Smoking: How To Stop

What Is A Smoking Addiction?

A smoking addiction means a person has formed an uncontrollable dependence on cigarettes to the point where stopping smoking would cause severe emotional, mental, or physical reactions.

Everyone knows that smoking is harmful and addictive, but few people realize just how risky and addictive it is.

Chances are that about one in three smokers who do not stop will eventually die because of their smoking. Some will die in their 40s, others will die later. On average, they will die 10 to 15 years earlier than they would have died from other causes.

Most smokers want to stop and do indeed try, but only one in three succeeds in stopping permanently before age 60. By this time, much harm may have been done to the body – some of it irreversible.

  • Those who eventually quit smoking usually try to stop two or three times before they’re successful.
  • Only 2.5 percent of smokers successfully quit each year.

The reason why so many people fail to stop is because they are addicted. Being addicted does not mean that you cannot stop – only that it is likely to be difficult. Anyone can succeed if he or she goes about it in the right way.

How you stop – and, especially, when you stop – is a very personal matter. Only you know what you have to give up, and how the benefits of smoking can be weighed against the benefits of stopping. Harassment and pressure from others who do not understand is often unhelpful. You will only stop when you have made a firm decision. When you do make up your mind, however, you can succeed, regardless of how addicted you may be.

If you stop smoking before or during middle age (age 35 to 50), you will avoid about 90 percent of the lung cancer risk. If you are currently middle-aged, you are also more likely to succeed in quitting now than when you were younger.

Why Is Smoking Addictive?

Nicotine is the drug in tobacco that causes addiction. It is absorbed and enters the bloodstream, through the lungs when smoke is inhaled, and through the lining of the mouth (buccal mucosa) when tobacco is chewed or used as oral snuff or for non-inhaled pipe and cigar smoking. It is also absorbed through the nose from nasal snuff, which was popular in the 18th century.

Nicotine is a psychoactive drug with stimulant effects on the electrical activity of the brain. It also has calming effects, especially at times of stress, as well as effects on hormonal and other systems throughout the body. Although its subjective effects are less dramatic and obvious than those of some other addictive drugs, smoking doses of nicotine causes activation of “pleasure centers” in the brain (for example, the mesolimbic dopamine system), which may explain the pleasure, and addictiveness of smoking.

Smokers develop tolerance to nicotine and can take higher doses without feeling sick than when they first started smoking. Many of the unpleasant effects of cigarette withdrawal are due to lack of nicotine and are reversed or alleviated by nicotine replacement (for example, nicotine chewing gum or the nicotine patch).

As with other addictions, it is difficult to give up smoking, and without help most smokers fail despite trying many times. Even after stopping successfully for a while, most relapse within 2 to 3 months. More alarming perhaps than the strength of the addiction is the ease with which it develops. Although teenagers often start smoking for psychosocial reasons, the effects of nicotine soon gain control.

Studies show that tobacco use usually begins in early adolescence, and those who begin smoking at an early age are more likely to develop severe nicotine addiction than those who start later. Each day, more than 4,800 adolescents smoke their first cigarette, and 42 percent of them go on to become regular smokers.

Is Smoking A Physical Addiction?

Smoking is a physical addiction that produces a “chain reaction” in the body:

  • Nicotine acts on receptors normally used by one of the main neurotransmitters in the brain and nervous system (acetylcholine). Neurotransmitters are the “chemical messengers” released by nerve cells to communicate with other cells by altering their electrical activity.
  • The body responds to nicotine at these receptors as if it was the natural transmitter (acetylcholine) and the activity and physiological functions of many brain systems are altered.
  • With repeated nicotine dosage the body adapts to what it regards as extra acetylcholine in an attempt to restore normal function. One way it does this is to grow more acetylcholine receptors.

Thus nicotine induces structural as well as functional changes in the brain of smokers. When nicotine is suddenly withdrawn, physiological functions in the brain and other parts of the body are disturbed. This is known as withdrawal syndrome. It takes time for the body to readjust to functioning normally without nicotine.

Social And Psychological Factors

In all drug addictions, psychosocial factors determine the initial exposures. Addiction may subsequently develop if the drug has pharmacological effects that people like or find rewarding.

It is essentially a learning process:

  • Learning when, where, and how to take the drug to get the most rewarding effects. The taste, smell, visual stimuli, handling, and other movements that are closely associated with the rewarding pharmacological effects gradually become rewarding themselves. This is known as conditioning.
  • The situations and activities associated with smoking, together with the smoker’s mood and psychological state at the time, also become linked with its rewards and with the relief of withdrawal. They come to serve as signals or triggers for the urge or craving for nicotine’s effects (for example, after meals, with coffee or alcohol, when meeting people, working, talking on the phone, and when anxious, angry, celebrating, or having a well-earned break, and so on).
  • Triggers that bring on the urge to smoke are numerous because smoking can take place in so many situations.

Smoking As A Drug-Taking Activity

Most smokers absorb sufficient nicotine to obtain pharmacological effects. The modern cigarette is a highly effective device for getting nicotine to the brain.

  • The smoke is mild enough to be inhaled deeply into the lungs. Due to the large surface area of the lungs, nicotine is absorbed rapidly into the bloodstream and reaches the brain within 7 seconds – more rapidly than after an intravenous injection.
  • In this way the smoker gets a small intravenous-like shot of nicotine after each inhaled puff: 20 cigarettes a day, each puffed 10 times, comes to more than 70,000 “shots” per year.

On average, smokers take in about 1 milligram (mg) nicotine from each cigarette, although some take 2 milligrams or more while others are satisfied with 0.5 milligrams or less. By altering puff-rate, puff-size and amount of inhalation, smokers unconsciously regulate their nicotine intake to their individually preferred levels, which are kept fairly constant from one day to the next.

The nicotine yields of the cigarettes make little difference. By puffing harder, inhaling more deeply, and smoking down to the tip, smokers can get 2 milligrams of nicotine or more from a low-yield cigarette with an official machine-smoked yield of only 0.6 milligrams. Cigarette smokers literally do have fingertip control over the delivery of nicotine to their brain.

Facts About Smoking And Addiction

  • Smoking-related illnesses cause about 440,000 deaths each year in the U.S.
  • Smoking is responsible for 87 percent of lung cancers and also causes most cases of emphysema and chronic bronchitis.
  • Tobacco use, especially smoking, is the number one cause of preventable disease and death in the U.S.
  • Cigarettes contain at least 43 distinct cancer-causing chemicals.
  • Nicotine is as highly addictive as heroin and cocaine.
  • Approximately 80 percent of adult smokers started smoking before age 18.
  • Most people try to quit smoking several times before they’re successful. Only 2.5 percent of smokers successfully quit each year.
  • The benefits of quitting smoking begin to occur within 20 minutes of the last cigarette smoked.
  • A person who stops smoking will have the same risk of heart disease and death 15 years after quitting as someone who has never smoked.
  • Secondhand smoke is known to cause cancer and is responsible for approximately 3,000 lung cancer deaths in nonsmokers each year.

How Smoking Affects The Body

Smoking causes many premature deaths from diseases that are largely incurable, but preventable by stopping smoking. There are three main killing diseases which smoking causes or brings on earlier:

  • Heart disease. Smoking is responsible for 30 percent of all heart attacks and cardiovascular deaths.
  • Cancer. It is responsible for at least 30 percent of all cancer deaths and 87 percent of lung cancer deaths each year.
  • Lung problems. Smoking is responsible for 82 percent of deaths due to emphysema and chronic bronchitis.

Smoking also exacerbates diseases and conditions that are not always fatal, but cause suffering or are sources of personal concern.

  • Smoking delays healing of peptic ulcers of the stomach and duodenum, many of which would heal spontaneously in non-smokers.
  • Its effects on blood vessels cause chronic pains in the legs (claudication) which can progress to gangrene and amputations of the toes or feet.
  • An effect on elastic tissue causes wrinkling of the skin of the face to develop earlier in chronic smokers. On average they look 5 years older than non-smokers of the same age do.
  • Smoking also brings on an earlier menopause in women, advancing it by an average of 5 years.
  • It reduces women’s fertility and delays conception after they stop using oral contraceptives.
  • It impairs erections in middle-aged and older men and may affect the quality of their sperm. It seems to “sedate” sperm and to impair their motility. This is reversed after stopping smoking.
  • Smoking accelerates the rate of osteoporosis, a disease which causes bones to weaken and fracture more easily.
  • Women who smoke during pregnancy damage their unborn child, causing effects that last throughout the child’s life. The risks of miscarriage, premature birth, and death of the baby in its first year of life are all significantly increased.

Need To Know:

Smoking During Pregnancy

In addition to the risk of miscarriage, premature birth, and death of the baby in its first year of life, a woman’s smoking during pregnancy also has other effects on the baby:

  • The growth and development of all unborn babies is impaired if their mothers smoke. On average, birth weight is reduced by about half a pound. This makes little difference to a baby of normal weight, but could be crucial to ones weighing 3 to 4 pounds.
  • The development of the brain is also affected. Children whose mothers smoked during pregnancy are on average about one year behind non-exposed children in reading and numerical ability, for example. Loss of a few IQ points may be hardly noticeable to a normally intelligent child or adult, but may be critical for someone on the borderline.
  • The child will be more likely to have behavioral problems and hyperactivity.
  • Finally, during the first few years of life, children are especially vulnerable to the harmful effects of passive smoking if their parents smoke. These effects include worsening of asthma, increased frequency of colds and ear infections, and increased risk of sudden infant death syndrome.

What’s In Cigarettes?

Tobacco smoke is a mixture of gases and small particles made up of water, tar and nicotine. The tar is a messy mixture of hundreds of toxic chemicals, many of which are known to cause cancer (for example, nitrosamines, benzpyrene).

Many of the gases in tobacco smoke are harmful. These include carbon monoxide, nitrogen oxides, hydrogen cyanide, ammonia, and other toxic irritants such as acrolein and formaldehyde. Due to the high temperatures (over 800°C or 1400°F), the burning end of a cigarette is like a miniature chemical factory. It churns out many more noxious chemicals than are found in unlit tobacco or taken in by use of smokeless tobacco (for example, snuff, which contains no tar or gases). Altogether more than 4,000 chemical compounds have been identified in tobacco smoke.

The chemicals that cause cancer are mainly in the tar. Tar, together with some of the irritant gases, may also be partly responsible for chronic bronchitis and emphysema. Nitrogen oxides are suspected, but the main agents responsible are not yet known. Neither nicotine nor carbon monoxide causes cancer, but they probably work together as causes of the heart diseases associated with smoking.

It is easy to understand why the main cancers caused by smoking are at sites having direct contact with the smoke, specifically the lungs, mouth, and throat. However, some cancer-producing chemicals are absorbed into the blood and transported to other parts of the body. This is how smoking causes cancer of the bladder, kidney, pancreas, and uterus.

The way in which smoking causes heart attacks, strokes and other cardiovascular diseases is quite complex.

  • After absorption through the lungs, carbon monoxide combines with hemoglobin in the red blood cells and reduces the amount of oxygen they can carry around the body.
  • Carbon monoxide and nicotine both appear to play a part in accelerating the deposition of cholesterol in the inner lining of arteries which over many years leads to arteriosclerosis, a kind of hardening and furring up of arteries which reduces blood flow.
  • Cigarette smoking also makes the blood clot more easily, making episodes of thrombosis more likely.
  • Impairment of blood flow, and of oxygen-carrying capacity due to carbon monoxide, all reduce the supply of oxygen. This happens at the same time that the heart’s need for oxygen is increased by the stimulant effect of nicotine on the rate and force of the heart’s contractions.
  • The lack of oxygen is damaging to the heart and increases the severity of a heart attack.
  • Nicotine can cause further problems by upsetting the regular rhythm of the heart.

Nicotine and carbon monoxide are also important factors in peripheral vascular disease, which can lead to gangrene of the feet. Nicotine causes constriction, or narrowing, of the small blood vessels. This, combined with carbon monoxide’s oxygen-reducing effect, tips the balance in people with narrowed leg arteries.

Likewise, nicotine constriction of blood vessels in the placenta (which provides nourishment to an unborn baby), combined with the effects of carbon monoxide, reduces oxygen supply to the unborn babies of pregnant women who smoke.

In these various ways both nicotine and carbon monoxide are involved in the effects of smoking on coronary heart disease, other vascular diseases, and on the development of the unborn child. Although stopping smoking may not reverse arteriosclerosis, a disease in which plaque builds up in the arteries, it will progress less quickly.

However, the other negative effects from smoking are reversed within 24 hours of stopping, when nicotine and carbon monoxide have cleared from the body.

Nice To Know:

  • Within 48 hours after quitting smoking, blood pressure decreases, pulse rate drops, body temperature of hands and feet increases, the carbon monoxide level in the blood returns to normal, the oxygen level in the blood increases to normal, the chance of a heart attack decreases, nerve endings start regrowing, and the ability to taste and smell is increased.
  • Within the first year after quitting smoking circulation and lung function increase, and coughing, sinus congestion and shortness of breath decrease.

About Low-Tar Cigarettes

The average yield of U.S. cigarettes is about 12 mg tar, .88 mg nicotine, and 14 mg carbon monoxide.

Cigarette brands having tar yields below 10 mg are labeled low-tar, and their yields of nicotine and carbon monoxide also tend to be low.

Only one in five smokers regularly smokes a low-tar brand. Many smokers find them unsatisfying at first and do not persist long enough to get used to them. A few ultra-low yield brands exist (tar below 3 mg, nicotine below 0.3 mg).

Due to continuous changes in cigarettes over the years and the time taken for smoking-related diseases to develop, it has been difficult to prove that low-tar cigarettes are less harmful. This remains controversial.

Despite the tendency for smokers to compensate for lower yields by puffing and inhaling harder, the compensation is usually incomplete. On average, blood nicotine and carbon monoxide levels are reduced by at least 10 to 15 percent after switching to low-tar cigarettes. It is therefore likely that they are also less harmful.

Pipe And Cigar Smoking

Pipe and cigar smokers who have never smoked cigarettes tend to be non-inhalers and their health risks are not as great as those of cigarette smokers. Due to the stronger, more alkaline smoke and longer periods of puffing, satisfying amounts of nicotine are absorbed slowly through the lining of the mouth and throat. However, their risk for cancers of the mouth and throat are significantly higher than that of nonsmokers.

Cigarettes, in contrast, provide pharmacological doses of nicotine only if they are inhaled. Cigarette smokers unfortunately become so addicted to the rapid absorption of nicotine through the lungs that they usually continue to inhale after switching to a pipe or cigars. Their health risks are therefore not reduced after switching and may even be increased. By providing smaller and milder cigars, the tobacco industry has made it easier for smokers to continue to inhale when they switch to cigars.

Passive Smoking

Passive smoking is the breathing in of air that has been polluted by other people’s smoke. The smoke and the chemicals it contains remain in the air of a room for many hours, especially if it is poorly ventilated. They can also spread to other rooms.

The concentrations of some cancer-producing nitrosamines are much higher in the side-stream smoke from the burning end of a cigarette than in the mainstream smoke inhaled directly by the smoker.

Passive smoking is difficult to avoid completely, and most nonsmokers who are exposed to it have measurable quantities of smoke products in their body fluids. Many nonsmokers find other people’s smoke unpleasant and irritating. It may give them headaches and feelings of hangover.

Passive smoke also carries significant health risks for nonsmokers:

  • The amount of nicotine absorbed by a nonsmoking child whose father smokes is equivalent to the child himself smoking about 30 cigarettes a year; 50 cigarettes a year from a mother who smokes, and 80 cigarettes a year if both parents smoke.
  • A nonsmoker who spends about four hours in a smoky room may absorb the equivalent of one cigarette.
  • Nonsmoking women whose husbands smoke have a 50% increase in their risk for lung cancer.
  • Secondhand smoke causes about 3,000 lung cancer deaths each year in nonsmokers.
  • Young children are especially vulnerable and have an increased risk of coughs and chest and ear infections if their parents smoke.

A Self-Help Approach To Stopping

Self-help is, in fact, the only way to quit smoking. Others can give you advice and support, but like learning to ski or ride a bicycle, in the end it is up to you. To succeed you must have sufficient motivation to carry you through the task ahead.

If the task is easy, little motivation is necessary, but for a difficult task motivation must be high. For some smokers, stopping smoking will be easier than learning to ride a bicycle. For others it will be much more difficult.

At least two-thirds of smokers are likely to find it difficult to give up smoking. Many will have tried and failed before. It is not their fault that they find it difficult. They do not continue smoking because they are weak-willed or irresponsible, but because they are addicted.

As a result of past exposure to nicotine, starting usually in their teenage years, the nervous system of addicted smokers has been altered and functions best when nicotine is present. They have consequently learned to rely on cigarettes to feel and function normally.

Because of the addictive nature of smoking, smokers generally need to stop smoking long enough for their nervous system to readjust to functioning normally without nicotine and to learn once again to feel happy and normal without cigarettes.

Motivation To Stop

The key to facing the difficult task of keeping off cigarettes long enough for the withdrawal effects to ease and disappear is your motivation to succeed. It helps to understand how smoking damages your body and affects those around you. However, there are also other reasons to think about.

People vary as to what is most important to them personally. An important motive for one smoker may be of little concern to another who stops for a different reason. In general, reasons people give for stopping smoking fall into the following seven themes.

  • Health. Concern for their own health is by far the most important motive for smokers who give up smoking. The onset of minor ailments, such as coughs, sore throats, breathlessness, indigestion, and feeling generally less well and less fit, are early signs that the body has had enough. These early warnings are more important in persuading some smokers to stop than is the risk of future fatal disease. Heart disease is the major risk and it is far more important that individuals stop smoking than worry about weight, lack of exercise or being screened for high cholesterol or blood pressure.
  • Health of others. Babies and young children are especially vulnerable to passive smoking in the home. The health of a nonsmoking spouse is also put at risk. For pregnant women, smoking impairs the development of their unborn child and has lifelong effects on the baby.
  • Expense. Many smokers avoid thinking too much about the financial cost. Others come to resent the waste of money, even if they can afford it. Few take the trouble to work out in detail what they could save by stopping smoking.
  • Example. For parents, doctors, and teachers, the responsibility of setting a good example to others is often an additional motive that tips the balance in favor of stopping.
  • Social pressure. The social pressures may be for or against smoking, depending on the company one keeps. Due to concern about passive smoking, pressures against smoking in offices, restaurants, and other public places are rising sharply. In some circles, an attitude is beginning to develop that people who still smoke must have a “problem,” rather like drinking too much.
  • Mastery. Some reach the stage where they realize that they get very little positive pleasure out of smoking and continue only because they are hooked. They come to resent the feeling of being controlled by their need to smoke, and are motivated to stop by their desire to regain control and self-mastery.
  • Aesthetic. Unlike nonsmokers, most smokers do not regard smoking as a nasty or dirty habit. They are not disturbed by the sight of overflowing ashtrays and stubs in saucers or put off by the smell of stale smoke on their partner’s clothes or breath. But, after years of unconcern, some smokers come to develop a strong dislike of the dirtiness and messiness of smoking and are motivated to stop on this account.

Thinking About Stopping Smoking

Most smokers are motivated and go on wanting to stop for many years before they finally decide to carry it through and stop. Half-hearted attempts to “have a go” or to “see how it goes” are soon abandoned when it gets difficult.

To succeed in stopping, those who find it difficult will need to think and make a plan. They will need to think about their motives and doubts to make sure of their commitment to never smoke again, and to then plan how to face the difficulties of withdrawal until they gradually subside.

To help make up your mind about stopping, make a list of all the reasons that are important for you. Make a similar list of all the positive benefits of smoking you will miss, and any withdrawal difficulties you anticipate when you stop.

When you weigh up the two lists, remember that what you may miss and any suffering you may endure will be temporary and may last only three to four weeks. However, the benefits of stopping will be permanent and success at stopping will give you lasting satisfaction. It is your choice. You will succeed if you commit yourself to stopping.

Don’t be discouraged if you have tried before and failed. Most successful ex-smokers will try a few times before finally succeeding. You can learn from previous attempts how to avoid making the same mistakes.

Planning And Preparing To Stop Smoking

You must be prepared to work hard at stopping smoking. You will have to plan to give quitting smoking priority over other tasks during the first three to four weeks, when it is most difficult.

Here are the steps to take:

  1. Plan to stop on a particular day. Choose a time when you are not under too much pressure from other tasks and when you can avoid situations that you know will make it more difficult. Don’t put it off for too long unless you have to. A week or two is usually sufficient for adequate preparation. If a crucial business or social demand forces you to delay stopping for a month or more, you should in the meantime switch to a lower-tar cigarette. Getting used to it may require persistence for one to two weeks, but it would be a useful first step towards stopping.
  2. Make plans to keep away from smokers and other tempting situations after you have stopped. You may have to change some of your usual habits and activities for a week or two to avoid temptation; for example, avoiding parties or taking a walk before or after dinner instead of relaxing in a chair.
  3. Decide before your target day for stopping whether you may need nicotine chewing gum or other aids to help you. Set your target day to fit in with this. For example, for nicotine gum you should have a supply ready on your target day.
  4. Plan to stop smoking completely on your target day. Cutting down gradually is less effective. Don’t bother to try to cut down just before your target day. It may use up valuable effort and will power that you will need for stopping.
  5. Telling too many people that you are going to stop is not always helpful. To be constantly asked how you are getting along can bring the subject to your mind just when you are learning not to think about it. However, it is advisable to seek support from those at home, and to explain the reason if your difficulties are noticed at work.
  6. Prepare on a small card a list of your reasons for stopping.You may need to have this in your pocket or close at hand if things get difficult and your motivation falters after you have stopped. Some find it useful to use a list or calendar to check off each smoke-free day as progress is made over the first three to four weeks.
  7. On the night before your target day, make sure all cigarettes, ashtrays and lighters are removed from your home, car and office.

When You Are Stopping

On the day you have decided to stop smoking, keep the following in mind:

  • Take it one day at a time. Aim to get through your first day without a cigarette, then the next day, and so on.
  • Stick to your plans for keeping away from temptation and doing different things to take your mind off smoking.
  • If you find it difficult, remember that it will eventually become easy. Think about the positive benefits of stopping. Think, one by one for a while, about the importance of each reason on your prepared list.
  • If someone offers you a cigarette, say “no thanks,” quickly and casually, then carry on the conversation on other topics. Mentioning that you have given up smoking opens up the subject for discussion. You need to keep it out of your mind as much as possible.
  • Don’t give up trying if you slip up and have a cigarette. Be determined not to have another. You can’t afford to slip up too many times. It makes things much harder for you.
  • If you use nicotine gum, remember to chew it slowly at first, especially if you find it unpleasant. It usually takes 2 to 3 days to get used to it. Don’t expect it to be like a cigarette. It will not give positive satisfaction, but will help by relieving craving and other withdrawal effects.
  • Don’t be discouraged if urges to smoke seem to get stronger for a while after three to four days. The urges sometimes fluctuate at first, but will gradually go away completely, provided you don’t give in and smoke.
  • If you have an increase in hunger and an urge to eat more between meals, try fresh or dried fruit rather than sweets and chocolate. Don’t worry about your weight or appetite at this stage, if it is difficult to control. Focus all your effort on not smoking.

When You Have Stopped

Once you have stopped smoking, keep the following in mind:

  • Even when you have succeeded and the difficult period is over, you will need to keep up your determination to avoid slipping back to smoking by being careless.
  • Don’t ever think you can just try one or two cigarettes on a special occasion. Avoid also the “occasional” cigar.
  • Added vigilance is needed for new situations in which you have not yet learned to cope easily without smoking (for example, while on vacation).
  • Some people have occasional urges to smoke, which seem to come “out of the blue,” several months after stopping. They shouldn’t discourage you; they are seldom strong and are only a problem if you are careless.
  • Most people are well over the worst at four weeks after stopping. There is no need to slip up after this time, yet so many do. The reason is carelessness and lack of vigilance. When you have stopped, and the hardest time is over, be confident but careful. Also, begin to think how to reward yourself with the money you’ve saved.

Worries About Weight

Smokers on average weigh about 7 pounds less than nonsmokers do, and after stopping they tend to make up the difference and put on this much. This is partly due to eating more and partly to changes in metabolism. Nicotine has a mildly suppressant effect on appetite, especially the desire for sweet-tasting foods. It also increases the metabolic use of energy, which is the consumption of calories not used for physical exertion. The result is a tendency to gain weight after stopping smoking, despite not eating more.

Worries about weight control deter many from giving up smoking and are also a common motive for smoking in women. However, weight gain after stopping is very varied. For many it is barely detectable, while a few may gain 15 pounds or more. The best approach is to focus on giving up smoking first and to attend to the weight problem, if it occurs, when staying off cigarettes is no longer a problem (six to 12 months after stopping).

Relatively small changes in diet and exercise will, over a few months, eliminate weight gains of six to eight pounds as well as benefiting your health generally. Finally, you should be reassured that the health risks of slightly increased body weight are negligible compared with the major health advantages of stopping smoking.

What If I Need More Help?

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: Frequently Asked Questions

Here are some frequently asked questions related to smoking and how to stop:

Q: I’ve smoked for 30 years. Will quitting do any good or has the damage already been done?

A: It’s never too late to quit smoking. The benefits begin just 20 minutes after your last cigarette. After 15 years of not smoking, your risk of heart disease and death is similar to someone who has never smoked.

Q: Isn’t there a pill I can take to quit smoking?

A: Nicotine is a powerful addiction and there is no “magic pill” that will completely alleviate your withdrawal symptoms. However there are a number of aids to help ease withdrawal, including: nicotine gum, patches, nasal sprays, inhalers, and an anti-depressant that has been approved as an aid to quit smoking. These medications, together with a support program, may be able to help you quit.

Q: Won’t I gain a lot of weight if I quit smoking?

A: You’ll probably only gain about seven pounds when you quit, due to increased appetite and changes in your metabolism. You should initially concentrate on stopping smoking, and worry about weight gain when and if it occurs.

Q: Is it better to stop cold turkey or cut back gradually?

A: It’s less effective to gradually cut back than it is to stop completely. Choose a target day about a week ahead of time and stop smoking on that day.

Q: If I use an aid containing nicotine, won’t I become addicted to it?

A: Medications used to stop smoking deliver less nicotine than cigarettes and are especially useful during the first three or four weeks, when withdrawal symptoms are at their worst. From there, it’s usually easier to gradually eliminate them.

Q: I quit smoking six months ago and was doing fine, when out of the blue, I had an incredible urge to smoke. What’s wrong with me?

A: It’s normal to experience occasional strong urges to smoke after the initial withdrawal period for no apparent reason. That’s why it’s important to remain committed to a healthier lifestyle and realize that these urges will pass.

Smoking: How To Stop: Putting It All Together

Here is a summary of the important facts and information related to smoking and how to stop:

  • People who eventually quit smoking usually try to stop two or three times before they’re successful.
  • Nicotine is a powerful drug that acts on neurotransmitters in the brain and is physically addictive.
  • Most smokers start as teenagers. The earlier you start, the more powerful your addiction is likely to be.
  • Smokers adjust the amount of tar, nicotine, and carbon monoxide they receive by how deeply they inhale, how many puffs they take on each cigarette, and the number of cigarettes they smoke each day.
  • Smoking is responsible for 87 percent of lung cancers and also causes most cases of emphysema and chronic bronchitis.
  • The benefits of quitting smoking begin as soon as 20 minutes after the last cigarette smoked.
  • A person who stops smoking will have the same risk of heart disease and death 15 years after quitting as someone who has never smoked.
  • Secondhand smoke is known to cause cancer and is responsible for approximately 3,000 lung cancer deaths in nonsmokers each year.
  • Only you can decide when you’re ready to quit smoking. It’s best to pick a target day and stop smoking completely on that day. Aids such as nicotine gum, patches, inhalers and nasal sprays can help ease withdrawal symptoms.

Smoking: How To Stop: Glossary

Here are definitions of medical terms related to smoking and how to stop:

Acetylcholine: A neurotransmitter, or chemical in the brain that carries information between nerve cells.

Addiction: A strong dependence on a drug.

Arteriosclerosis: A disease in which a sticky substance known as plaque adheres to the walls of the arteries, narrowing and eventually clogging them.

Bronchitis: An inflammation of airways in the lungs known as bronchi, usually caused by an infection or by smoking.

Claudication: Pain in the muscles (especially the calf muscles) during exercise caused by too little blood flow.

Emphysema: An enlargement and destruction of the tiny air sacs in the lungs known as alveoli.

Mesolimbic dopamine system: A circuit in the brain that when stimulated by certain substances, such as nicotine, can lead to intense cravings.

Neurotransmitters: Chemicals in the brain that carry information between nerve cells.

Nicotine: The substance found in tobacco that causes addiction.

Nitrosamines: Compounds found in cured meats and tobacco than can cause cancer.

Osteoporosis: A progressive disease that weakens the bones, causing them to fracture more easily.

Passive smoking: The breathing in of air that contains other people’s smoke.

Peripheral vascular disease: A circulation disorder in which arteries carrying blood to the arms and legs become narrowed or clogged.

Thrombosis: Blood clots in the legs that can break off and go to the lungs causing respiratory distress or failure.

Withdrawal: Symptoms that occur after stopping a drug. Smoking withdrawal may include anxiety, irritability, insomnia, dizziness, difficulty in concentrating, fatigue, depression, and constipation.

Smoking: How To Stop: Additional Sources Of Information

Here are some reliable sources that can provide more information on smoking and how to stop:

American Cancer Society 
Phone: 1-800-ACS-2345

American Lung Association 
Phone: 1-212-315-8700

Office on Smoking & Health National Center for Disease Prevention and Health Promotion 
Phone: 1- 770-448-5705

Nicotine Anonymous 
Phone: 1- 415-750-0328

American Heart Association 
Phone: 1-800-242-1793

Office of the Surgeon General 
5600 Fishers Lane Room 18-66
Rockville, MD20857

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