Best way to quit smoking

More than 430,000 premature deaths a year in the United States or about one in five of the total deaths are attributed to the smoking habit. Up to age 65, people who smoke a pack a day or more die at almost twice the rate of nonsmokers in the same age group. The deadliest risks from smoking are cancer of the lungs, throat, and mouth. (About 90 percent of lung cancer cases are directly attributable to smoking.) Smoking is also the main cause by far of chronic obstructive pulmonary disease (COPD) a progressive blockage of air flow into and out of the lungs due to chronic bronchitis and emphysema. COPD affects some 14 million Americans, 80 percent of whom have significant exposure to tobacco smoke. Smoking is a major risk factor in heart attacks. Almost one-fifth of the nearly one million deaths annually from cardiovascular disease are attributed to smoking many more than the number of smoking-related deaths from cancer and COPD. Also, mounting evidence indicates that smoking may place young women at risk for cervical cancer.

Besides greatly increasing your risk for life threatening diseases, smoking has many smaller disadvantages. Long-term smokers are four times more likely to turn gray prematurely. Smokers are twice as probable to become bald or balding as compared to nonsmokers. Smokers are also more likely to develop serious premature wrinkling and are more likely of losing their teeth, since smoking may result in periodontal disease, regardless of how well smokers take care of their teeth

Low tar and nicotine brands of cigarettes haven’t helped. Even though tar and nicotine levels of cigarettes have declined substantially since 1955, American smokers (especially women) now smoke more cigarettes, inhale them more deeply, and start at earlier ages. Thus, smoking-related mortality rates are much higher today than they were 40 years ago.

Of the estimated 48 million Americans who smoke, 70 percent want to quit, and 34 percent try to quit each year. Unfortunately, fewer than 3 percent of those who try to quit succeed. Despite campaigns against smoking which have had some notable victories the smoking rate among American adults did not continue to drop during the 1990s. Most heavy smokers continue to smoke. And each year some one million young people (ages 1 1 to 20) take up the habit at least 3,000 each day, of whom an estimated one-third will eventually die from tobacco related illnesses. Many statistics show sharp increases in teenage smoking in recent years. (Smokers have their first cigarette, on average, at age 13, and become daily smokers within a few years.)

On the other hand, about 1.3 million Americans become former smokers each year. In all, nearly 45 million have succeeded in quitting a sure sign that you can choose not to smoke. The great majority of those former smokers quit on their own the simplest method and the one most likely to work. But there are a number of effective strategies you can draw on to help break the habit.

Why Quitting is Tough

Psychology and physiology play complex roles in the smoking habit. Nicotine is a psychoactive, addictive drug that causes marked alterations in body chemistry. It acts through specialized cell formations in the brain and muscles, but unlike alcohol or other psychoactive drugs, it does not produce dramatic evidence of intoxication, and thus people underestimate its power. (Tobacco companies have long recognized the addictive power of nicotine and have purposely manipulated its concentration in tobacco.)

Inhaled nicotine goes almost immediately to the brain, rapidly producing a sense of euphoria, particularly if you are smoking the first cigarette (or pipe or cigar) of the day. By taking more or fewer puffs, inhaling more or less deeply, and pacing your cigarettes, you unconsciously try to recreate this feeling again and again. What appears to be casual and random behavior is instead highly controlled.

Nicotine directly affects blood pressure, heart rate, skin temperature, hormone production, muscle tension, and pain sensitivity. It also alters mood. You are not merely imagining that smoking a cigarette enhances your powers of concentration or soothes your anxiety. Yet the tense, uptight feeling that a cigarette supposedly relieves can itself be caused by nicotine. It’s a vicious cycle.

Smoking and sex appeal

Smoking is not just a matter of nicotine. Nearly all smokers start at age 18 or younger, and typically, an adolescent takes up smoking to gain peer approval, to express rebelliousness, or simply to satisfy a curiosity. What psychologists call modeling is a strong factor? If the people you admire smoke, you may emulate them. As you begin to smoke, you learn that just handling cigarettes can be a pleasurable activity. You learn to associate them with such pleasures as mealtime, or the end of classes or work, or with the relief of tension. And if you go by the ads, the brand of cigarette you choose confirms your masculinity or your femininity, or identifies you as avant-garde or as a lean adventurer. The charming, healthy young men and women in ads (who mostly aren’t shown smoking) are swimming or playing tennis or sailing. Who wouldn’t wish to be part of their world?

Cigar smoking and trendy cigar bars have been growing in popularity, especially among educated people who don’t smoke cigarettes. Though cigars may be less damaging than cigarettes, they are far from harmless. Cigar smoking increases the risk of emphysema and cancers of the mouth, throat, and lungs. Smoking five or more cigars a day increases the risk of oral cancer by a factor of six, compared with nonsmokers. Drinking alcohol with cigars appears to worsen the health risks.

Intermittent “pack-a-week” smokers

Social restrictions on smoking have resulted in a growing class of occasional or intermittent smokers, who sneak in a few cigarettes a day or every other day. Some used to be heavy smokers, some are new smokers. According to estimates from the Centers for Disease Control and Prevention (CDC), about 6 percent of smokers, or three million, fall into this category.

Although research into intermittent smoking is virtually nonexistent, studies on light daily smoking indicate that the more you smoke, the greater the damage. One study showed that men who smoked anywhere from one to nine cigarettes daily had nearly five times greater risk of dying from lung cancer than nonsmokers. There is also some evidence that how long you have smoked may be an even greater risk factor for lung cancer than the amount you smoke.

Keys to quitting

Nearly every method no matter how odd has worked for somebody. If you know former smokers, talk to them. Chances are you’ll find some “goitaloners,” others who joined a group, and even one or two who swear by hypnosis or acupuncture. The important thing is to find a method that suits your needs. A previous failure is nothing to be ashamed of. If you’ve tried and failed and are now trying again, that simply indicates the strength of your motivation. Abandoning tobacco is learning processes so don’t give up. Like learning to ride a bike, it may take more than one try.

Finding a substitute

The best way to quit smoking varies according to what kind of smoker you are, what you think you get out of smoking, and what it seems to do for you. Knowing why you smoke will help you find substitutes for smoking. For example:

• If you smoke for stimulation or a lift, find a healthy substitute, such as a brisk walk or moderate exercise.
• If you smoke for pleasurable relaxation or to relieve tension (sometimes it’s hard to discern the difference), physical exertion, social activity, a new hobby, or deep breathing can serve as a partial substitute.
• If you feel as though you can’t start the day without a cigarette, you are likely smoking because of the physiological effects of nicotine. Going cold turkey may be the only way to combat this. First, try switching to a brand you dislike in order to decrease your nicotine intake and thereby alleviate later withdrawal symptoms. To work up to quitting, set a final date, and then smoke too much for a day or two.
• Some people have quit by switching to low tar, low-nicotine cigarettes for a week or two, then quitting completely. Others have found help in nicotine chewing gum or patches. The only catch is that the nicotine in these devices can also be addictive.
• If the habitual factor is strongest, work to alter your daily patterns. Cut down gradually eliminate a certain number of cigarettes each day. Form the habit of asking yourself if you really want the cigarette you are about to light. You may be surprised at how often you say no.
• If handling the cigarettes is important, try doodling or keeping some small object in your fingers. Take up cooking or a craft such as embroidery that supplies tactile sensations.
• Throw out any cigarettes in the house along with matches, lighters, and ashtrays.
• Visit the dentist and have the tobacco stains removed from your teeth. Steer clear of friends and family members who smoke. Plan a number of activities for the day you quit.
• Go places where smoking is not permitted museums, stores, theaters. Take public transportation. Swim, jog, ride a bike, or play tennis.
• Try to avoid any activity that you associate strongly with smoking.
• Be especially watchful when you drink alcohol. Researchers have long known that drinkers tend to smoke more and that drinking often serves as a cue to smoke simply out of habit, but a study at Purdue University showed that, in smokers, alcohol also actually increases the craving to smoke.

Drugs that can help

Health professionals now believe that smokers must choose their own route. In recent years pharmaceutical aids in the form of nicotine replacement devices, as well as antidepressant drugs have come on the market. If you can quit cold turkey, that’s the safest way But if you can’t, one or more of these may be worth considering. Nicotine replacement devices, which put nicotine (the addictive drug in cigarette smoke) in your blood, can buffer withdrawal symptoms. If you have heart disease, particularly angina or arrhythmias, talk to your doctor before trying nicotine replacement. Nicotine gums and patches pose some risk, though not as much as continuing to smoke.

Here is what is available:

Nicotine gum

Sold over the counter, nicotine gum is convenient and supplies nicotine faster than a patch. There are two formulations: 4 milligrams (for very dependent smokers) and 2 milligrams (for average smokers). Most people chew 10 to 15 pieces a day and settle at half that amount after the first couple of weeks. You can’t eat or drink within 15 minutes after chewing the gum, because that reduces its effectiveness. You chew the gum slowly until you experience a peppery taste, and then park it between your gums and cheek, continuing the process for about half an hour. Ten pieces (about one day’s supply) of the stronger version costs about $7 and the 2 milligram formulation about 50 cents.

Drawbacks

You may not like to be seen chewing gum. It may cause indigestion. And it’s hard for some people to give up the gum. You should wean yourself off it after you’ve quit smoking, but chewing the gum long term is less harmful than cigarettes.

The nicotine patch

This device, sold over the counter, can take two to four hours to deliver nicotine. But it’s less obtrusive than gum, and provides a steady blood level of nicotine. It’s also less likely to result in addiction. If you weigh less than 110 pounds or smoke fewer than 10 cigarettes daily, you should use a lower-dose patch.

After a couple of months, most people are able to switch to lower doses and finally taper off. The patch can be combined with other forms of nicotine replacement for example, with an inhaler. This may be recommended if you’ve failed to quit with other methods, but talk to your doctor before combining nicotine products. The patch costs about $4 a day.

Drawbacks

Possible skin irritation may occur. You shouldn’t smoke while using the patch, since that can cause a heart attack.

The nicotine inhaler

Available by prescription only, the inhaler looks like a cigarette (it has a mouthpiece and a porous plug containing a nicotine cartridge) and may help people who miss the act of smoking as much as the nicotine. You may need from 6 to 16 cartridges a day, for up to six months. You are supposed to taper off during the last three months. As with gum, you must not eat or drink within 15 minutes after using the inhaler. It is expensive about $11 for 10 cartridges.

Drawback

Possible throat and mouth irritation, coughing.

Nicotine nasal spray

This prescription only device is the fastest nicotine delivery system. You use about two doses an hour for the first eight weeks, and then reduce the dose and daily frequency for the next four to six weeks. Cost: $5.40 for 12 doses. Like the inhaler, this can be costly.

Drawbacks

Possible nose and throat irritation, sneezing, coughing, and watery eyes but most people develop a tolerance. Also, some people find it embarrassing to use the spray in public.

Antidepressant therapy

Certain prescription antidepressant medications can help some smokers quit, particularly when combined with some type of nicotine replacement. The only drug approved by the FDA for this use is Zyban, the quit-smoking version of the antidepressant Wellbutrin (generic name: bupropion hydrochloride).

Zyban alters brain chemistry to reduce cravings and depression. Combined with nicotine replacement, it has the highest quit rate in studies and the combination is more effective than either method alone. It’s not a magic bullet, but it can help.

If you decide you want to try Zyban, talk with your doctor. This is important if you also plan to use the patch, since the combination can raise your blood pressure. You’ll need to plan a quit date, then begin taking the drug one or two weeks beforehand, continuing for 7 to 12 weeks. If you have a history of eating disorders, are a heavy drinker, or are taking other antidepressants, you should not take Zyban. It poses a slight risk of seizures. Pregnant and nursing women should avoid it. Cost: about $3.50 a day. Medical insurance often does not pay for it.

Drawbacks

Possible dry mouth and insomnia occur. You’ll need to have your blood pressure checked periodically. While Zyban is the best drug treatment, it doesn’t work for everyone. In case it doesn’t work for you, your doctor may want you to try an older antidepressant, Pamelor. It’s less expensive, but has not been approved by the FDA as a quit-smoking aid. Clonodine, used to treat high blood pressure, may also work as a quit smoking aid, but also is not approved for this purpose. Your doctor must closely monitor you if you take this drug because its side effects can be significant.