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Smoking: How To Stop

What If I Need More Help?

Tuesday, April 24, 2012 - 15:19

Contributing Author: Guy Slowik FRCS

However addicted or non-addicted you may be, it is your motivation and your decision to stop that are vital to the outcome. There is no single path to success suitable for everyone. People and their smoking habits vary so much that only guidelines can be given on how to set about making your own decision to undertake the task of overcoming your own problem.

There is no drug for smoking that can cure your problem for you without you having to make any effort. However, there are some treatments that you can use as aids to your self-help:

Counseling And Support

Skilled counseling and support can be helpful, either individually or in a group. Guidance on how to stop can be made more specific to your individual problems than is possible in a booklet. Also, support and encouragement is always helpful at difficult times. Unfortunately it is hard to find skilled help for giving up smoking. Most primary care providers have time for only brief support.

Hypnosis And Acupuncture

Hypnosis and acupuncture may be worth trying. There is some evidence that these techniques may be effective in some people. In addition, the practitioners are likely to provide additional support and encouragement, which is helpful.

Nicotine Chewing Gum

Nicotine chewing gum (such as Nicorette), available over-the-counter, is an effective treatment, especially for the more addicted smoker, and can double the chances of success.

Nicotine is released gradually as the gum is chewed and is absorbed through the lining of the mouth (as with oral snuff or chewed tobacco). Blood nicotine levels from gum use rise more slowly and are lower than those from smoking; about one-third to two-thirds of smoking levels.

Thus the gum doesn't replace the full positive satisfaction of smoking, but helps by alleviating unpleasant withdrawal symptoms such as irritability, restlessness, and difficulty with concentration, and it reduces the strength of the urges or cravings to smoke. It also reduces the tendency to gain weight after stopping smoking.

The gum helps you to achieve long-term success by enabling you to overcome your addiction in two stages. In the first stage you can focus on the social, psychosocial, sensory and behavioral aspects of your dependence on cigarettes, without at the same time having to cope with all the pharmacological effects of nicotine withdrawal. These can be tackled at a later stage (after one to four months) when you no longer have such strong urges to smoke. Gradual withdrawal of nicotine gum is less difficult because you will already have adjusted to lower nicotine levels than you had when smoking.

The gum will only be successful for you if you use it correctly. It is not a magic cure. It will make your task easier but not easy. Your commitment and effort is essential. It will not stop your smoking or give you the same satisfaction as smoking, but it will help ease the severity of withdrawal after you have stopped. Above all, it may not taste pleasant at first, but if you persist for a few days it will become tolerable and eventually you may come to like it.

How-To Information:

Getting the most from nicotine gum

  • Start using the gum on your target day for stopping if the craving to smoke gets severe. Chew one piece gently until you get a nicotine taste (about 10 chews), then pause until the taste weakens (one or two minutes) before chewing again. Continue this way for at least 30 minutes.
  • You will learn to chew faster or more slowly to suit yourself. Most of the nicotine will be released from the gum after 30 minutes of chewing. You can go on chewing it if you wish or start a fresh one. Use the gum as necessary, but if craving persists try to use at least one gum per hour if you can. This may not be possible on the first day.
  • Remember that the nicotine is absorbed through the lining of the mouth. If you chew too fast it will be swallowed with your saliva. Swallowed nicotine is mostly wasted. Only one-third of it will get into your bloodstream. Too much swallowed nicotine may give you a feeling of indigestion, slight nausea or even hiccups. If you get these side-effects chew more slowly in the future. Nicotine cannot be absorbed properly if you sip hot or cool drinks while you are chewing.
  • The gum can only help if you are not smoking. It is useless to go on with it while you are still smoking, even if only a few cigarettes. Don't bluff yourself that you are making progress if it only helps you to cut down on cigarettes.
  • After getting used to it, don't worry if you need 15 to 20 pieces a day or more. Some people use two pieces at a time.
  • Start weaning yourself gradually off the gum after about a month, if you are finding it easy to stay off cigarettes. If it is not easy, don't bother to reduce the gum dosage until three to four months. If it is too difficult then, go on for a year or more. Only one in twenty heavy smokers gets hooked on the gum, which is far safer than going back to smoking. But at some convenient time after a year or two, it would be advisable for such people to make the effort to give up the gum. It is a mistake to give it up too early in the first few months for fear of becoming addicted to it.

Nicotine Patches

Nicotine patches, or transdermal nicotine systems, deliver nicotine through a patch worn on the skin. They are available over-the-counter and in different strengths so that you can gradually wean yourself off as withdrawal symptoms become more manageable.

For average smokers, the 16-hour patch may be sufficient, and is less likely to cause side effects, which can include skin irritations, racing heartbeat, sleep disturbances, and headaches. For heavier smokers, the 24-hour patch delivers a steady dose of nicotine and may help with early morning withdrawal.

Most smokers should probably start with a full-strength patch (15 to 22 milligrams of nicotine) and wear it daily for about four weeks. Then a weaker patch (five to 14 milligrams) can be worn for another four weeks. The patch should be applied to a clean, dry area of the skin that doesn't have a lot of hair, below the neck and above the waist (the arm, for example). The FDA recommends using the patch for three to five months, but some studies have shown that it can be just as effective if worn for eight weeks.

If side effects occur, try a different brand or a lower dose patch. Sleep problems may clear up after a few days. Other forms of nicotine replacement are also available.

Nicotine Lozenge

In late 2002, the U.S. Food and Drug Administration approved the Commit Lozenge, first nicotine lozenge available for over-the-counter sale. The lozenge help control cravings by delivering nicotine quickly when a smoker feels a craving for a cigarette. The lozenge is available in different strengths, depending on the nature of a person's smoking addiction.

Similar to nicotine gum and the nicotine patch, the lozenge help relieve craving and nicotine withdrawal symptoms by providing a temporary alternative source of nicotine, without exposing a person to the harmful tars and carbon monoxide from cigarette smoke. The lozenge releases nicotine as it dissolves in the mouth. The goal is for a person to use fewer and fewer lozenges during a 12-week program until he or she is nicotine-free.

Nasal Sprays

Nicotine nasal sprays are available by prescription, easy to use, and deliver nicotine to the bloodstream quickly. However, like cigarettes, they contain nicotine and can be addictive. The FDA recommends using the spray for no longer than six months.

The most common side effects last a week or two and include nasal irritation, runny nose, watery eyes, sneezing, and coughing and throat irritation. It is also easy to use more than you actually need. If you have asthma, allergies or sinus problems, your doctor may suggest another form of nicotine replacement.

Nicotine Inhalers

Nicotine inhalers are available by prescription. When you puff on the inhaler, the nicotine cartridge delivers a vapor containing nicotine. Most of the medication goes to the mouth (as opposed to other inhalers, which deliver medication to the lungs). The inhaler may make you feel as if you are substituting some of the behavioral aspects of smoking, such as inhalation. Side effects include coughing and throat irritation.

Anti-Depressant Medication

Bupropion (Zyban, Wellbutrin, Amfebutamone), normally used to treat depression, is the first non-nicotine medication approved by the FDA as an aid to quit smoking. The drug is thought to work by mimicking nicotine's effect on the brain. It's best to start taking it one week prior to quitting and continue using it for seven to 12 weeks.

Need To Know:

You shouldn't take medication to stop smoking if you are pregnant or have heart disease without consulting your physician.

Smoking: How To Stop