“It’s easy to quit smoking; I’ve done it hundreds of times.” — Mark Twain
By Catharine Paddock
There are many different ways to quit smoking. Some experts advocate using pharmacological products to help wean you off nicotine, others say all you need is a good counselor and support group, or an organized program. To add to the confusion, you may find there is a study that says this way works better than that one, and then when you look again, you find there is another study that says, no, that one works better than this one.
But one thing most experts agree on is that a combination works best. For example, nicotine replacement therapy on its own, or counseling on its own is not as effective as a combination of the two.
In this article you can read about some of the more common elements of successful quit smoking programs. And at the end is a list of Top Tips to Quit Smoking.
- Elements of Successful Quit Programs If you are looking to put together or select a quit smoking program, I suggest you consider four elements in your “combination”:
- Appropriate use of pharmacological products. If you feel you are severely addicted to smoking, you may wish to consider nicotine replacement products so your body gradually gets used to living without nicotine: always talk to your doctor, pharmacist, or qualified quitting expert first before using these drugs.
- Advice and support. Advice and support can help you become more self-aware, identify your triggers and when moments of weakness may occur, develop strategies and contingencies, keep you realistically grounded and on track with your plan, and prevent relapse. Examples include one-to-one or in-person counselling, telephone counselling, internet programs, group support, mentoring, and coaching.
- Measuring and recording. To help you see in black and white how much you smoke, how much it costs you, how much you could save; also keeping a journal of your quitting journey.
- Improving your knowledge: Read the science, talk to experts, and learn for yourself how smoking damages your health and the health of those around you. Learn how others tackled the challenge.
If you have had a health problem, such as a heart attack or stroke, or if you are pregnant or planning to start a family, go and see your doctor and discuss your quit plan before you start.
Pharmacological products There are more than 4,000 harmful chemicals in tobacco. Nicotine is the one that makes you addicted to smoking. The idea of nicotine replacement products is to help you gradually wean yourself off nicotine. They deliver a small amount of nicotine to relieve the symptoms of withdrawal. Giving up the replacement product is easier than giving up smoking.
Nicotine replacement products come in many forms, the main ones being:
- Nicotine gum
- Nicotine patch
- Nicotine nasal spray
- Nicotine inhaler
Proper use of such products can often be the key to successfully quitting for good. Here is an example of how it works:
- Stage 1: Stop smoking (NEVER use nicotine replacement products if you are still smoking).
- Stage 2: Use nicotine replacement therapy (having first consulted an expert about the best product and dose for you) to help manage your cravings. Gradually reduce the dose in line with the program you are following.
- Stage 3: Meanwhile, seek out and start on a support program, such as counselling or group therapy. Make sure you discuss your use of nicotine replacement products in your counselling so the two therapies work with each other.
Aim to be free of both cigarettes and the nicotine replacement product within three to six months. To decide which product is most likely to help you, talk to a qualified expert. Go and see your doctor, he or she may advise you, or refer you to a smoking cessation expert who knows about appropriate use of nicotine replacement products.
Knowing how dependent you are on nicotine can help you decide whether you wish to use replacement products. Some quitting centres may ask you to fill in a short questionnaire, such as the “Fagerstrom Test” to assess your nicotine dependence. This asks you:
- How soon do you smoke your first cigarette after waking up?
- Do you find it difficult to abstain from smoking in places where it is forbidden?
- Which cigarette would you most hate to give up?
- How many cigarettes do you smoke a day?
- Do you smoke more frequently in the morning (in the hours after getting up), than the rest of the day?
- Do you smoke even if you are so ill you have to stay in bed?
Your answers generate a score that indicates how dependent you are on nicotine. The higher your dependence, the more likely you are to benefit from pharmacological products to help you cope with withdrawal symptoms and quit smoking.
Other products are also available, such as bupropion hydrochloride, that target the biologic basis of tobacco addiction. Bupropion is sold under various brand names, eg Zyban, Wellbutrin, and is available on prescription. The drug has a similar effect on the brain as nicotine, it boosts levels of dopamine and norepinephrine to create a sense of wellbeing and vitality. Like all nicotine substitutes, the drug is intended for use with a quit smoking behavior change program.
Advice and Support Evidence suggests that advice and support from others makes a difference to long-term success in quitting smoking. Randomized controlled trials of commonly used techniques, including one-to-one, group, and telephone counseling, show they help smokers quit and remain abstinent. Even brief advice from a doctor has an effect on cessation rates.
The World Health Organization (WHO) takes the view that any professional trained in the appropriate skill should be involved in helping smokers quit: that it is an activity for the whole health care system, providing as many access points as possible for smokers to connect with and benefit from support to help them quit.
Many quitting practitioners employ techniques from cognitive behavioural therapy (CBT). These help you change your habitual thinking and behavior around smoking: for example, identifying and managing triggers (the things that make you want to smoke), developing and reinforcing alternative “good habits” such as exercise, relaxation, or self-rewards for each day without a cigarette or each cigarette or packet not smoked.
The techniques should focus not only on the period leading up to and during quitting, but also afterwards, helping you sustain changes in thinking and behavior to remain abstinent. You don’t have to go to a cognitive behavioural therapist to benefit from CBT techniques. Many other care professionals are trained in CBT because it complements how they deliver their own service. I have met doctors, nurses, social workers, physiotherapists, hypno-therapists, business coaches, Reiki healers and yoga teachers trained in CBT.
An effective program also offers several ways or “modalities” to help you stay connected and on track. For instance, as well as offering one-to-one advice and support, such a program might include group discussions, access to online materials and knowledge bases where you can read articles on smoking cessation, tips and stories from successful quitters, as well as the opportunity to pair up with a buddy or a mentor.
In the UK, under the NHS Smokefree campaign, there are free local services that provide expert advice, information and support to smokers who want to quit. They can help you get stop smoking aids such as nicotine patches and gum, or other prescription products from your GP such as Champix or Zyban if they are suitable for you. One such example is in Buckinghamshire, where support centres throughout the county offer confidential sessions for a minimum of six weeks. They also work with local employers and set up free workplace groups for staff who find it difficult to get to support centres.
Measuring and Recording Many quitting programs have an element where where you sit down and quantify the effect that smoking has on your life. For example, you work out how many cigarettes you smoke per day, per week, per year, and how much this costs you. For some smokers this is often their first “reality check”.
- In a week you spend 34.65
- In a month you spend 148.50
- In a year you spend 1,806.75
- In 5 years you spend 9,033.75
- In 10 years you spend 18,067.50
Some people find it helps to keep a quit journal. You can use it to jot down your plan or little notes to remind you about why you want to quit, and to record snippets of your quitting experience. For example, you may wish to list your triggers and your options for alternative action to avoid taking up smoking again. You could list what you think will be your biggest challenges, such as keeping the weight off: how might you prepare for and deal with that?
Once you’ve reached your quit date, use your journal to keep track of how you are doing. How did you deal with those challenges?
Some people find their journal helps them put things in perspective. On bad days things can look much bleaker than they really are. Looking back through the journal you can see that there have been good days too: what was it about them that you can use in the bad days to help you along? Many countries have “quitlines” where you can call an expert who understands the health effects of smoking, the quitting process, and how difficult it can be to give up.
Knowledge and Information You may find it helps to stay motivated about quitting to keep up to date with the science surrounding tobacco and smoking. Finding out how other quitters faced and dealt with their challenges can also give you ideas that help you on your own quitting journey.
Another resource that may help keep you motivated is the “Within 20 Minutes of Quitting” poster from the US Centers for Disease Control and Prevention (CDC). The poster, included in the 2004 US Surgeon General’s Report, lists the following statements:
- 20 minutes after quitting: your heart rate drops.
- 12 hours after quitting: carbon monoxide in your blood drops to normal.
- 2 weeks to 3 months after quitting: your heart attack risk begins to drop; your lung function begins to improve.
- 1 to 9 months after quitting: your coughing and shortness of breath decrease.
- 1 year after quitting: your added risk of coronary heart disease is half that of a smoker’s.
- 5 years after quitting: your stroke risk is reduced to that of a non-smoker’s 5 – 15 years after quitting.
- 10 years after quitting: your lung cancer death rate is about half that of a smoker’s; your risk of cancers of the mouth, throat, oesophagus, bladder, kidney and pancreas decreases.
- 15 years after quitting: your risk of coronary heart disease is back to that of a non-smoker’s.
Top Tips to Quit Smoking
- List your own reasons for quitting.
- Choose a “low stress” time to quit. Set a date and stick to it.
- Build a support network around you. Ask for help from your dentist, doctor, family, friends, work colleagues.
- Use medicines that help your body get used to life without nicotine: they can double your chances of quitting for good. Ask your doctor, dentist, pharmacist about them first.
- Seek tobacco-free environments to curb your temptations: e.g movies, theatres, libaries, restaurants.
- Plan activities that leave no opportunity for smoking.
- Remove smoking paraphernalia from your home, office and car.
- Anticipate problems and have a realistic plan to deal with challenges (e.g if going out with smokers, practise what you are going to say when you refuse a cigarette).
- Exercise: not only can it make you feel better about yourself and your decision to quit, it is hard to smoke when you’re cycling, swimming, or jogging.
- Keep your hands occupied. Take up some manual activities: woodworking, gardening, do the housework, keep some needlework or a small book of puzzles or crosswords with you.
Practise the 4Ds when you feel cravings coming on: Delay (craving will pass in 5 to 10 minutes); Drink water (helps wash toxins from your body, keeps your hands and mouth busy); Distract yourself (keep active, do something else); Deep breathing (inhaling and exhaling deeply is soothing and relaxing). Tips list is adapted from the American Dental Association’s Oral Health Topics.
And finally, the most important tip of all, Persevere and don’t let setbacks get you down. It is like learning to ride a bike: when you fall off, just get back on again and keep trying. There will be bad days, and there will be good days.
Remember, the majority of successful quitters did not stop on their first quit attempt.