Smoking Cessation Overview

Smoking is highly addictive, and, over time, takes a major toll on the body. Smoking and other forms of tobacco use are among the top preventable causes of death and disease in the United States. Smoking cessation is the use of one or more methods to quit smoking.

Why bother?

Quitting smoking now can decrease your risk of getting smoking-related illnesses such as:

• Heart disease
• Stroke
• Several types of cancer
• Chronic lung diseases, such as bronchitis, emphysema, and asthma
• Cataracts
• Macular degeneration
• Thyroid conditions
• Hearing loss
• Erectile dysfunction
• Dementia
• Osteoporosis

Also, because second-hand smoke is harmful, quitting smoking enhances the health of the people around you.

It is clear from all of the studies on smoking cessation that your chances of long-term success depend a great deal on your motivation and commitment to quitting, regardless of which therapy you choose.

The bad news: Smoking is highly addictive.

The good news: There are lots of ways to quit, and you don't have to do it alone.

Tobacco products contain nicotine, which is transported to the brain and causes pleasurable sensations. Because the effects of nicotine dissipate within a few minutes, tobacco users to continue using tobacco to maintain the pleasurable effects and prevent withdrawal. Other chemicals in tobacco products may also contribute to their addictive quality.

Smoking cessation uses various methods to help the tobacco use get through nicotine withdrawal and learn to live without smoking.

Once you’ve decided to quit smoking, set your “target quit date” a few weeks away. In the time leading up to your quit day, try some of these ideas offered by the Tobacco Control Research Branch of the National Cancer Institute to help you successfully quit smoking.

For the best results, work with your doctor. Together, you can test your lung function and compare the results to those of a nonsmoking person. The results can be given to you as your “lung age.” Finding out your “lung age” right after having the test done may help you to stop smoking.

Your doctor can also discuss with you all of your options and refer you to smoking-cessation support groups. You may wish to use nicotine replacement (gum, patches, inhaler) or one of the prescription medications that have been shown to increase quit rates and prolong abstinence from smoking. But whatever you and your doctor decide on these matters, it will still be you who decides when an how to quit. Here are some techniques:

Switch Brands

• Switch to a brand you find distasteful.
• Change to a brand that is low in tar and nicotine a couple of weeks before your target quit date. This will help change your smoking behavior. However, do not smoke more cigarettes, inhale them more often or more deeply, or place your fingertips over the holes in the filters. All of these actions will increase your nicotine intake, and the idea is to get your body used to functioning without nicotine.

Cut Down the Number of Cigarettes You Smoke

• Smoke only half of each cigarette.
• Each day, postpone the lighting of your first cigarette by one hour.
• Decide you'll only smoke during odd or even hours of the day.
• Decide beforehand how many cigarettes you'll smoke during the day. For each additional cigarette, give a dollar to your favorite charity.
• Change your eating habits to help you cut down. For example, drink milk, which many people consider incompatible with smoking. End meals or snacks with something that won't lead to a cigarette.
• Reach for a glass of juice instead of a cigarette for a "pick-me-up."
• Remember: Cutting down can help you quit, but it's not a substitute for quitting. If you're down to about seven cigarettes a day, it's time to set your target quit date, and get ready to stick to it.

Don't Smoke "Automatically"

• Smoke only those cigarettes you really want. Catch yourself before you light up a cigarette out of pure habit.
• Don't empty your ashtrays. This will remind you of how many cigarettes you've smoked each day, and the sight and the smell of stale cigarettes butts will be very unpleasant.
• Make yourself aware of each cigarette by using the opposite hand or putting cigarettes in an unfamiliar location or a different pocket to break the automatic reach.
• If you light up many times during the day without even thinking about it, try to look in a mirror each time you put a match to your cigarette. You may decide you don't need it.

Make Smoking Inconvenient

• Stop buying cigarettes by the carton. Wait until one pack is empty before you buy another.
• Stop carrying cigarettes with you at home or at work. Make them difficult to get to.

Make Smoking Unpleasant

• Smoke only under circumstances that aren't especially pleasurable for you. If you like to smoke with others, smoke alone. Turn your chair to an empty corner and focus only on the cigarette you are smoking and all its many negative effects.
• Collect all your cigarette butts in one large glass container as a visual reminder of the filth made by smoking.

Use Telephone and Internet Support

Telephone, web-, and computer-based programs can offer you the support that you need to quit and to stay smoke-free. You can find many programs online, like the American Lung Association's Freedom from Smoking.

Tips

Just Before Quitting

• Practice going without cigarettes.
• Don't think of never smoking again. Think of quitting in terms of one day at a time.
• Tell yourself you won't smoke today, and then don't.
• Clean your clothes to rid them of the cigarette smell, which can linger a long time.

On the Day You Quit

• Throw away all your cigarettes and matches. Hide your lighters and ashtrays.
• Visit the dentist and have your teeth cleaned to get rid of tobacco stains. Notice how nice they look and resolve to keep them that way.
• Make a list of things you'd like to buy for yourself or someone else. Estimate the cost in terms of packs of cigarettes, and put the money aside to buy these presents.
• Keep very busy on the big day. Go to the movies, exercise, take long walks, or go bike riding.
• Remind your family and friends that this is your quit date, and ask them to help you over the rough spots of the first couple of days and weeks.
• Buy yourself a treat or do something special to celebrate.

Immediately After Quitting

• Develop a clean, fresh, nonsmoking environment around yourself—at work and at home. Buy yourself flowers—you may be surprised how much you can enjoy their scent now.
• The first few days after you quit, spend as much free time as possible in places where smoking isn't allowed, such as libraries, museums, theaters, department stores, and churches.
• Drink large quantities of water and fruit juice (but avoid sodas that contain caffeine).
• Try to avoid alcohol, coffee, and other beverages that you associate with cigarette smoking.
• Strike up conversation instead of a match for a cigarette.
• If you miss the sensation of having a cigarette in your hand, play with something else—a pencil, a paper clip, a marble.
• If you miss having something in your mouth, try toothpicks or a fake cigarette.

Nicotine replacement therapy (NRT) are used to relieve nicotine withdrawal symptoms. It can be used in addition to behavioral changes.

Examples of NRT products include: nicotine gum, lozenges, nasal sprays, patches, and inhalers. Sometimes, these products are used in combination, which may help some people stay smoke-free. Since NRT does not produce the pleasurable effects of tobacco, there is little chance that these products will be abused.

According to studies, NRT may help you to:

• Reduce the amount of tobacco you usually consume and quit altogether even if you are unable or unwilling to stop smoking
• Quit and stay smoke-free if you use the product before your actual "quit day"
• Abstain from smoking

Talk to you doctor about how to best use this therapy. Combining behavioral therapy with NRT may be even more helpful.

Research has shown that certain medications, including the antidepressants bupropion (Zyban) and varenicline tartrate (Chantix) may help people quit smoking. Varenicline tartrate helps ease symptoms of nicotine withdrawal and may block the effects of nicotine if people resume smoking. One potential side effect with these medicines is that they may increase the risk of serious mood and behavior changes in some people.

American Lung Association website. Available at: http://www.lungusa.org/. Accessed July 15, 2008.

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/. Accessed July 15, 2008.

National Cancer Institute website. Available at: http://www.cancer.gov/. Accessed July 15, 2008.

3/25/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ. 2008;336:598-600.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169:929-937.