotine is carried deep into the lungs, where it is absorbed quickly into the bloodstream and carried throughout the body. Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, your metabolism, and your brain. Nicotine can be found in breast milk and even in cervix mucous secretions of smokers. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.
Several different factors can affect the rate of metabolism (the work of the living cell in the body) and excretion (or getting rid of the waste) related to nicotine. In general, a regular smoker will have nicotine or its by-products present in the body for about 3 to 4 days after stopping.
Nicotine produces pleasant feelings that make the smoker want to smoke more. It also acts as a kind of depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, smokers tend to increase the number of cigarettes they smoke, and therefore the amount of nicotine in their blood. After a while, the smoker develops a tolerance to the drug, which leads to an increase in smoking over time. Over time, the smoker reaches a certain nicotine level and then smokes to maintain this level of nicotine. In fact, nicotine, when inhaled in cigarette smoke, reaches the brain faster than drugs that enter the body intravenously.
Nicotine Withdrawal
When smokers try to cut back or quit, the absence of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body reacts to the absence of nicotine. Psychologically, the smoker is faced with giving up a habit, which requires a major change in behavior. Both must be addressed in order for the quitting process to work.
Withdrawal symptoms can include any of the following:
dizziness (which may only last 1-2 days in the beginning)
depression
feelings of frustration and anger
irritability
sleep disturbances, including having trouble falling asleep, staying asleep and having bad dreams or even nightmares
trouble concentrating
restlessness
headache
tiredness
increased appetite
These symptoms can lead the smoker to again start smoking cigarettes again to boost blood levels of nicotine back to a level where there are no symptoms.
If a person has smoked regularly for a few weeks or longer and abruptly stops using tobacco or greatly reduces the amount smoked, withdrawal symptoms will occur. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later. Withdrawal symptoms can last for a few days to several weeks. For information on coping with withdrawal, see the section, "How to Quit."
Why Quit?
Your Health
Health concerns usually top the list of reasons people give for quitting smoking. About half of all smokers who continue to smoke will end up dying from a smoking-related illness. Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer as well, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemias. For the first time, the Surgeon General includes pneumonia in the list of diseases caused by smoking.
Smoking increases the risk of lung diseases such as emphysema and chronic bronchitis. These progressive lung diseases – grouped under the term COPD (chronic obstructive pulmonary disease) – are usually diagnosed in current or former smokers in their 60s and 70s. COPD causes chronic illness and disability and is eventually fatal.
Smokers are twice as likely to die from heart attacks as are nonsmokers. And smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles, as well as cerebrovascular disease that can cause strokes.
Smoking also causes premature wrinkling of the skin, bad breath, bad smelling clothes and hair, and yellow fingernails and hair, yellow fingernails and an increased risk of macular degeneration, one of the most common causes of blindness in the elderly.
For women, there are unique risks. Women over 35 who smoke and use birth control pills are in a high-risk group for heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to have a miscarriage or a lower birth-weight baby. Low birth-weight babies are more likely to die or to be impaired.
Based on data collected in the late 1990s, the US Centers for Disease Control (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.
No matter what your age or how long you've smoked, quitting will help you live longer. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who continue to smoke. Ex-smokers also enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health, and reduced rates of bronchitis and pneumonia.
Ex-smokers also enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health status, and reduced rates of bronchitis and pneumonia.
For decades the Surgeon General has reported the health risks associated with smoking. Regardless of your age or smoking history, there are advantages to quitting smoking. Benefits apply whether you are healthy or you already have smoking-related diseases. In 1990, the Surgeon General concluded:
Quitting smoking has major and immediate health benefits for men and women of all ages. Benefits apply to people with and without smoking-related disease.
Former smokers live longer than continuing smokers.
Quitting smoking decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.
Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth weight baby to that of women who never smoked.
The health benefits of quitting smoking far exceed any risks from the less than 10 pound weight gain or any adverse psychological effects that may follow quitting.
When Smokers Quit – What Are the Benefits Over Time?
20 minutes after quitting: Your heart rate and blood pressure drops.
12 hours after quitting: The carbon monoxide level in your blood drops to normal.
2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.
1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.
5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease.
15 years after quitting: The risk of coronary heart disease is that of a nonsmoker's.
Visible and Immediate Rewards of Quitting
Quitting helps stop the damaging effects of tobacco on your appearance including:
Premature wrinkling of the skin
Bad breath
Stained teeth
Gum disease
Bad smelling clothes and hair
Yellow fingernails
Kicking the tobacco habit offers benefits that you'll notice immediately and some that will develop gradually over time. These rewards can improve your day-to-day life immensely.
Food tastes better.
Your sense of smell returns to normal
Ordinary activities no longer leave you out of breath (for example, climbing stairs or light housework)
The prospect of better health is a major reason for quitting, but there are others as well.
Cost
Smoking is expensive. It isn't hard to figure out how much you spend on smoking: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been using tobacco and that amount will probably astound you.
Multiply the cost per year by 10 (for the upcoming 10 years) and ask yourself what you would rather do with that much money.
And this doesn’t include other possible expenses, such as higher costs for health and life insurance, as well as the health care costs due to tobacco-related conditions.
Social Acceptance
Smoking is less socially acceptable now than it was in the past.
Most workplaces have some type of smoking restrictions. Some employers even prefer to hire nonsmokers. Studies show smoking employees cost businesses more to employ because they are "out sick" more frequently. Employees who are ill more often than others can raise an employer’s need for expensive temporary replacement workers. They can increase insurance costs both for other employees and for the employer, who typically pays part of the workers’ insurance premiums. Smokers in a building also typically increase the maintenance costs of keeping odors at an acceptable level, since residue from cigarette smoke clings to carpets, drapes, and other fabrics.
Landlords may choose not to rent to smokers since maintenance costs and insurance rates may rise when smokers occupy buildings.
Friends may ask you not to smoke in their houses or cars. Public buildings, concerts, and even sporting events are largely smoke-free. And more and more communities are restricting smoking in all public places, including restaurants and bars. Like it or not, finding a place to smoke can be a hassle.
Smokers may find their opportunities for dating or romantic involvement, including marriage, are largely limited to other smokers, who make up only about 1/4th of the population.
Health of Others
Smoking not only harms your health but the health of those around you. Exposure to secondhand smoke (also called environmental tobacco smoke or passive smoking) includes exhaled smoke as well as smoke from burning cigarettes.
Studies have shown that secondhand smoke causes thousands of deaths each year from lung cancer and heart disease in healthy nonsmokers.
Smoking by mothers is linked to a higher risk of their babies developing asthma in childhood, especially if the mother smokes while pregnant. It is also associated with sudden infant death syndrome (SIDS) and low-birth weight infants. Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis, and other respiratory problems than children from nonsmoking families. Secondhand smoke can also cause eye irritation, headaches, nausea, and dizziness.
Setting an Example
If you have children, you probably want to set a good example for them. When asked, nearly all smokers say they don't want their children to smoke, but children whose parents smoke are more likely to start smoking themselves. You can become a good role model for them by quitting now.
Help Is Available
With the wide range of counseling services, self-help materials, and medicines available today, smokers have more tools than ever to help them quit successfully.
Remember, tobacco addiction has both a psychological and a physical component. For most people, the best way to quit will be some combination of medicine, a method to change personal habits, and emotional support. The following sections describe these tools and how they may be helpful for you.
In This Section:What About Nicotine Replacement Therapy? Types of Nicotine Substitutes Which Is Right for You? Other Methods of Quitting Telephone-based Help to Stop Smoking Support A Word About Success Rates Special Concerns Where Can I Go for Help
Help With Psychological Addiction
Some people are able to quit on their own, without the help of others or the use of medicines. But for many smokers, it can be hard to break the social and emotional ties to smoking while getting over nicotine withdrawal symptoms at the same time. Fortunately, there are many sources of support out there – both formal and informal.
Telephone-based Help to Stop Smoking
Most states run some type of free telephone-based program, such as the American Cancer Society’s Quitlineฎ tobacco cessation program that links callers with trained counselors. These specialists help plan a quit method that fits each person's unique smoking pattern. People who use telephone counseling stop smoking at twice the rate of those who don't get this type of help. With guidance from a counselor, quitters can avoid common mistakes that may self-destruct a quit attempt.
Telephone counseling is also more convenient for many people than some other support programs. It doesn't require transportation or childcare, and it's available nights and weekends. Counselors may recommend a combination of methods including medicines, local classes, self-help brochures, and/or a network of family and friends.
Smokers can get help finding a Quitlineฎ phone counseling program in their area by calling ACS at 1-800-ACS-2345 or 1-800-227-2345.
Support of Family, Friends, and Quit Programs
Many former smokers say a support network of family and friends was very important during their quit attempt. Other people who may offer support and encouragement are coworkers, your family doctor, and members of support groups for quitters. You can check with your employer, health insurance company, or local hospital to find support groups or call the ACS at 1-800-ACS-2345.
What to Look for in a Stop-Smoking Program
Stop smoking programs are designed to help smokers recognize and cope with problems that come up during quitting and to provide support and encouragement in staying quit. Studies have shown that the best programs will include either individual or group counseling. There is a strong association between the intensity of counseling and the success rate. In general, the more intense the program, the greater the likelihood of success.
For example, intensity may be increased by having more or longer sessions or by increasing the number of weeks over which the sessions are given. So, when considering a program, look for one that has the following:
Session length – at least 20 to 30 minutes per session
Number of sessions – at least 4 to 7 sessions
Number of weeks – at least 2 weeks
Be certain the leader of the group has training in smoking cessation.
Some communities have a Nicotine Anonymous group that holds regular meetings. This group applies the principles of Alcoholics Anonymous to the addiction of smoking. This may include admitting you are powerless over your addiction to nicotine and having a sponsor to talk with when you are tempted to smoke. There is no fee to attend.
Often your local American Cancer Society, American Lung Association, or your local health department will sponsor quit smoking classes. Call 1-800-ACS-2345 for more information.
There are some programs to watch out for as well. Not all programs are ethical. You should be concerned about programs that do the following:
Promise instant, easy success with no effort on your part.
Use injections or pills, especially "secret" ingredients (nicotine replacement is covered elsewhere).
Charge a very high fee. Check with the Better Business Bureau if you have doubts.
Are not willing to provide references from people who have taken the class.
Help With Physical Addiction: Nicotine Replacement Therapy and Other Medicines
Nicotine Replacement Therapy
As mentioned earlier, the nicotine in cigarettes leads to actual physical dependence, which can cause unpleasant symptoms when a person tries to quit. Nicotine replacement therapy (NRT) provides nicotine – in the form of gums, patches, sprays, inhalers or lozenges – without the other harmful chemicals in tobacco. It can help relieve some of these symptoms so that you can concentrate more on the psychological aspects of quitting.
How Nicotine Replacement Works
Nicotine substitutes treat the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. By using a nicotine substitute, a smoker's withdrawal symptoms are reduced.
While a large number of smokers are able to quit smoking without nicotine replacement, most of those who attempt quitting are not successful on the first try. In fact, smokers usually need several attempts – sometimes as many as 8 to 10 – before they are able to quit for good.
Lack of success is often related to the onset of withdrawal symptoms. And most relapses occur within the first 3 months of quitting. So don't be discouraged if you start smoking again. Just begin again trying to quit and make your attempt more successful by adding another method or technique to help you quit. By reducing these symptoms with the use of nicotine replacement therapy and a support technique, smokers who want to quit have a better chance of being successful.
Getting the Most From Nicotine Replacement
Nicotine replacement therapy only deals with the physical aspects of addiction. It is not intended to be the only method used to help you quit smoking. It should be combined with other smoking cessation methods that address the psychological component of smoking, such as a stop smoking program. Studies have shown that approach - pairing NRT with a program that helps to change behavior – can double your chances of successfully quitting.
The US Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guideline on Smoking Cessation in 2000 recommended NRT for all smokers except pregnant women and people with heart or circulatory diseases. However,recent data suggests that nictotine replacement (specifically the nicotine patch) can be used safely even in people with cardiovascular disease who smoke under a doctor's careful monitoring. These studies have found the benefits of quitting smoking exceed the risks of nicotine replacement therapy in patients with cardiovascular disease. In all situations, the benefits of smoking cessation must outweigh the potential health risks. Smokers who are pregnant should also talk with their doctor before using over-the-counter nicotine replacement.
The most effective time to start NRT is at the beginning of an attempt to quit. Many smokers ask if it is possible to start a program of nicotine replacement while you are still smoking. There is some research being done with smokers using NRT while still smoking, but the results are still too early to say for certain if this is dangerous to your health. The most important consideration is to make sure that you are not overdosing on nicotine, which can have effects on your cardiovascular system. It is safest to be under a doctor's care if you wish to try smoking and using HRT while you are tapering down your cigarette use.
Often smokers first try to quit on their own, then decide to try NRT. This method does not give you the greatest chance of success, but do not let this discourage you. There are still many options available for quitting smoking successfully.
When May I Begin Using NRT?
You may start using nicotine replacement products as soon as you throw away that last cigarette. You do not need to wait a specific period of time to put on the patch or start using the method you have chosen. You should double check this information with the instructions on your chosen method of nicotine replacement, but in general there in no need to wait on beginning your nicotine replacement product.
Some NRT products make their recommendations based on whether you consider yourself a light, regular or heavy smoker. How are these categories determined?
There is no formal category in any textbook or group that specifically states what determines a light, average or heavy smoker. You will find different definitions for this information. In general a light smoker would be considered somewhere in the range of smoking fewer than 10 cigarettes per day. A heavy smoker would be considered a pack a day smoker. Sometimes a doctor will write on a chart a term called "pack year." A pack year is defined as smoking 20 cigarettes per day for 1 year. That is considered 1 pack year.
Types of Nicotine Substitutes
Five types of nicotine replacement therapy have been approved for use by the US Food and Drug Administration (FDA).
Nicotine patches (transdermal nicotine systems): Patches provide a measured dose of nicotine through the skin. As the nicotine doses are lowered by switching patches over a course of weeks, the tobacco user is weaned off nicotine. Patches can be purchased both with and without a prescription. Several types and different strengths are available. Package inserts describe how to use the product as well as special considerations and possible side effects.
The 16-hour patch works well for light-to-average tobacco users. It is less likely to cause side effects like skin irritation, racing heartbeat, sleep problems, and headache. But it does not deliver nicotine during the night, so it is not helpful for early morning withdrawal symptoms.
The 24-hour patch provides a steady dose of nicotine, avoiding peaks and troughs. It helps with early morning withdrawal. However, there may be more side effects such as disrupted sleep patterns and skin irritation.
Depending on body size, most tobacco users should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5-14 mg of nicotine) for another 4 weeks. The patch should be applied in the morning to a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist - for example, on the arm. The FDA recommends using the patch for a total of 3 to 5 months. However, some studies have shown that using it for 8 weeks or less is just as effective as using it for longer.
Side effects are related to:
The dose of nicotine
The brand of patch
Your individual skin characteristics (such as the person’s tendency to have a skin reaction to the patch)
How long you use the patch
How it is applied
Some possible side effects of the nicotine patch include:
Skin irritation – redness and itching
Dizziness
Racing heartbeat
Sleep problems or unusual dreams
Headache
Nausea
Vomiting
Muscle aches and stiffness
What to do about side effects:
Try a different brand of patch if skin irritation occurs.
Reduce the amount of nicotine by using a lower dose patch.
Sleep problems may be temporary and pass within 3 or 4 days. If not (and you're using a 24-hour patch), try switching to a 16-hour patch.
Stop using the patch and try a different form of nicotine replacement.
Nicotine gum (nicotine polacrilex): Nicotine gum is a fast-acting form of replacement that acts through the mucous membrane of the mouth. It can be bought over-the-counter without a prescription. It comes in 2 mg and 4 mg strengths.
For best results, follow the instructions of the package insert. Chew the gum slowly until you note a peppery taste. Then, "park" it against the cheek, chewing it and parking it off and on for about 20 to 30 minutes. Food and drink can affect how well the nicotine is absorbed. You should avoid acidic foods and drinks such as coffee, juices, and soft drinks for at least 15 minutes before and during gum use.
If you smoke a pack or more per day, smoke within 30 minutes of rising, or have trouble not smoking in restricted areas, you may need to start with the higher dose (4 mg). No more than 20 pieces should be used in one day. Nicotine gum is usually recommended for 1 to 3 months, with the maximum being 6 months. Tapering the amount of gum chewed may help you stop using it.
If you have sensitive skin, you may prefer the gum to the patch. Another advantage of nicotine gum is that it allows you to control the nicotine doses. The gum can be chewed as needed or on a fixed schedule during the day. The most recent data have shown that scheduled dosing is more effective. A schedule of 1 to 2 pieces per hour is common. On the other hand, with an as-needed schedule, you can chew more gum during a craving.
Some possible side effects of the gum:
Bad taste
Throat irritation
Mouth sores
Hiccups
Nausea
Jaw discomfort
Racing heartbeat
Symptoms related to the stomach and jaw are usually caused by improper use of the gum, such as swallowing nicotine or chewing too rapidly. The gum can also cause damage to dentures and dental prostheses.
Long-term dependence is one possible disadvantage of nicotine gum. In fact, research has shown that 15% to 20% of gum users who successfully quit smoking continue using the gum for a year or longer. Although the maximum recommended length of use is 6 months, continuing to use the gum is likely to be safer than going back to smoking. But since there is little research on the health effects of long-term nicotine gum use, most health care providers still recommend limiting its use to 6 months.
Nicotine nasal spray: The nasal spray delivers nicotine quickly to the bloodstream as it is absorbed through the nose. It is available only by prescription.
The nasal spray immediately relieves withdrawal symptoms and offers you a sense of control over nicotine cravings. Because it is easy to use, smokers report great satisfaction. However, the FDA cautions that since this product contains nicotine, it can be addictive. It recommends the spray be prescribed for 3-month periods and should not be used for longer than 6 months.
The most common side effects last about 1 to 2 weeks and can include the following:
Nasal irritation
Runny nose
Watery eyes
Sneezing
Throat irritation
Coughing
There is also the danger of using more than is needed. If you have asthma, allergies, nasal polyps, or sinus problems, your doctor may suggest another form of nicotine replacement.
Nicotine inhalers: Introduced in 1998, inhalers are available only by prescription. The nicotine inhaler is a plastic tube with a nicotine cartridge inside. When you puff on the inhaler, the cartridge provides a nicotine vapor. Unlike other inhalers, which deliver most of the medication to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth. In terms of similar behavior, nicotine inhalers are the closest thing to smoking a cigarette, which some smokers find helpful.
The recommended dose is between 6 and 16 cartridges a day, for up to 6 months.
The most common side effects, especially when first using the inhaler, include:
Coughing
Throat irritation
Upset stomach
At this time, inhalers are the most expensive of the forms of NRT available.
Nicotine lozenges: These are the newest form of NRT on the market. The FDA recently approved the first nicotine-containing lozenge as an over-the-counter aid in smoking cessation. As with nicotine gum, the Commit lozenge is available in 2 strengths: 2 mg and 4 mg. Smokers determine which dose is appropriate based on how long after waking up they normally have their first cigarette.
The lozenge manufacturer recommends using it as part of a 12-week program. The recommended dose is one lozenge every 1-2 hours for 6 weeks, then one lozenge every 2-4 hours for weeks 7 to 9, and finally, one lozenge every 4-8 hours for weeks 10 to 12. In addition, the manufacturer recommends the following:
Stop all tobacco use when beginning therapy with the lozenge.
Do not eat or drink for 15 minutes before using the lozenge. (Some beverages can reduce the effectiveness of the lozenge).
Suck on the lozenge until it dissolves. Do not bite or chew it like a hard candy, and do not swallow it.
Do not use more than 5 lozenges in 6 hours, or more than 20 lozenges total per day.
Stop using the lozenge after 12 weeks. If you still feel you need to use the lozenge, talk to your doctor.
Do not use the lozenge if you continue to smoke, chew tobacco, use snuff or any other product containing nicotine (e.g., nicotine patch or gum).
Possible side effects of the nicotine lozenge include:
Trouble sleeping
Nausea
Hiccups
Coughing
Heartburn
Headache
Flatulence (gas)
Which Type of Nicotine Replacement May Be Right for You?
There’s no evidence that any type of nicotine replacement therapy is significantly better than any other. When choosing which type of nicotine replacement you will use, think about which method will best fit your lifestyle and pattern of smoking. Do you want/need something to chew or occupy your hands? Or are you looking for once-a-day convenience?
Some important points to consider:
Nicotine gums, lozenges, and inhalers are oral substitutes that allow you to control your dosage to help keep cravings under better control.
Nicotine nasal spray works very quickly when you need it.
Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler.
Nicotine patches are convenient and only have to be applied once a day.
Both inhalers and nasal sprays require a doctor’s prescription.
Some people may not be able to use patches, inhalers, or nasal sprays due to allergies or other conditions.
Combination of the patch and other nicotine replacement products: Using the nicotine patch along with shorter-acting products such as the gum, lozenge, nasal spray, or inhaler is another method of nicotine replacement therapy. The idea is to provide a steady dose of nicotine with the patch and to use one of the shorter-acting products when strong cravings arise. The few studies that have been done on combination NRT have found that it may be slightly better than a single product, but more research is needed to prove this and to find safe and effective doses. The combined use of nicotine replacement products has not yet been approved by the FDA. If you are considering using more than one nicotine replacement product, be sure to discuss this with your doctor first.
High-Dose Nicotine Replacement Therapy
One of the newer concepts in nicotine replacement therapy is to give smokers a higher dose specifically titrated to the amount of nicotine that they have been using. Sometimes this method has required larger doses of nicotine than have been used traditionally in the past. High-dose nicotine replacement therapy with patches has been studied with patients receiving from 35 mg to 63 mg of nictotine at a time. The research suggests that patients' withdrawal symptoms disappear with these higher doses and their cravings decrease without any adverse cardiovascular side effects. Patient were carefully monitored in these studies to make sure they were doing well and were not becoming ill or having any problems. This is still a new procedure that should be considered only with a doctor's guidance and supervision.
Bupropion (Zyban)Bupropion (Zyban) is a prescription antidepressant in an extended-release form that reduces symptoms of nicotine withdrawal. It does not contain nicotine. This drug affects chemicals in the brain that are related to nicotine craving. It can be used alone or together with nicotine replacement. The usual dosage is one or two 150 mg tablets per day. This medication should not be taken if you have a history of seizures, anorexia, heavy alcohol use, or head trauma. Some doctors may recommend combination drug therapy for heavily addicted smokers, such as using bupropion along with a nicotine replacement patch and/or a short acting from of nicotine replacement (such as gum or lozenges).Varenicline (Chantix) Varenicline (Chantix) is a newer medicine developed specifically to help people stop smoking. It works by interfering with nicotine receptors in the brain, which has two effects. It lessens the pleasurable physical effects a person gets from smoking, as well as reducing the symptoms of nicotine withdrawal.Several studies have shown varenicline can more than double the chances of quitting smoking. Some studies have also found it may be more effective than bupropion, at least in the short term. Reported side effects of varenicline have included headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence (gas), and changes in taste. Although these side effects can occur, in general, Varenicline is well-tolerated. Since Varenicline is a new drug, research has not been done to determine if it is safe to use along with nicotine replacement products.
Other Methods of Quitting Other tools may also help some people, although there is no strong evidence they can improve your chances of quitting.Atropine and scopolamine combination therapy: Some smoking cessation clinics offer a program using shots of the anticholinergic drugs atropine and scopolamine to help reduce nicotine withdrawal symptoms. These drugs are more commonly prescribed for other reasons, such as digestive system problems, motion sickness, or Parkinson’s disease. The treatment usually involves shots given in the clinic on one day, followed by a few weeks of pills and wearing patches behind the ear. It may include other drugs to help with side effects as well.Possible side effects of this treatment can include dizziness, constipation, dry mouth, an altered sense of taste and smell, problems urinating, and blurry vision. People who are pregnant or have a history of heart problems, glaucoma, or uncontrolled high blood pressure are not allowed to participate in these programs. Some clinics claim high success rates, but there is no published scientific research to back up these claims. Both atropine and scopolamine are FDA approved for other uses, but they have not been formally studied or approved for help in quitting smoking. Before considering such a program, you may want to ask the clinic about long-term success rates (up to a year). Because these medicines are directed only at the physical aspect of quitting, you may also want to ask if the program includes counseling or other methods aimed at the psychological aspects of quitting.
Hypnosis might be useful for some people. Ask your doctor if he or she can recommend a good hypnotist if you are interested in this.
Acupuncture has been used for quitting smoking, but there is little evidence to support its effectiveness. Acupuncture, when it is done, is typically done on the ears on particular ear sites. Although there is a very weak suggestion that acupuncture might lower the desire for smoking, there still is no solid evidence that it is truly effective as a smoking cessation tool (see ACS document on Acupuncture.) For a list of local physician acupuncturists, contact the American Academy of Medical Acupuncture at 1-800-521-2262.
Low level laser therapy, also called cold laser therapy, is a related technique. Cold lasers are sometimes used for acupuncture, with laser beams to stimulate the body's acupoints rather than needles. The treatment is supposed to relax the smoker and release endorphins (naturally-occurring pain relief substances) in the body to simulate the effects of nicotine in the brain, or balance the body’s energy to relieve the addiction. Despite claims of success by some cold laser therapy providers, there is no scientific evidence that shows this is an effective method of helping people stop smoking (see ACS document on Cold Laser Therapy.)
Filters that reduce tar and nicotine in cigarettes are generally not effective since studies show that smokers who use filters actually tend to smoke more.
Smoking deterrents such as over-the-counter products that change the taste of tobacco, "stop smoking diets" that curb nicotine cravings, and combinations of vitamins have little scientific evidence to support their claims.
The same is true of “homeopathic” aids and herbal supplements. Because they are marketed as dietary supplements (as opposed to drugs), they don’t need FDA approval to be sold. The manufacturers don’t have to prove they’re effective, or even safe. Be sure to look closely at the product label of any product claiming it can help you stop smoking. No dietary supplement has been proven effective in helping people quit smoking. Some of these supplements have no nicotine in them, but have multiple combinations of herbal preparations. They too have no proven track record of helping people to stop smoking. Other Nicotine/Tobacco Products, Not Reviewed or Approved by the FDATobacco lozenges and pouches: Lozenges containing tobacco, (Ariva, Interval) and small, tobacco-containing pouches (Revel, Exalt) are being marketed as alternative ways for smokers to get nicotine in places where smoking is not permitted, rather than as quit smoking aids. The FDA has ruled that these are types of smokeless tobacco, not smoking cessation aids; therefore, the FDA does not have authority over them. There is no evidence that these products can help a person quit smoking.Nicotine lollipops and lip balms: In the past, some pharmacies made a product called a "nicotine lollipop". These lollipops often contained a product called nicotine salicylate with a sugar sweetener. Nicotine salicylate is not approved for pharmacy use by the FDA. The FDA has warned several pharmacies to stop selling nicotine lollipops and lip balm on the Internet, calling the products "illegal." The FDA also said "the candy-like products present a risk of accidental use by children."Other similar smoking cessation products may not use nicotine salicylate, and therefore may be legal. However, they still pose a risk for children if they are not sufficiently labeled and stored safely.Nicotine water and nicotine wafers: These products have been sold in recent years as ways to get nicotine in places where smoking is not permitted. They are not marketed as aids to quitting smoking, but questions about their safety and legality have been raised.
A Word About Quitting Success Rates
Before you start using nicotine replacement or sign up for a stop smoking class or program, you may wonder what its success rate is. That's a hard question to answer for several reasons. First, not all programs define success in the same way. Does success mean that a person is not smoking at the end of the program? After 3 months, 6 months, or 1 year? If a program you're considering claims a certain success rate, ask for more details on how success is defined and what kind of follow-up is done to verify the rate.
The truth is, quit smoking programs, like other programs that treat addictions, often have a fairly low success rate. But that does not mean they are not worthwhile or that you should be discouraged. Your own success in quitting is what really counts, and that is under your control. About 5% to 16% of people are able to quit smoking for at least 6 months without any medicine to help with withdrawal. Several articles in medical journals have reported that between about 25% and about 33% of smokers who use medicines can remain smoke-free for over 6 months. There is early evidence that combining some medicines may be more effective than using them alone. Behavioral and supportive therapies may increase success rates even further. Check the package insert of any product you are using to see if the manufacturer provides free telephone-based counseling.
How to Quit
Smokers often say, "Don't tell me why to quit, tell me how." There is no one right way to quit, but there are some key elements in quitting smoking successfully. These 4 factors are crucial:
Making the decision to quit
Setting a quit date and choosing a quit plan
Dealing with withdrawal
Staying quit (maintenance)
Making the Decision to Quit
The decision to quit tobacco use is one that only you can make. Others may want you to quit, but the real commitment must come from you.
Researchers have looked into how and why people stop tobacco use. They have some ideas, or models, of how this happens.
The Health Belief Model says that you will be more likely to stop tobacco use if you:
believe that you could get a tobacco-related disease and this worries you
believe that you can make an honest attempt at quitting
believe that the benefits of quitting outweigh the benefits of continuing tobacco use
know of someone who has had health problems as a result of their tobacco use
Does any of these apply to you?
The Stages of Change Model identifies the stages that you go through when you make a change in behavior. Here are the stages as they apply to quitting tobacco use:
Pre-contemplation: At this stage, the tobacco user is not thinking seriously about quitting right now.
Contemplation: The tobacco user is actively thinking about quitting but is not quite ready to make a serious attempt yet. This person may say, "Yes, I'm ready to quit, but the stress at work is too much, or I don't want to gain weight, or I'm not sure if I can do it."
Preparation: Tobacco users in the preparation stage seriously intend to quit in the next month and often have tried to quit in the past 12 months. They usually have a plan.
Action: This is the first 6 months when the user is actively quitting.
Maintenance: This is the period of 6 months to 5 years after quitting when the ex-user is aware of the danger of relapse and take steps to avoid it.
Where do you fit in this model? If you are thinking about quitting, setting a date and deciding on a plan will move you into the preparation stage, the best place to start.
Setting a Quit Date and Deciding on a Plan
Once you've made a decision to quit, you're ready to pick a quit date. This is a very important step. Pick a specific day within the next month as your "Quit Day." Picking a date too far in the future allows you time to rationalize and change your mind. But do give yourself enough time to prepare and come up with a plan. You might choose a date that has a special meaning like a birthday or anniversary, or the date of the Great American Smokeout (third Thursday in November each year). Or you may want to simply pick a random date. Circle the date on your calendar. Make a strong, personal commitment to quit on that day.
There is no one right way to quit. Most tobacco users prefer to quit "cold turkey" – that is, abruptly and totally. They use tobacco until their Quit Day and then stop all at once, or they may cut down on tobacco for a week or 2 before their Quit Day. Another way involves cutting down on the number of times tobacco is used each day. With this method, you gradually reduce the amount of nicotine in your body. While it sounds logical to cut down in order to quit gradually, in practice this method is difficult.
Quitting tobacco is a lot like losing weight; it takes a strong commitment over a long period of time. Users may wish there was a magic bullet – a pill or method that would make quitting painless and easy. But that is not the case. Nicotine substitutes can help reduce withdrawal symptoms, but they are most effective when used as part of a stop tobacco use plan that addresses both the physical and psychological components of quitting.
Here are some steps to help you prepare for your Quit Day:
Pick the date and mark it on your calendar.
Tell friends and family about your Quit Day.
Get rid of all the cigarettes and ashtrays in your home, car and place of work.
Stock up on oral substitutes – sugarless gum, carrot sticks, and/or hard candy.
Decide on a plan. Will you use NRT or other medications? Will you attend a class? If so, sign up now.
Practice saying, "No thank you, I don't smoke."
Set up a support system. This could be a group class, Nicotine Anonymous, or a friend or family member who has successfully quit and is willing to help you. Ask them not to smoke around you or leave cigarettes out where you can see them.
Think back to your past attempts to quit. Try to analyze what worked and what did not work for you.
Successful quitting is a matter of planning and commitment, not luck. Decide now on your own plan. Some possibilities include using the nicotine patch or gum, joining a tobacco cessation class, going to Nicotine Anonymous meetings, or using self-help materials such as books and pamphlets. For the best chance at success, your plan should include one or more of these options.
On your Quit Day, follow these suggestions:
Do not smoke. This means at all - not even one puff!
Keep active – try walking, exercising, or doing other activities or hobbies.
Drink lots of water and juices.
Begin using nicotine replacement if that is your choice.
Attend stop smoking class or start following a self-help plan.
Avoid situations where the urge to smoke is strong.
Reduce or avoid alcohol.
Think about changing your routine. Use a different route to work. Drink tea instead of coffee. Eat breakfast in a different place or eat different foods.
Dealing With Withdrawal
Withdrawal from nicotine has 2 parts – the physical and the psychological. The physical symptoms, while annoying, are not life threatening. Nicotine replacement can help reduce many of these physical symptoms. But most users find that the bigger challenge is the mental part of quitting.
If you have been smoking for any length of time, smoking has become linked with nearly everything you do – waking up in the morning, eating, reading, watching TV, and drinking coffee, for example. It will take time to "un-link" smoking from these activities. That is why, even if you are using a nicotine replacement, you may still have strong urges to smoke.
One way to overcome these urges or cravings is to recognize rationalizations as they come up. A rationalization is a mistaken belief that seems to make sense at the time but is not based on facts. If you have tried to quit before, you will probably recognize many of these common rationalizations.
I’ll just use it to get through this rough spot.
Today is not a good day; I’ll quit tomorrow.
It's my only vice.
How bad is tobacco, really? Uncle Harry chewed all his life and he lived to be over 90.
You've got to die of something.
Life is no fun without smoking.
You probably can add more to the list. As you go through the first few days without tobacco, write down any rationalizations as they come up and recognize them for what they are: messages that can trap you into going back to using tobacco. Use the ideas below to help you keep your commitment to quitting.
Avoid people and places where you are tempted to smoke. Later on you will be able to handle these with more confidence.
Alter your habits. Switch to juices or water instead of alcohol or coffee. Take a different route to work. Take a brisk walk instead of a coffee break.
Alternatives. Use oral substitutes such as sugarless gum or hard candy, raw vegetables such as carrot sticks, or sunflower seeds.
Activities. Do something to reduce your stress. Exercise or do hobbies that keep your hands busy, such as needlework or woodworking, which can help distract you from the urge to smoke. Take a hot bath, exercise, read a book.
Deep breathing. When you were smoking, you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air. Remind yourself of your reasons for quitting and the benefits you'll gain as an ex-smoker.
Delay. If you feel that you are about to light up, delay. Tell yourself you must wait at least 10 minutes. Often this simple trick will allow you to move beyond the strong urge to smoke.
What you're doing is not easy, so you deserve a reward. Put the money you would have spent on tobacco in a jar every day and then buy yourself a weekly treat. Buy a magazine, go out to eat, call a friend long-distance. Or save the money for a major purchase. You can also reward yourself in ways that don't cost money: vist a park or the library, develop a new hobby, or take a yoga class.
Staying Quit (Maintenance)
Remember the quotation by Mark Twain? Maybe you, too, have quit many times before. So you know that staying quit is the final, and most important, stage of the process. You can use the same methods to stay quit as you did to help you through withdrawal. Think ahead to those times when you may be tempted to smoke, and plan on how you will use alternatives and activities to cope with these situations.
More dangerous, perhaps, are the unexpected strong desires to smoke that occur sometimes months (or even years) after you've quit. To get through these without relapse, try the following:
Review your reasons for quitting and think of all the benefits to your health, your finances and your family.
Remind yourself that there is no such thing as just one cigarette – or even one puff.
Ride out the desire. It will go away, but do not fool yourself into thinking you can have just one.
Avoid alcohol. Drinking lowers your chance of success.
If you are worried about gaining weight, put some energy into eating a healthy diet and staying active with exercise.
What if you do smoke? The difference between a slip and a relapse is within your control. You can use the slip as an excuse to go back to smoking, or you can look at what went wrong and renew your commitment to staying off smoking for good.
Even if you do relapse, try not to get too discouraged. Very few people are able to quit for good on the first attempt. In fact, it takes most people several attempts before quitting for good. What’s important is figuring out what helped you in your attempt to quit and what worked against you. You can then use this information to make a stronger attempt at quitting the next time.
Special Concerns
Weight Gain
Many smokers do gain some weight when they quit. Even without special attempts at diet and exercise, however, the gain is usually less than 10 pounds. Women tend to gain slightly more weight than men. There is some evidence that smokers will gain weight after they quit even if they do not eat more.
For some, a concern about weight gain can lead to a decision not to quit. But the weight gain that follows quitting smoking is generally very small. It is much more dangerous to continue smoking than it is to gain a small amount of weight.
You are more likely to be successful with quitting smoking if you deal with the smoking first, and then later take steps to reduce your weight. While you are quitting, try to focus on ways to help you stay healthy, rather than on your weight. Stressing about your weight may make it harder to quit. Eat plenty of fruits and vegetables and limit the fat. Be sure to drink plenty of water, and get enough sleep and regular physical activity.
Walking is a great way to be physically active and increase your chances of staying quit. Walking can help you by:
Reducing stress
Burning calories and toning muscles
Giving you something to do instead of thinking about smoking
No special equipment or clothing is needed for walking, other than a pair of comfortable shoes. And you can do it pretty much anytime or anywhere. Try the following:
Walking around a shopping mall
Getting off the bus one stop before you usually do
Finding a buddy to walk with during lunch time at work
Taking the stairs instead of the elevator
Walking with a friend, family member, or neighbor after dinner
Pushing your baby in a stroller
Set a goal of 30 minutes of physical activity 5 or more times a week. If you don’t already exercise regularly, please check with your doctor before starting an exercise program.
Stress
Smokers often mention stress as one of the reasons for going back to smoking. Stress is a part of all of our lives, smokers and nonsmokers alike. The difference is that smokers have come to use nicotine to help cope with stress. When quitting, you have to learn new ways of handling stress. Nicotine replacement can help to some extent, but for long-term success other strategies are needed.
As mentioned above, physical activity is a good stress-reducer. It can also help with the temporary sense of depression that some smokers experience when they quit. There are also stress-management classes and self-help books. Check your community newspaper, library, or bookstore.
Spiritual practices such as prayer and meditation have been used very successfully with other addictions and are an integral part of 12-step recovery programs. These same principles can be applied to quitting smoking and can help with stress reduction.
Taking Care of Yourself
Any past or current tobacco use is important information for your health care provider to know so he or she can be sure that you have appropriate preventive health care. It is well known that tobacco use puts you at risk for certain health-related illnesses, so part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible. For example, you will want to be certain that you regularly check the inside of your mouth for any changes and have an oral exam by your doctor or dentist if you have any changes or problems. The American Cancer Society recommends that periodic checkups should include oral cavity (mouth) exams. By doing this tobacco users may be able to prevent, or detect early, oral changes, leukoplakia (white patches on the mouth membranes), and oral cancer.
You should also be aware of any change in cough, a new cough, coughing up blood, hoarseness, difficulty breathing, wheezing, headaches, chest pain, loss of appetite, weight loss, general fatigue, and repeated respiratory infections. Any of these could be signs of lung cancer or a number of other lung conditions and should be reported to your doctor. While these can be signs of a problem, many lung cancers do not cause any noticeable symptoms until they are advanced and have spread to other parts of the body.
Remember that tobacco users have an increased risk for other cancers as well, depending on the way they use tobacco. You can become familiar with the types of cancer you may be at risk for by reading the American Cancer Society document that discusses the way you use tobacco. Other risk factors for these cancers may be more important than your use of tobacco, but you should be aware of the additional risks that might apply to your situation.
If you have any health concerns that may be related to your tobacco use, please see your health care provider as quickly as possible. Taking care of yourself and getting treatment for small problems will give you the best chance for successful treatment. The best way, though, to take care of yourself and decrease your risk for life-threatening lung problems is to quit using tobacco.
Where Can I Go for Help?
It is hard to stop smoking. But if you are a tobacco user you can quit! More than 46 million Americans have quit smoking for good. Many organizations offer information, counseling, and other services on how to quit as well as information on where to go for help. Other good resources where help can be found include your doctor, dentist, local hospital, or employer.
Additional Resources
More Information From Your American Cancer Society
We have selected some related information that may also be helpful for you. These materials may be viewed on our Web site or ordered from our toll-free number, 1-800-ACS-2345.
Cigarette Smoking (available in Spanish only through our toll-free number)
Double Your Chances of Quitting Smoking
Guide to Quitting Smoking (available in Spanish only through our toll-free number)
Helping a Smoker Quit: Dos and Don'ts
Questions About Smoking, Tobacco, and Health (available in Spanish only through our toll-free number)
Quitting Smoking - Help for Cravings and Tough Situations (available in Spanish only through our toll-free number)
Smoking and Cancer Mortality Table
Smoking in the Workplace -- A Model Policy
Women and Smoking (available in Spanish only through our toll-free number)
National Organizations and Web Sites*
If you want to quit smoking and need help, contact one of the following organizations. In addition to the American Cancer Society, other sources of patient information and support include:
American Cancer SocietyTelephone: 1-800-ACS-2345 (1-800-227-2345)Internet address: www.cancer.orgAmerican Heart Association & American Stroke AssociationTelephone: 1-800-AHA-USA-1 or 1-800-242-8721 Telephone: 1-888-4-STROKE or 1-888-478-7653 Internet address: www.amhrt.orgInternet address: www.strokeassociation.orgAmerican Lung AssociationTelephone: 1-800-LUNG-USA or 1-800-548-8252Internet address: www.lungusa.orgCenters for Disease Control and Prevention Office on Smoking & Health Telephone: 1-800-CDC-INFO or 1-800-232-6237 Internet address: www.cdc.gov/tobacco
National Cancer Institute Cancer Information ServiceTelephone: 1-800-4-CANCER 1-800-422-6237Internet address: www.cancer.gov
Nicotine Anonymous Telephone: 1-415-750-0328 Internet address: www.nicotine-anonymous.org
Smokefree.gov (Online materials, including info on state telephone-based programs) Telephone: 1-800-QUITNOW or 1-800-784-8669 Internet address: www.smokefree.gov
Smoking Cessation Leadership Center Telephone: 1-800-QUITNOW or 1-800-784-8669 Internet address: http://smokingcessationleadership.ucsf.edu/
Inclusion on this list does not imply endorsement by the American Cancer Society.
The American Cancer Society is happy to address almost any cancer-related topic. If you have any
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