Quit Smoking

After decades of willful misinformation by tobacco companies, the world now knows what doctors have long warned: smoking is lethal. It is the number-one cause of avoidable illness and death in the nation, killing almost a half-million people every year. If smoking were a disease, it would be considered an epidemic of epic proportions.

And lung cancer isn’t the only cause of these deaths; smoking causes or severely worsens a wide range of medical conditions, including other forms of cancer, obstructive lung disease, stroke, pregnancy complications, and—most important to us—heart disease.

Smoking and Your Heart

How does smoking cause heart disease? Researchers have demonstrated conclusively that atherosclerotic plaques build up in the arteries 50 percent faster in smokers than in non-smokers. What’s more, nicotine itself causes heart problems: it triggers the release of high amounts of adrenaline in the body, which, in turn, increases blood pressure.

It turns out you don’t even have to be a smoker to develop heart problems; all you have to do is live with one: secondhand smoke increases a person’s risk of heart problems by up to 60 percent. If you’ve already had a heart attack and continue to smoke, you have a 50 percent higher risk for having another heart problem than non-smokers do.

On the other hand, if you do quit smoking after that heart attack, your risk for future heart problems falls to the same level as that of non-smokers within three years of quitting. That’s not the only benefit. After your last cigarette:

  • Your blood pressure goes down to what it was before you started smoking within twenty minutes
  • The level of carbon monoxide in your blood drops within hours
  • Your lung function improves by 30 percent in two to three months
  • Your risk for heart disease drops by 50 percent within one year
  • Your risk of stroke decreases to the level of a non-smoker within five to fifteen years.

The American Heart Association/American College of Cardiology guidelines couldn’t be clearer: If you smoke, stop. And avoid being exposed to secondhand smoke as well. Mark Twain once said, “To cease smoking is the easiest thing I ever did. I ought to know because I’ve done it a thousand times.” Some 50 million people in America smoke, and seven out of every ten of them have tried to quit at least once.

Fewer than 20 percent of these people are still smoke-free one year later. Why? Because smoking isn’t a bad habit; it’s an addiction. The tars and other substances in tobacco are what cause lung cancer and other diseases, but it’s the nicotine in the leaves that keeps you wanting more even though you know it’s harming you.

Nicotine, like alcohol, is both a stimulant and a relaxant. It stimulates the production of adrenaline (among other things that increase your heartbeat) but also affects neurotransmitter chemicals in your brain to produce a mild euphoria. It is very fast-acting; it takes only seven seconds for nicotine to reach your brain after you inhale cigarette smoke.

But it also doesn’t last long; its effect wanes in less than an hour. When that happens, your brain craves more. When it doesn’t get it, you become irritable, anxious, and headachy. That’s nicotine’s addiction cycle. Most people who smoke started in their teenage years.

They may have experimented with cigarettes, drawn by the symbolic act of defiance. By age twenty, 80 percent of smokers regret that they started smoking. Unfortunately, the hold of the nicotine makes it difficult for them to quit. You can cure a bad habit by willpower alone, but it takes serious work to kick an addiction. Some people can do it without help, but many more cannot.

For the most part, people who fail when they try to stop smoking have failed only in understanding that for most people it takes a complex mix of medical and psychological strategies—and a lot of support from others—to kick this addiction for good. The expert guidelines recommend a combination of medications, organized smoking cessation programs, and counseling.

How to Stop Smoking

For something so difficult, the “prescription” to stop smoking successfully is simple:

Decide you want to quit

The sheer difficulty of kicking an addiction, the discomfort, the fear of failure, the abandonment of familiar patterns of being and habits of acting—all these things and more make simply deciding to quit an enormous hurdle to overcome. Yet millions of people make that decision every year. The hard part is making it stick.

As in so many things that are difficult in life, knowledge can help smooth the way. Let’s begin with the positive: the rewards of quitting. You’ll soon:

  • Become medically healthier
  • Feel physically healthier
  • Perform better in any physical activity
  • Improve your self-esteem
  • Enjoy a great sense of accomplishment
  • Find that food tastes better
  • Improve your sense of smell
  • Improve the smell of your home, car, and clothing
  • Find that your breath will be fresher
  • Enhance your skin
  • Know that you won’t be exposing people around you to smoke
  • No longer have to worry about quitting
  • Save a lot of money.

That’s a pretty impressive list of positives. Add to that list the fact that smoking is a powerful predictor of sudden death, increasing the risk of this tragic effect about twofold. But the good news is that the risk goes down when you quit. If the benefits are so clear, why do people fail? Because it’s hard; stopping smoking will present you with some very difficult challenges—at least in the beginning. You may:

  • Have to change your routine to avoid situations in which you typically smoked
  • Miss the physical pleasures of smoking
  • Feel depressed
  • Experience unpleasant withdrawal symptoms
  • Find that the fear of failure will be ever-present
  • Gain weight
  • Have trouble asking for and getting enough support from friends and family.

Make your own list of the reasons you want to stop smoking. Write them down and put the list where you’ll see it often. At the top of the list, write this: Because I’ll live longer and healthier, and I owe that to myself and to those who care about me. Then see your doctor.

Design a program for quitting with your doctor

Because tobacco is both physiologically and psychologically addictive, you need help in addressing both kinds of addiction. That is, you’ll need both medication and counseling. The FDA has approved five medications to help people quit smoking, all of which are effective. Four of these medications are types of nicotine-replacement therapy: gum, inhalers, nasal sprays, and patches.

Nicotine-replacement products reduce withdrawal symptoms but, unlike smoking, do not contain tar or other harmful toxins and are not as addictive. Although nicotine-replacement medications can be bought without a prescription, you should talk to your doctor before using them to find what will work best for you.

The fifth medication, the antidepressant bupropion (trade name: Zyban and Wellbutrin SR—the “SR” is for “sustained release”), causes somewhat less weight gain than other medications. When given with intensive behavioral support, bupropion is as effective as nicotine-replacement therapy and can nearly double your chance of quitting smoking.

Prolonged use may be helpful in preventing relapse. Bupropion is contraindicated in patients with current or past epilepsy and in those at risk of seizure (e.g., alcohol abusers). It should also not be used for patients with severe liver disease or bipolar disorder. Each of these alternatives has advantages and disadvantages, as laid out in the following:

  • Bupropion SR - Many people like the convenience of this once-a-day pill. Others dislike the insomnia and dry mouth it can cause. It should not be taken by those with seizures, eating disorders, known allergy to the drug, or those taking monoamine oxidase inhibitor antidepressants.
  • Nicotine gum - Many people like the ease and flexibility of using the gum. Others dislike the taste, having to use it frequently, or the jaw ache it can cause.
  • Nicotine inhaler - Many people like the flexibility of using the inhaler and find that it feels similar to smoking. Others dislike having to use it frequently, or the mouth and throat discomfort that it can cause.
  • Nicotine nasal spray - Many people like the flexibility of dosing. Others dislike having to use it frequently, or the nose and eye irritation that it can cause.
  • Nicotine patch - Many people like the once-a-day use of the patch. Others prefer a more flexible medication or dislike the skin rash that it can occasionally cause.

Nicotine replacement and bupropion, alone or together, but in combination with a physician-patient partnership, may provide the best opportunity to success. Another medication, called clonidine, also is effective, but because of potential side effects it should be used only when first-line medications have failed.

Two other medication strategies have also been tried: the antidepressant nortriptyline, and the combined use of a nicotine patch along with another form of nicotine replacement. Relatively little research has been done on these treatment strategies. Because addiction is both physical and mental, medication alone is unlikely to successfully help you stop smoking.

Counseling, which is available from many different professionals—doctors, nurses, psychologists, social workers, even dentists and pharmacists—has proven to be essential to smokers who want to quit and stay smoke-free over the long term. Often the need for professional support when craving and other withdrawal symptoms hit is too immediate for appointment-scheduling with a counselor.

Thankfully, there are many twenty-four-hour, toll-free “quitlines” staffed by counselors trained to help people quit smoking. Studies show that using a quitline may as much as double your chance of staying smoke-free after quitting. There are now quitlines in thirty-three states and a national quitline sponsored by the American Cancer Society.

For more information, simply call the American Cancer Society at 1-800-ACS-2345. In addition to these proven medication and counseling treatments, other forms of treatment have been promoted as effective but still need more research to confirm their usefulness.

These treatments include hypnosis, gradually cutting down the number of cigarettes smoked, positive and negative physiological feedback techniques, individual and group 12-step programs, restricted environmental stimulation (a form of therapy that, among other things, fosters reflection on the reasons one smokes), a drug called mecamylamine, and antidepressants other than bupropion or nortriptyline.

Also, rimonabant, the experimental drug that was found to be effective for weight loss, may have benefits for smoking cessation. Finally, there are two treatments that have been tried in the past for which there is no convincing evidence of effectiveness: acupuncture and the ingestion of silver acetate.

Get support from others

People who smoke associate many of their daily activities—meals, a coffee break, or having a drink with friends, to name but a few—with having a cigarette. Their social interactions are strongly linked with smoking. Indeed as smoking has become banned in many places, smokers’ own friendship patterns are affected, often limiting them to relationships with other smokers.

All of these patterns and relationships make quitting more difficult, and in many instances succeeding will require a change in these patterns and the support of family and friends when you are tempted to light up again. This support is critical; researchers have found that people with ongoing social support are 50 percent more likely to be successful at quitting and staying smoke-free.

Set a quit date

The next step is to set a date when you will stop smoking. This is actually more complicated than it sounds. Choose a day when you will be busy and be able to avoid places or social situations that you associate with smoking. For example, if you tend to smoke more at work or on weekdays, choose a Saturday or the beginning of a holiday.

If you smoke more on the weekends, choose a Monday, or some other workday. In addition, choose a day when you will be able to take some time at the end to reward yourself in some fashion for having quit. Finally, tell your friends and family so that they can support you and help you celebrate.

Frequently Asked Questions

How will I feel just after I quit smoking?

Even if you are taking nicotine-replacement therapy, you may still experience withdrawal symptoms after you stop smoking. These include cravings for tobacco, irritability, restlessness, increased appetite, trouble concentrating, fatigue, anxiety, depression, constipation, gas, and stomach upset. Each of these symptoms can be managed using the coping strategies described above.

How can I avoid the urge to smoke?

You probably can’t. But you can take steps to avoid places or situations that you connect with smoking, thus decreasing the frequency with which those urges arise. Also, avoid coffee, soft drinks, and alcohol, all of which can make your cravings worse.

What can I do when the urge to smoke hits?

Distract yourself. Sounds silly, doesn’t it? But it works. Much of the urge to smoke comes from the association you make between the activities you’re used to pursuing and smoking.

Now when the craving hits, do something else right away: take a few deep breaths, drink some water, listen to music, talk to a friend, take a bath, go for a walk, or busy yourself with a task or chore. The craving will pass, as will the stress that comes along with it. Whatever you do, don’t smoke. Not even one puff. It will only make your cravings worse.

I’ve tried to quit many times before. Now what?

Don’t be discouraged. People who have quit smoking usually have tried two or three or more times before managing to stay smoke-free. Try to identify what caused you to start smoking again in the past and think about how you’ll deal with these challenges this time. By the same token, think about what helped you stay smoke-free in the past and try those strategies again. Also, ask friends or family to help you stay on track.