Mark Twain once said, “Quitting smoking is easy. I’ve done it a thousand times!”
f you find yourself puffing away on a cigarette, or reaching for that chew after you swore you were “done for good,” know that you’re in good company and that there are steps you can take to improve your success. 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. COSAP has the information here to get you started on the path to becoming a nonsmoker.
Nicotine is a drug that occurs naturally in tobacco. It is highly addictive – as addictive as cocaine and heroin, and capable of producing both emotional and physical dependence. The level of nicotine smokers typically consume per cigarette increased an average of 10 percent between 1998 and 2004, making it harder to quit and easier to get addicted, according to a study conducted by the Massachusetts Department of Health. The study also found no significant difference in the total nicotine delivered among full flavor, medium, light or ultralight cigarettes, and the highest concentrations of nicotine were found in Marlboro, Newport and Camel brands.
When you inhale smoke, nicotine is carried deep into your lungs where it is absorbed quickly into the bloodstream and carried throughout your body. Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, metabolism, and your brain.
Nicotine produces pleasant feelings that make a 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 amount of tobacco they consume, and therefore the amount of nicotine in their blood. After a short period, the smoker reaches a certain nicotine level and then smokes to maintain this level. This process is similar for individuals who use smokeless tobacco.
Several different factors can affect how long it takes the body to remove nicotine and its by-products. In general, a regular smoker will have nicotine or its by-products, such as cotinine, in the body for about 3 to 4 days after stopping.
When a person tries to cut back or quit, the lack of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body reacts to the absence of nicotine. Mentally, the individual is faced with giving up a habit which calls for a major change in behavior. Both must be addressed in order to quit successfully.
Withdrawal symptoms may include any of the following:
Health reasons often top the list of reasons people give for quitting smoking. This is a very real concern as 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, throat, esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemia's.
Other reasons people choose to quit using tobacco, especially smoking tobacco, include:
Within 20 minutes of quitting: Your heart rate and blood pressure drop.
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 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.
Quitting smoking offers some benefits that you’ll notice right away. These rewards can improve your day-to-day life a great deal.
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.
In New Mexico you can call 1-800- QUIT NOW (800-784-8669) for free help with quitting. QUIT NOW services include:
The Stop Smoking Center: Allows you to connect with other quitters and health educators in online forums, helps you develop a personalized quit plan, and offers creative tools such as a QuitMeter. www.stopsmokingcenter.net
Quit Smoking All Together: Free online resource offering personalized quit plans, online support groups, tools and tips, detailed information/education, and one-to-one cessation counseling. Designed for those struggling to quit and "ex-smokers" working to stay clean.www.quitnet.com
About.Com: Smoking Cessation: Free online smoking cessation forum http://quitsmoking.about.com/mpboards.htm
ChewFree.com: Sponsored by the Natioanl Cancer Institute, this website offers specific help for individuals who use chew and spit. Includes online forums, assistance in developing a personalized quit plan, and detailed information and education. www.chewfree.com
UNM Student Health And Counseling (SHAC): Services include medical consultation, nicotine replacement therapy, and one-on-one sessions with a trained, peer consultant. Walk-in or call 277-3136 to schedule an appointment.
UNM COSAP: Stop by Mesa Vista Hall, rm. 3059 for free workbooks, pamphlets and referrals to community resources. Call 277-2795 to arrange for individual sessions with a peer consultant and nicotine replacement therapy.
American Lung Association: Offers Freedom From Smoking, a highly structured, 7-week approach to smoking cessation using well researched information, proven methods, educational materials and supportive strategies; designed to teach tobacco users how to gain mastery of their smoking addiction. Register for the next class at http://www.lungnewmexico.org/QuitSmoking.htm, or call 265-0732.
Nicotine Anonymous: 12-step support group for smoking cessation. Meets Wednesdays at 7:30 PM at St. Thomas of Canterbury Church, 425 University Blvd. NE. For more information, call 265-8113 or 798-4595.
*If you select a program or approach that isn’t discussed here, investigate it thoroughly, and be especially wary of programs that:
Nicotine substitutes treat the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their sole reason for not quitting. Although many individuals can quit without using a NRT, most people who attempt to quit are not successful their first time. In fact, smokers usually need many tries, sometimes as many as five or more before they are able to quit for good.
The philosophy of “Never Quit Quitting” indeed applies to tobacco cessation, so don’t get discouraged if you start smoking again. Instead, set a new quit date and improve your odds by adding another method or technique to help you quit.
NRTs only deal with the physical addiction and aren’t meant to be the only method used to help you quit. You should combine it with other cessation methods that will help you address the psychological (emotional and habitual) components of tobacco addiction, such as a stop smoking program. Research shows that you can double your chances of success by combining NRT with a behavioral approach.
The best time to start NRT is when you first quit. This is when you will encounter the major withdrawal symptoms. Some smokers want to know if they can start using a NRT while they are still smoking. Research is currently being done with smokers using NRTs while actively smoking, but it is too early to determine the overall health impact. The most important thing is to be sure you don’t overdose on nicotine. It’s best to be under a doctor’s care if you want to start using a NRT to help you cut down while you are still smoking.
The Food and Drug Administration (FDA) has approved five types of NRTs:
1. Nicotine Patches (transdermal nicotine systems)
These patches, available with or without a prescription, administer a measured and steady dose of nicotine through the skin. Most individuals use the patches over a course of several weeks, switching to lower nicotine-dose patches as they progress.
The 16-hour patch works best for light-to-average smokers and is less likely to cause side effects such as skin irritation, racing heartbeat, sleep disturbances, and headaches. Because it doesn’t deliver nicotine during the night, it is not helpful for early morning withdrawal symptoms.
The 24-hour patch provides a steady dose of nicotine which helps with morning withdrawals but is more likely to cause side effects such as those mentioned above.
Depending on body size, most smokers should start with a full-strength patch (15-22 mg of nicotine) daily for four weeks, and then use a weaker patch (5-14 mg of nicotine) for an additional four weeks. The patch should be applied in the morning on a clean, dry area of the skin that doesn’t have much hair. It should be placed below the neck and above the waist. The FDA recommends using the patch for a total of three to five months.
The side effects one may experience are related to:
Some possible side effects of the nicotine patch include:
If you experience side effects, consider the following:
2. Nicotine Gum (nicotine polacrilex)
Nicotine gum is a fast-acting NRT that is absorbed through the mucous membrane of the mouth. It’s available over-the-counter and comes in 2 mg and 4 mg strengths.
For best results, carefully follow the package insert’s directions. Chew the gum slowly until you experience a peppery taste and then “park” it against your cheek. Continue this chew and park process for about 20 to 30 minutes.
Because food and liquids can interfere with how well the nicotine is absorbed, it is best to avoid acidic products (e.g., coffee, juices, and soft drinks) for at least 15 minutes before and during gum use.
If you smoke a pack a day or more, smoke within 30 minutes of awakening, or have trouble not smoking in restricted areas, you may need to start with the 4 mg dose and then switch to the lower 2 mg dose. Regardless of dose, chew no more than 20 pieces of gum in one day. Doctors recommend smokers use nicotine gum for one to three months and for no longer than six months. As you near the date set to stop using the gum, begin tapering the amount of gum you chew.
If you have sensitive skin, nicotine gum may be a better choice than the patch. Another advantage of the gum is that it allows you to control the amount and timing of your nicotine doses. You can use it on an as-needed basis, or on a fixed schedule – although the most recent research shows that the fixed schedule works better for most people.
Some possible side effects of nicotine gum are:
* Symptoms related to stomach and jaw discomfort are generally the result of improper use of the gum, such as swallowing nicotine or chewing too fast.
Long-term dependence is one possible disadvantage of nicotine gum. Studies show that 15-20% of smokers who successfully quit continue using the gum for a year or longer, although the recommended length of use is six months. Use of the gum is considered safer than smoking, but there is little research on the health effects of long-term nicotine gum use.
3. Nicotine Nasal Spray
The nasal spray delivers nicotine directly to the bloodstream as it is quickly absorbed through the skin of the nose. This form of NRT is available only by prescription. The nasal spay relieves withdrawal symptoms rapidly, allowing you to control your cravings. Most people find the spray easy to use, and like that they can control the timing of the doses. However, caution should be taken to ensure that you don’t take more than needed. If you have asthma, nasal polyps, or sinus problems, your doctor may want to recommend another form of NRT.
As with nicotine gum, the FDA warns that it can be addictive due to its nicotine content and thus, recommends that it be used no longer than six months. Most physicians will prescribe the nasal spray for a three-month period.
The most common side effects last about one to two weeks and can include:
4. Nicotine Inhalers
These also are available only by prescription. The inhaler is a thin, plastic tube that contains a nicotine cartridge. When you puff on the inhaler, the cartridge emits a nicotine vapor which is absorbed into the mouth – unlike other inhalers that deliver most of the medicine to the lungs. Because the inhaler mimics the act of smoking more closely than other NRTs, some smokers may find it more helpful.
The recommended dose is between six and 16 cartridges a day, for up to six months. Inhalers are by far the most expensive form of NRT currently available. The most common side effects, particularly when first using the inhaler, include:
5. Nicotine Lozenges
The newest NRT product on the market, nicotine-containing lozenges are available without a prescription. As with the nicotine gum, the lozenges come in two strengths – 2 mg and 4 mg. Smokers choose their dose based on how long after waking up they normally smoke their first cigarette.
The manufacturer recommends the lozenges be used as part of a 12-week program. The recommended dose for the first six weeks is one lozenge every one to two hours. Then, one lozenge every two to four hours for weeks seven to nine, and finally, one lozenge every four to eight hours for weeks 10 to 12. It is also recommended that users:
The most common side effects of the nicotine lozenge are:
Which Type of NRT is Best for Me?
There is no evidence that one type of NRT is better than another. To get the most success with an NRT, it is important to consider your pattern of smoking and how the different methods will fit into your lifestyle. For example, do you want something you can chew, or do you want to occupy your hands? Do you prefer the once-a-day convenience of a patch, or do you want to be able to control the timing of your doses?
Some important factors to consider when choosing a NRT:
Is it Safe to Combine NRTs?
Using the nicotine patch along with shorter-acting products such as nicotine gum, lozenge, inhaler, or spray is a method some people have used. The idea is to provide a steady dose of nicotine with the patch while using the other NRTs to quickly address strong cravings that occur.
The few studies that have examined the use of combination NRTs have found only a slight advantage over the use of a single product. More research needs to be done to explore the safety of this approach and the determinants of dosage. The FDA has not approved the combining of NRTs and this should not be done without consulting your physician.
OTHER MEDICATIONS USED TO SUPPORT SMOKING CESSATION
Bupropion (Zyban)
Bupropion is a prescription antidepressant in an extended-release form that has been found to reduce symptoms of nicotine withdrawal. This drug works by acting on chemicals in the brain that are related to nicotine cravings and because it contains no nicotine, it can be used alone or in combination with a NRT. Bupropion works best if it is started one to two weeks prior to the quit date. The usual dosage is one or two, 150 mg tablets per day.
You should not take this drug if you have ever had seizures, heavy alcohol use, serious head injury, bipolar disorder, anorexia, or bulimia.
Varenicline (Chantix)
Varenicline is a newer prescription medicine that was developed for the sole purpose of assisting people who want to quit smoking. It works by interfering with the nicotine receptors in the brain, thereby lessening the pleasurable physical effects derived from smoking and reducing the symptoms of nicotine withdrawal.
Several studies have shown varenicline can more than double the chances of quitting smoking, and some studies have shown it to be more effective than bupropion.
Reported side effects include headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence, and changes in taste. It should be noted there have been recent reports of depressed mood, thoughts of suicide, attempted suicide, and changes in behavior among people taking varenicline. Anyone who experiences these problems should contact their physician immediately.
Although these side effects may happen and are potentially serious, studies have found that varenicline is well-tolerated by most people. Because varenicline is a new drug, there has not been sufficient research to assess the safety of using varenicline along with NRT products.
GET READY FOR SUCCESS
Set a Quit Date
Choose a specific day within the next month as your Quit Day. Circle the day on your calendar, and make a strong, personal commitment to quit on that day.
Prepare for Your Quit Day
Many smokers opt to quit “cold turkey” – where they toss out their cigarettes on Quit Day, and quit all at once. Others prefer to gradually reduce the number of cigarettes they smoke for a couple of weeks prior to their Quit Day. This method allows the smoker to slowly reduce the amount of nicotine in the body and hopefully reduce the withdrawal symptoms. Although this method sounds logical, it is harder than it appears and some of the most recent research indicates the “cold turkey” approach works better for most individuals.
Quitting smoking is like dieting – it requires a strong commitment over a long period of time. There’s no magic bullet, but you can increase your chances of success when you combine nicotine replacement therapy (NRT) with cessation counseling or classes, and a well-defined quit plan. Some specific steps you can implement to prepare for Quit Day include:
When Quit Day Arrives
Remember, Never Quit Quitting. As the U.S. Surgeon General has stated, “Smoking cessation represents the single most important step that smokers can take to enhance the length and quality of their lives.” Quitting smoking is not easy and it often takes more than one attempt, but YOU CAN DO IT!