Tobacco smoking is still the number one most preventable cause of death in the US and in the world. It directly causes more than 443, 000 deaths each year, and contributes four out of five deaths caused by heart disease, cancer, lung disease and stroke. Now, quitting smoking is not easy. And the fact is, you may have to attempt a few times before you succeed. Put in perspective, of the 46% of smokers who actually attempt to quit, 90% go on to relapse within a year. Less than 5% of those who go unassisted (read: cold turkey) will succeed in the long-term. The good news is that with the right combination of assistance and the best techniques to quit smoking, your chances for quitting successfully could more than triple.
Most effective techniques to quit smoking
Smoking is a chronic addiction. Some people smoke, but may not be addicted to it. However, the majority of smokers, 85 % to be exact, are addicted. The first few hours after you quit smoking might seem too easy, but about 4 hours in come the cravings, followed by intense withdrawal symptoms. Withdrawal is going to happen; there is no choice for detour available. Withdrawal symptoms peak in three days, and improve within 10 days. On the other hand, the cravings may persist for a lifetime, and this is the biggest hurdle you will face. So, what exactly can you do about these cravings? When you prepare to quit smoking, you need to list down all the situations and activities that trigger your cravings. For some, it’s inhaling secondhand smoke; for others, it’s drinking alcohol. Figure out what triggers you and develop strategies to beat the urge. When an urge arises:
- Remove yourself from or avoid situations that make you want to smoke.
- Minimize spending time with smokers. If your spouse is also a smoker, plan to quit smoking together.
- Distract yourself for 5 to 10 minutes to keep your mind off the urge. You will find that the urge fades after just a few minutes.
- Take deep breaths. A study found that Yoga-style breathing exercises could reduce cravings in smokers who are trying to quit smoking.
- Drink water instead of munching on food to avoid weight gain.
- Keep your mouth busy. Try sucking on hard candy or sugarless gum.
- Go for a walk. Or bound up and down the stairs. A short burst of physical activity can boost your mood and help beat a craving.
- Never consider taking “just one puff” because you know it will never end at just one.
- Realize that if you manage to stay off nicotine for a week, you are 10 times more likely to quit smoking for good than those who can’t.
Nicotine Replacement Therapy
Nicotine replacement therapy (NRT) is specifically designed to ease the intensity of withdrawal symptoms like you will experience when you try to stop smoking. With a success rate of 50 to 70%, NRT works as well either with or without counselling. It is available over-the-counter at pharmacies in the form of gums, patches, lozenges and nasal spray.
Nicotine patches deliver a steady stream of nicotine over 16 to 24 hours. The nicotine content of patches is lower than that of cigarettes but enough to reduce symptoms. One disadvantage of patches is that they don’t mimic the usual high’s and low’s of nicotine levels when you smoke. Success rate: Nicotine patches may increase your chances to quit smoking by 21% at six months, 28 % when combined with gums. When to start using: More often, experts recommend to start using nicotine patches on the same day you quit smoking. However, a study published in the journal Nicotine and Tobacco Research suggests that using the patch for two weeks before you quit smoking could actually double success rates. Basically, when you start using NRT entirely depends on your preference. How to use: Patches are available in 7, 14 and 21 mg doses. If you smoke more than 10 sticks per day, you should start with the 21-mg dose. From there, follow the package instruction for the “step-down” process. Apply the patch once a day on clean, dry and hairless skin for 16 to 24 hours. It is generally recommended to limit treatment with nicotine patches to eight weeks because longer use does not confer additional benefits. Side effects: About 50% of users will experience skin irritation, burning and rashes. Other side effects include insomnia and vivid dreams. Other considerations: Although patches are available without prescription, there are things you have to consider before going ahead with them. If you’re recovering from a heart attack, wait at least four weeks from the incident before starting the treatment. Consult your physician if you have severe chest pains or severe and uncontrolled hypertension.
Nicotine gum is also perfect as a first choice for NRT, although it is only recommended for those who have relapsed after having used the patch. This is because nicotine gums are more expensive and relatively harder to use. Success rate: It boosts chances to quit smoking by 24% at six months. How to use: Gums are available in 2 and 4 mg strengths. If you smoke 18 or more cigarettes a day, you are recommended to start with 4 mg. Chew up to 15 pieces per day, and chew the gum slowly then rest it between your cheek and gum. Don’t drink or eat for 15 minutes before use. Recommended duration of use is a max of three months. Side effects: May include mouth irritation, nausea and soreness of jaw muscles. Other considerations: The gum is not suitable for people wearing dentures for obvious reasons.
Like gums, nicotine lozenges release nicotine into the saliva over a period of hours. The difference is that lozenges deliver about 25 % more nicotine than the gum. Because they do not need to be chewed on, lozenges may be better for some people to use. Success rate: Nicotine lozenges could increase your chances of stopping smoking by 16 % at eight weeks, and 24% at six months. How to use: Nicotine lozenges come in strengths of 2 to 4 mg. Start with the 4 mg lozenge if you smoke more than 20 sticks per day or if you smoke 30 minutes after rising in the morning. You can use a max of 15 lozenges per day. Each brand has different instructions, but generally, it is recommended to use one lozenge every 2 hours for a maximum of 8 weeks. Side effects: Possible side effects include sore mouth, hiccups and nausea.
Nicotine Nasal Spray
Compared to the patch, gum and lozenge, the nicotine nasal spray rapidly increases nicotine levels, closely mimicking the surge of nicotine you get from smoking. This is perfect for easing sudden cravings. A disadvantage is that the nasal spray is the most addictive form of NRTs. Success rate: It has a success rate of 30% at six months. How to use: It is generally recommended to start with or two doses hourly, one dose in each nostril for up to 8 weeks. Side effects: 1 in 3 users experience nose and throat irritation, coughing and watering eyes.
First created to treat depression, bupropion (brand names: Zyban, Wellbutrin) was approved by the FDA as the first drug of choice for smoking cessation. Bupropion appears to change the way the brain responds to nicotine, causing smoking to be less pleasurable. By balancing the chemicals in your brain, bupropion reduces craving and withdrawal symptoms. Another advantage is that bupropion does not contain nicotine, so it can be used with NRT. Bupropion can also delay weight gain for a bit after you quit smoking. Success rate: By itself, bupropion has a success rate of about 30% at six months and 35% when combined with nicotine patch. How to use: For best results, start the treatment 1 to 2 weeks before you quit smoking. For the first three days, take one 150 mg pill. From there, double your dose to 300 mg by taking two 150 mg pills 8 hours apart. You can expect to start seeing results within seventh week. Treatment usually lasts seven to 12 weeks at a cost of $4 per day. If you don’t experience any significant progress by the seventh week, treatment is usually suspended. Common side effects: The most common side effects include dizziness, constipation, nausea/vomiting, dry mouth, excessive sweating, headaches, insomnia and restlessness. Other considerations: You need a doctor’s prescription and guidance to take bupropion. If you develop agitation, depression and suicidal thoughts, stop the drug and inform your doctor. You cannot take this drug if you have seizures disorders, brain injury, anorexia, bulimia, or are suffering from alcoholism.
Nortriptyline (brand name: Pamelor) is a tricyclic antidepressant. Although it is used as a second-choice drug for smoking cessation, nortriptyline is not FDA-approved for this purpose. By influencing the hormones in the brain, nortriptyline reduces the rewarding and pleasurable effects of smoking. In effect, it also mitigates the depression that comes along with quitting smoking. Success rate: Some studies say it has a success rate of 14%, and others say it works 25% of the time. When combined with a nicotine patch, success rate increases to 27.3%. How to use: To allow the drug to reach effective and stable levels in the body, you should start 1 to 2 weeks before your designated quit date. Take 25 mg once daily for the first 10 days, then gradually increase to 75-100 mg onwards for 5 weeks. Treatment lasts for 12 weeks and costs about $24 for a box of 60 tablets. Common side effects: Nausea, fatigue, dry mouth, nightmares, anxiety, weight gain, change in sex drive Other considerations: Nortriptyline is prescription-only. Anyone with seizure disorders should not use nortriptyline and those pre-existing heart condition should inform their doctor. Like other antidepressants, nortriptyline increases the risk for suicide and other serious mental health issues in users below age 24 years. If you experience sudden changes in mood and behavior, report immediately to your doctor.
Varenicline (brand name: Chantix) triggers the release of the hormone dopamine, which controls the brain’s reward and pleasure system in the same way that nicotine works. When you quit smoking, you could experience depression and anxiety until your natural dopamine production is restored. Varenicline counteracts the effects of low dopamine levels and reduces some of the symptoms of nicotine withdrawal. Like bupropion, it inhibits the pleasurable and satisfying effects of nicotine to help you taper down on smoking if you’re not ready to quit cold-turkey. Success rate: Although Pfizer claims a 44 % success rate, a 2011 study found that it works just 14 % of the time. How to use: The recommended dose of Chantix is 1 mg per day following a seven-day titration. So, it’s one 0.5 mg tablet for the first three days. Then, for the next four days, it’s one 0.5 mg tablet twice daily. At day 7, start taking 1.0 mg twice daily. Ideally, you should already have quit smoking by day 7. If so, treatment is continued 12 weeks, and an additional 12 weeks if you are successfully quitting to further boost your chances. Common side effects: Nausea, indigestion, constipation, gas, weakness, unpleasant taste in mouth, headaches, and insomnia Other considerations: In 2011, the FDA reported that Chantix may increase the risk of acute heart problems if you have pre-existing heart disease. Another report by the Institute for Safe Medication Practices released in the same year revealed an increasing trend of suicide by Chantix users. The report also found that Chantix was associated with twice as many deaths as other monitored substances.
Quitting smoking is hard enough, but going at it alone is worse. Unassisted, only 4 to 7% will ever succeed. If you want to quit smoking, you can meet with a counselor or therapist alone or in a group setting, or talk over the phone. The counselor can help (you):
- Establish a date to quit smoking
- Motivate to keep going
- Explore strategies to beat cravings
- Recognize trigger situations, including feelings, events, and activities
- Tobacco-proof your home
- Stay informed about latest developments in nicotine addiction research
- Build a social support
Some quit programs, clinics and hospitals in your area offer face-to-face counselling. While you can get some for free or for a small amount, Medicare, if you have one, will cover up to 8 counseling sessions per year. In a nutshell, counselling combined with medication has an abstinence rate of 27%, which is higher than counselling or medication alone. That said, your success rate could vary depending on the type of counselling you receive. Generally, face-to-face individual counselling delivered a minimum of 10 minutes each session over 8 sessions have been found to deliver the best results.
So, what is the best way to quit smoking?
The best way to quit smoking is the way the works for you. There is no magic-bullet cure-all that works for everyone who tries to quit smoking. There is no study that can predict how the best-known techniques will work for you either. Every quitting experience is as unique as each person that quits. You may have to combine, mix and match techniques. Or you may find quitting cold turkey is the best for you. You may have to attempt a few times, or you may succeed on your first try. The tips and practical advice you’ve just read can be adjusted to suit your own needs. And hopefully, they will help beat the odds stacked against you so you can finally move on to a healthier future.