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Let's
Talk Facts About...
QUITTING
SMOKING
Treatment
Works...When You Choose to Stop Smoking
Thinking of getting some help next time you try to quit
smoking? This guide presents the pros and the cons of
different treatments. In it we provide information that
will help you decide which treatment best fits your
situation. Before we discuss the treatments, we want
to correct some myths many smokers have about quitting.
COMMON
MYTHS
Treatment
is not necessary. I just have to tough it out.
It is true that many smokers quit without treatment,
but for most, it takes many attempts over many years
before they finally quit. By using the treatments in
this guide, you double your chances of quitting. Don't
fool around-give yourself the best chance of quitting.
It's important to quit now, before you get a disease
caused by smoking.
Medications
containing nicotine, like a patch or gum, are harmful
and addicting.
Actually, the tar, carbon monoxide, and other toxins
in cigarettes, not the nicotine, produce most of the
harm from smoking. Long-term use of nicotine itself
does not appear to be harmful. In addition, current
research indicates that nicotine medications that provide
a slower, lower dose of nicotine are not addicting.
If
I go to counseling for smoking cessation, I'll have
to bare my soul.
Smoking cessation groups are not psychotherapy. They
are no-nonsense groups of smokers and ex-smokers that
focus on mutual support and tips to help you stop smoking.
I
can't afford it.
Smokers have a 50% chance of dying from a smoking-related
disease such as lung cancer, a heart attack, or emphysema.
The cost of most treatments to stop smoking is low.
Most treatments last only 6 to 12 weeks. During this
time, medications cost $3 per day or less, and group
counseling costs $5 to $25 per week. (Compare this to
how much you spend on smoking.)
I'll
gain weight.
Smokers weigh 5 to 7 pounds less than nonsmokers. When
they quit smoking, they gain back those 5 to 7 pounds.
When smokers diet while quitting smoking, they often
relapse and start smoking again. The best solution is
not to diet but to increase your activity while quitting.
You should wait until you are sure of your abstinence
(1 to 3 months) before trying to lose weight.
WHERE
CAN YOU GET HELP?
Your
doctor
Spend a few minutes during your next doctor's visit
and talk to your doctor, the office nurse, or a health
educator. Brief, personal advice from this team increases
your chances of success by 50%. A hint-write down your
questions ahead of time.
Your
family and friends
Some people like the support and encouragement of others;
plus, making your commitment public can help motivate
you. Even if these reasons are not important to you,
you must talk to your family or best friend and let
them know whether you want them to be involved and,
if so, how-for example, not smoking in front of you
or offering you a cigarette.
A
group
Maybe it's time to try stopping with a group of people.
Voluntary organizations (see box on page 4) often run
groups to support and to give tips to smokers. Groups
usually last 45 to 60 minutes once a week for 1 to 3
weeks before the quit date and then 1 to 3 weeks after
the quit date. One common problem is that groups are
offered only once every few months; thus, you will have
to decide whether it's important to delay your quit
attempt until a group starts.
A
specialist
Many, but not all, addiction counselors, health educators,
nurses, psychologists, and physicians have experience
helping smokers stop smoking. Some new treatments require
a physician's prescription. Be sure any specialist is
using a proven method for smoking cessation (we'll describe
the proven methods later), and ask if they have treated
smokers before.
Telephone
advice
Sometimes this is just recorded tips, but now, many
health plans, wellness programs, state health departments,
and drug companies that sell smoking-cessation medications
offer free, advice over the phone from a real person.
Often this advice consists of personalized quitting
plans and ongoing supportive counseling.
Written
materials
All of the organizations in the box on page 4 offer
pamphlets and books with many tips to help smokers stop
smoking. It's best to pick out a few tips especially
important to you in your attempt to quit.
Costs
Groups can be free or can cost up to $150. Written materials
can be free or can cost up to $10. Specialists can charge
from $60 to $150 per hour. Some health plans cover smoking-cessation
treatment, but others do not. Be sure to check.
The
Treatments
The boxes on pages 6 and 7 list the treatments that
are scientifically proven to work and those that do
not appear to work.
Medications
Medications
That Contain Nicotine
Four
different types of nicotine medications are available:
two you can buy without a prescription-nicotine gum
and nicotine patch-and two for which you need a prescription-nicotine
nasal spray and nicotine inhaler. They all are effective-that
is, they all double your chances of quitting. However,
they have different pros and cons that will appeal to
different smokers. All are used for 6 to 12 weeks.
Nicotine
gum (Nicorette). This gum contains a small amount of
nicotine that is released by chewing and is absorbed
in the mouth. There are two doses: 2 milligrams for
light smokers and 4 milligrams for heavy smokers. The
gum produces nicotine levels lower than those from smoking.
As soon as you quit, the gum is used as needed but at
least once every hour for up to 12 weeks. The biggest
plus of the gum is that you use it when you need it-for
example, when a craving occurs. You chew the gum for
about 30 minutes at a time. Unfortunately, caffeinated
coffee and soda and juices limit the absorption of nicotine
from the gum, so you cannot drink these right before,
during, or right after using the gum. The most common
side effects are disliking the taste, sore jaw, and
burning mouth. Although some people use the gum for
long periods, very few of these have trouble stopping
the gum. You should talk to your doctor before choosing
to use nicotine gum if you have heart problems, high
blood pressure, dental problems, ulcers, or diabetes;
if you use medication for asthma or a mental illness;
or if you are younger than 18 years old, pregnant, or
breast-feeding.
Nicotine
patches (Habitrol, Nicoderm, Nicotrol, Prostep). Nicotine
can be absorbed through the skin, which has led to the
development of several different skin patches for delivery
of nicotine. The key advantage of the patches is that
they are easy to use. The Nicotrol patch is used for
16 hours (while awake), and the Nicoderm patch is used
for 24 hours. After 6 weeks of treatment with Nicoderm,
you switch to lower- and then even lower-strength patches
to slowly wean yourself. After 6 weeks of treatment
with Nicotrol, you simply stop using the patch. Although
the two patches have different features, use of either
doubles quit rates and they appear equally helpful.
If you have one of the conditions mentioned in the previous
paragraph on nicotine gum, then you will need to consult
with your doctor before using the patch. The most common
side effects of the patches are skin irritation and
(with 24-hour wear) insomnia. Addiction to patches does
not occur. When patches were first introduced, some
physicians thought that smoking and wearing a patch
simultaneously caused heart attacks. Several scientific
studies since then have concluded that smoking and wearing
a patch simultaneously do not increase the risk of heart
attacks. However, most physicians believe it is best
not to smoke while using the patch.
Nicotine
nasal spray (Nicotrol NS). Nicotine nasal spray delivers
nicotine in a manner similar to the nasal sprays used
for colds. The major advantage of the nasal spray is
that it gives you more nicotine faster. However, even
with the nasal spray, you receive less nicotine than
with a cigarette. As with the gum, at first it's best
to use the spray at least once per hour. Some, but not
all, studies suggest that smokers with stronger addictions
are especially helped by the nasal spray. Initially,
many users experience nose and throat burning, sneezing,
runny nose, and watery eyes. However, for most users
these go away or are greatly reduced within a week.
Although early reports suggested that some people might
become addicted to nicotine nasal spray, later reports
have not supported this finding.
Nicotine
inhaler (Nicotrol IN). The inhaler is a nicotine plug
in a plastic rod that a user puffs on. Although labeled
an "inhaler," in reality, almost none of the
nicotine goes into the lungs; rather, it is absorbed
in the mouth. Thus, the inhaler results in relatively
low levels of nicotine in the blood. As with the gum
and nasal spray, the inhaler can be used as needed,
but it should be used at least hourly. The main advantage
of using the inhaler is that it mimics the habit or
hand-to-mouth motions of smoking. The most common side
effects of the inhaler are mild coughing and throat
irritation. Addiction to inhalers doesn't occur, but
one drawback is that the inhaler produces less nicotine
in cold weather (below 50 degrees).
Medications
That Do Not Contain Nicotine
Bupropion
(Zyban, Wellbutrin). Bupropion was originally used as
an antidepressant, but it has now been found to be as
effective as nicotine medications in helping smokers
stop smoking. Its main benefit is that, although receiving
nicotine from medications is safe, many smokers prefer
a medication that does not contain nicotine. Although
we don't know exactly how bupropion works, it doesn't
work by its antidepressant effects; thus, you don't
have to be depressed for bupropion to help you. With
bupropion you take medication for one week before you
stop smoking and then for 6 to 12 weeks thereafter.
The most common side effects are dry mouth and insomnia.
Although higher doses of a version of the medication
in bupropion may cause seizures, this does not appear
to be a risk when bupropion is used as directed for
treatment of smoking cessation.
Clonidine.
Clonidine, a prescription medication usually used to
treat high blood pressure, has been found to help some
smokers stop smoking. It does not contain nicotine.
Most specialists believe that for most smokers, clonidine
taken as a pill or a patch is less effective and has
more side effects than the other medications available.
However, your doctor may recommend this medication based
on his or her experience or knowledge of your situation.
Combining
Medications
Wearing
a patch and then using nicotine gum for the hard times
or wearing a patch and taking bupropion appear to increase
your chances of quitting over using either method alone,
although this has not been definitely proved. Because
these are new treatments, you should ask your doctor
about combining medications before doing so.
Counseling Treatments
-
Behavioral/Supportive Therapy
Behavioral/supportive
therapy is the most widely used talking therapy for
smoking cessation because it is scientifically proven
to double your chances of quitting. Behavioral/supportive
therapy can be done in several formats: groups, individual
counseling, telephone contacts, or written materials.
The behavioral portion often begins with writing down
when you smoke to determine your specific triggers for
smoking. Next, you develop a plan to avoid your smoking
triggers and then use behavioral and thinking strategies
when you encounter a trigger (for example, take a short
walk or tell yourself why you want to quit). Sometimes
this therapy involves rewarding yourself for not smoking
or making personal contracts with people close to you
in which you pledge that you will not smoke.
-
Combining Counseling and Medication
If you want the best chance of quitting, you should
use both a counseling treatment and a medication treatment.
When you do both, your chance of quitting increases
to near triple that of quitting without treatment.
If
You Start Smoking Again
First of all, try not to be discouraged. Think of it
as falling off a bicycle. It hurts, but you are one
step closer to success. In addition to remotivating
yourself to try again, ask yourself three questions:
- What
did I learn from this attempt? Write down a list of
things you will do differently the next time and store
it away for your next attempt.
- Did
I really give the medicine or counseling my best try,
and did it still not help? If so, then maybe you need
to investigate a different treatment for your next
attempt. Maybe you found out that you really do need
some counseling help, or maybe you do need medication
to help control your cravings.
- Do
I have a problem that's keeping me from quitting?
Perhaps you have a psychological problem such as depression,
or perhaps you have alcohol problems. Or perhaps your
spouse smokes and is not at all supportive. Whatever
the problem, you should consider trying a group or
specialist to get help with that particular problem.
If
You Succeed in Quitting Smoking
Remember, successful ex-smokers are those who have plans
for relapse situations such as stress and partying.
They also know that for them, there is no such thing
as smoking just one cigarette.
Make
a commitment to help others around you when they try
to quit. You know how hard it is to quit. When you talk
to your friends who are still smokers, tell them how
you did it and offer to support their attempt to quit.
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