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
Agency for Health Care Policy and Research, Clinical Practice Guideline on Smoking Cessation, No. 18, AHCPR, Rockville, MD, April 1997.
American Cancer Society. Cancer Facts & Figures 2007. Atlanta, GA. 2007.
Benowitz NL. Drug therapy-pharmacology of smokeless tobacco use: nicotine addiction and nicotine-related health consequences. In: Smokeless Tobacco or Health: An International Perspective. Smoking and Tobacco Control Monograph No.2. Bethesda (MD): US Department of Health and Human Services, Public Health Service, National Institutes of Health. NIH Publication No. 93-3461, 1992b:219-228.
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.