Tools to Help You Successfully Quit Smoking

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There are nearly as many methods for quitting smoking as there are ex-smokers. Those who succeeded in breaking nicotine's bonds cite everything from quitting cold turkey to hypnosis and even prescription lozenges as effective ways to stop smoking. Most of the tools offer temporary relief from the physical withdrawal symptoms of smoking cessation, but do not address the powerful psychological addictions. These are best addressed by behavioral modification counseling or group therapy, and by other techniques used successfully by former smokers, which are outlined in Tips from the Pros. Strategies that address both the physical and psychological addictions are the most likely to succeed.

The first two weeks after quitting smoking are critical to a person's success. Withdrawal symptoms begin within just a few hours of the last cigarette smoked then will increase in intensity until these symptoms peak after 3 to 5 days. After two weeks, the withdrawal symptoms disappear. Withdrawal symptoms include:

Physical Symptoms:

• Headache
• Tingling in hands and feet
• Sweating
• Intestinal pain and discomfort in the form of cramps or nausea
• Sore throat, coughing, general respiratory problems similar to cold symptoms (the good thing, though, is this means the smokers' lungs are clearing)

Emotional Symptoms:

• Extreme mood swings: temper tantrums, feelings of dependency, neediness
• Irritability
• Anxiety
• Insomnia
• Lack of mental clarity — difficulty in concentrating
• Depression — in the short term, some smokers actually grieve the loss of cigarettes. Planning for these feelings of loss can help a smoker get through the early withdrawal symptoms of depression.

Going Cold Turkey
Many people try to quit smoking without any outside help. Although some smokers are unsuccessful in quitting cold turkey, certain activities can help a smoker through the first two weeks of nicotine withdrawal. One of the biggest obstacles in quitting cold turkey is learning to make the behavioral changes associated with smoking habits without any outside help. There are a number of excellent books, tapes and manuals designed for those who want to quit cold turkey. Most importantly, the decision to quit has to come from the smoker. Studies show that only those smokers who are committed to quitting are successful in breaking the habit.

The American Lung Association offers tips for quitting and a free, step-by-step program, "Freedom from Smoking." Visit them at www.lungusa.org/tobacco/.

Nicotine Replacement Therapy
Several types of nicotine replacement therapies are available, including nicotine patches, gums, nasal sprays, inhalers and lozenges. The objective in using nicotine replacement therapy is to break the habit of smoking, while gradually overcoming the physical addiction to nicotine. These methods provide a low dosage of nicotine without the harmful tars and other contaminants found in cigarette smoke. Clinical evidence does not prove which replacement therapy is best, since individual preferences vary.

Overall, when using a nicotine replacement, consider the following:

• Not cheating on the first day of nicotine replacement increases the chance of quitting permanently tenfold.
• Nicotine replacement therapy is temporary and is used to aid in smoking cessation. These therapies should never be used as a long-term substitute for smoking.
• Counseling, self-help, or group therapy programs can enhance the effectiveness of the nicotine replacement therapy.
• Smoking is prohibited while using nicotine replacement. Smoking and using nicotine replacement simultaneously can cause toxic levels of nicotine in the bloodstream.
• Most users will experience some side effects from nicotine replacement, including headache, nausea and insomnia.
• Nicotine replacement may adversely affect individuals with certain conditions such as heart disease, circulatory problems or pregnant women. No matter what your health, check with your doctor before beginning any nicotine replacement therapy.

Nicotine Patches
The patch is sold over the counter, but it is best to consult your doctor before using them. Patches are easy to use and are sold under a variety of brand names in different strengths and dosages. All patches are similarly used:

• A single patch is used each day, providing a steady dosage of nicotine through the skin.
• The patch is replaced every 24 hours, and is applied to a hairless location above the waist and below the neck (back, shoulder, arm, etc.)
• Patches must be stored safely and discarded safely, especially in homes with small children.
• The Food and Drug Administration recommends using the patch for three to five months.

Nicotine Gum
Nicotine gum is also available over the counter. The gum contains small amounts of nicotine, which are absorbed into the lining of the mouth. Though the product is called "gum," it is not chewed like regular chewing gum. After initial chewing to release the nicotine, the gum is then 'parked' between your cheek and gum so that the nicotine is absorbed in the mouth rather than swallowed from over-chewing. Some things to consider when using nicotine gum:

• Gum is convenient, flexible and delivers nicotine to the bloodstream faster than the patch.
• Users chew one to two pieces of gum per hour, never more than 20 per day.
• Coffee, tea, soft drinks and other acidic beverages interfere with nicotine absorption, so cannot be used within fifteen minutes of chewing nicotine gum.
• Side effects from nicotine gum include upset stomach, mouth ulcers, hiccups and throat irritation.

Nicotine Inhaler
Nicotine inhalers are plastic, cigarette-shaped cylinders filled with nicotine cartridges. Inhalers are available by prescription only. Before asking your doctor for a prescription for a nicotine inhaler, consider the following:

• Dosage is flexible since users inhale on demand.
• Inhalers satisfy oral urges since it mimics the hand-to-mouth action of smoking.
• The nicotine vapor is absorbed in the mouth, not the lungs.
• Side effects include throat and mouth irritation since the inhaler must be used frequently to obtain satisfactory levels of nicotine.

Nicotine Lozenges
A new form of nicotine replacement therapy is now available over-the-counter as the Commit lozenge. This type of replacement therapy is used in the following ways:

• Lozenges come in two dosages, 2 and 4 milligrams, and are designed to reduce nicotine cravings and withdrawal symptoms.
• The nicotine lozenges are taken for 12 weeks, and dosage is gradually reduced over this period as nicotine cravings subside.
• Lozenges are equally priced to nicotine gum and patches, roughly $25 per week.
• The dosage of nicotine in the lozenges is the same as that in nicotine gum, but approximately 25% more nicotine is released from the lozenge compared to the gum.
• If approved in the United States, the lozenges will be available by prescription only since a doctor determines which dosage is right for each individual.

Hypnosis
Some smokers use hypnosis as a tool for quitting. During private sessions with a therapist, hypnotherapy utilizes techniques like guided imagery, meditation and relaxation to relax the subject. Hypnotherapists work on convincing a person's subconscious to break the emotional ties with smoking. Once the patient is in a relaxed state, the hypnotherapist offers motivations for quitting smoking and reinforces a positive self-image for the subject. Through mental relaxation and conditioning techniques they learn, many smokers are able to quit using hypnosis therapy.

Acupuncture
Acupuncture is a healing technique derived from ancient Chinese medicine in which needles are placed in certain nerves on the body that are believed to play a role in a specific health problem. Acupuncture is thought to cause endorphin release, decreasing the withdrawal symptoms that occur with quitting smoking.

The acupuncture technique most widely used for smoking cessation is to attach small, curved staples to three different places around the edge of the ear. The patient is then instructed to apply pressure to each staple, in a particular order, when cigarette craving occurs. Acupuncture for smoking cessation has become popular and more wide-spread, but its long term success rates have not been fully studied.

Bupropion (Zyban)
Bupropion is a unique antidepressant used to aid in smoking cessation. Approved by the Food and Drug Administration in 1996, and marketed under the brand name Zyban, this prescription-only medication is an easy-to-use pill with few side effects. Bupropion increases the effects of certain neurotransmitters in the brain, particularly dopamine, which may play a strong role in nicotine addiction.

The medication enhances brain chemistry to bring on the same pleasurable effects that nicotine has in a smoker. Bupropion is not habit-forming and does not alter mood — it gives no "high" feeling. Also, don't be deceived by the term "antidepressant." Bupropion is still effective in the cessation process even for those who don't suffer from depression. Bupropion may be right for you, but before you discuss it with your healthcare provider, consider the following:

• Bupropion may take 2-3 weeks to begin working, so should be started before the actual targeted stop-smoking date.
• Bupropion can be used alone or with nicotine replacement therapy. Studies show high success rates in people who used bupropion along with a nicotine patch for long term smoking cessation.
• Bupropion has been used for several years as an anti-depressant under the name Wellbutrin, but is an effective smoking cessation aid even in people with no depression. Those who do not suffer from depression that use bupropion for smoking cessation will have no noticeable effect on mood.
• Bupropion is not addictive, and unlike nicotine replacement therapy can be used long-term.
• Although most people tolerate bupropion well, some people experience a few side effects such as dry mouth, nausea, headache, nervousness, excessive sweating and insomnia. Most of these side effects occur the drug is started and subside with continued use.
• If you have a history of seizure or epilepsy, bupropion may not be the best choice. Make certain that your doctor is aware of any history of seizures before prescribing bupropion.