The Best Ways to Kick the Smoking Habit
Most smokers make a number of attempts before finally being able to kick the habit for good. Are you one of them?
The decision to quit and your success is influenced by how much you want to stop smoking, according to the Agency for Healthcare Research and Policy (AHRP), a federal agency which produces a consumer's guide on smoking cessation. If you don't want to quit but your spouse or mother wants you to, you probably won't.
Going "cold turkey" - just putting a cigarette out and making it your last - works for some smokers but not for everyone. Most smokers, particularly long-term or heavy smokers, need a little help. Fortunately, those who have the resolve to kick the smoking habit once and for all have more help at their fingertips than ever before.
There is no "right way" to quit. Choosing a quitting method boils down to "smoker preference. The more comfortable you are with the method you pick, the better the chances you will stick with it. Research has shown, though, that using some form of nicotine replacement (gum, patch or spray) with some form of counseling or therapy can improve your chances of quitting and avoiding relapse.
The most popular - and effective - methods are listed below.
- Nicotine gum, patch or spray
- Nicotine-free medications
- Smoking cessation programs or counseling
- Hypnosis
- Acupuncture
A smoking addiction has both biological and behavioral components. In the early days, smoking was thought mostly to be habit forming, not addictive, because of social situations, behaviors or rituals of lighting up. Therefore, the key to quitting, the theory said, was to change your behavior such as finding something different to do with your hands or not being around other smokers.
Researchers have proven today, though, that nicotine is a powerfully addictive drug. It takes about 10 to 12 seconds to get from the lungs into the bloodstream and brain. For some people, it can be as addictive as heroin or cocaine.
Nicotine replacement therapy (gum, patch, spray): Nicotine gum, patch and spray all help lessen the urge to smoke. The nicotine in the patch and gum passes through the skin while the nicotine in the spray passes through the nasal membranes for even quicker action. This reduces the craving for nicotine when you stop smoking. If you are pregnant or have heart or blood vessel problems, consult your health care provider about whether these products are right for you. Nicotine replacement therapy can help smokers quit once they're ready. The choice is a personal one.
Nicotine gum: The gum must be chewed slowly until a "peppery" taste comes out. Then, the gum is placed between the cheek and gum. Each piece of gum should be used for about 30 minutes. According to the AHRP, most people chew too few pieces of gum per day and for too few weeks to get the most benefit from using it. A fixed schedule (at least one piece every one to two hours for at least one to three months) may give the best results. Some people develop mild side effects such as hiccups, upset stomach or jaw ache. Most of these side effects do not occur if the gum is used correctly.
The gum is available without a doctor's prescription. Many smokers should start using the 2 mg dose, according to the AHRP. However, you may want to use 4 mg gum if you smoke more than 20 cigarettes a day, have tried and failed to quit on a lower dose and have severe withdrawal symptoms when you don't smoke.
Nicotine patch: Studies on nicotine patches have shown they are safe and effective. Patches come in different strengths and you don't need a prescription. Many smokers should start using a full-strength patch (15 to 22 mg of nicotine) daily for four weeks and then use a weaker patch for another four weeks (5 to 14 mg of nicotine). At the start of each day, a new patch is placed on a part of the body between the neck and waist. Each day, the patch is moved to a new spot to lessen skin irritation. The patch is usually used for up to eight weeks. Some people develop a rash where the patch is placed. Skin rashes are usually mild and easily treated. Moving the patch to another part of the body helps. Other side effects from the patch may include sleep disturbances, nausea and headache.
Nicotine nasal spray: Nicotine nasal spray is another tool in the nicotine replacement line-up. The nasal spray requires a prescription. The nicotine nasal spray has a couple advantages over the gum and the patch: Nicotine is rapidly absorbed across the nasal membranes, providing a rush much like the real thing. The disadvantage, however, is that the spray has a greater potential for addiction than the slower-acting gum and patch. It is recommended that the spray be used for three months and no longer than six months. Most people using the spray experience nasal or sinus irritation but can tolerate these effects, according to the FDA. However, because of these irritating effects, the spray is not recommended for people with underlying nasal or sinus conditions, allergies or asthma.
Nicotine-free pills: Even though the nicotine replacement products have been found helpful, half of all smokers still had a tendency to miss the high or surge of energy that they get from smoking. The nicotine-free pill, which is available by prescription, not only reduces the urge to smoke but it makes quitting more bearable because it controls the moody, irritable or depressive feelings that smokers often experience when they stop smoking. Nicotine is a mood-regulating drug. It stimulates the production of a brain chemical called dopamine, which in turn creates a sense of pleasure or reward. However, it also sets a person up to have an emotionally depressed feeling when that stimulation is over. Once a dopamine-stimulating drug like nicotine is stopped, the dopamine reward system doesn't function normally. This can result in mood changes, which often cause a smoker to relapse and pick up a cigarette to feel better.
Zyban (bupropion hydrocholoride), the nicotine-free pill, is an antidepressant. Essentially, it acts by returning the level of dopamine in the brain toward normal, something the nicotine patch was only partially able to achieve. (However, both bupropion and the nicotine patch can be used together for an added effect and to provide relief from cravings for heavily addicted smokers.)
It is generally recommended that Zyban be taken during the first three to four months after quitting smoking. Zyban is the same drug as Wellbutrin, which is marketed for clinical depression. Smokers should note, though, that while Zyban and Wellbutrin are the same, not all antidepressants have a stimulating effect on the dopamine system.
Other less used drugs that demonstrate some effectiveness include the anti-depressant nortriptyline (similar to buproprion), clonidine, and the beta-blocker metoprolol.
Varenicline (Chantix) reduces the severity of nicotine cravings and the intensity of withdrawal symptoms. Varenicline is normally taken for 12 weeks. People who quit during that time can continue therapy for an additional 12 weeks to increase their chances of remaining tobacco-free. People taking Chantix should be watched closely for unusual activity including agitation, depression and suicidal thoughts and behavior.
Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
Smoking cessation programs or counseling: Studies of people who have quit show the more counseling you have, the greater your chance of success. Here is what to look for in a quit-smoking program, according to the AHRP:
- Session length: at least 20 to 30 minutes long
- Number of sessions: at least four to seven sessions
- Number of weeks: at least two weeks
Your family, friends or health care provider can also offer support and encouragement. Self-help materials and hotlines also are available to help. It's also important to learn how to handle urges to smoke and stress. For example, being around people who smoke or drink alcohol may cause you to want to smoke. Also, being under time pressure, getting into an argument or feeling sad or frustrated.
Hypnosis: Hypnotism has become one of the most advertised methods of quitting. Experts say it can dramatically diminish the psychological component of a nicotine addiction and prepare someone to cope with the nicotine craving.
When you are hypnotized, you are neither asleep nor unconscious. You are in an altered state of consciousness in which you "let things happen" through our subconscious mind rather than trying to consciously make them happen.
Hypnotists try to change subconscious beliefs and attitudes that may stand in a smoker's way to quitting through suggestion. Post-hypnotic suggestions are carried out by the person when he or she comes out of the hypnotic state.
If you are inclined to try hypnotism, keep in mind that you have to be motivated to "kick the habit." If you aren't, it won't work.
Often hypnosis includes relaxation methods, meditation, rewards and counseling. Hypnosis also involves these different techniques:
Auto-suggestion: suggesting change to smokers or altering perceptions about addictive behavior.
Hypnoaversion: using hypnosis to instill an aversion to addictive behavior.
Hypnotherapy: using hypnosis with psychotherapy and teaching self-hypnosis.
According to the
Single individual sessions have been reported to have quit rates of 0 percent to 68 percent. Group hypnosis has been reported to have quit rates of 8 percent to 88 percent, according to the COHIS.
Acupuncture: Acupuncture is a healing technique derived from ancient Chinese medicine. As with hypnosis, acupuncture may work for those with a strong desire to quit, but has not been proven.
Needles are placed or pressure is applied in areas of the body associated with certain nerves believed to play a role in the specific health problem. The stimulation on selected acupuncture points is thought to make your body produce natural medicines such as endorphins (a brain chemical involved in producing pain relief and pleasure). These agents are believed to block your "pleasure response" to tobacco and to decrease the withdrawal symptoms that normally occur with quitting.
The treatment involves the insertion of four to six needles into well-defined acupuncture points. The treatment is painless. A minimum of two treatments is recommended. Some people return for a follow-up treatment.
After treatment, some acupuncturists place tiny magnetic balls on selected ear points of patients to maintain the stimulation. When the smokers get a craving for a cigarette, they stimulate the magnets on their ears. Acupuncture works best with other methods of quitting, such as counseling.
According to the COHIS, success with acupuncture alone has been considered to be fairly low. Quit rates at one year have reportedly ranged from 8 percent to 40 percent.
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