Okay, everyone's told you to quit. You realize it's bad for your health, but you just can't seem to quit!

It is indeed the hardest thing many people (including myself) have done. However, it really can be done, and it really is worth it. Just as with so many things to do with health habits, there is no "magic bullet" which will cure the problem . . . but there are many things that can help if you're truly wanting to quit.

That's just the problem . . . I almost want to quit . . . but not quite enough to do it.

As we'll see, that's really not an unusual sentiment. And there's a reason for it. I have not really known anyone who was absolutely sure they wanted to quit, or were absolutely sure they were going to be able to do it. However, I know many, many people who have quit despite their doubts.

Smokers get tired of hearing it, and physicians get tired of saying it, but make no mistake, it is so very important. In fact, the American Heart Association declares that it is "THE SINGLE MOST ALTERABLE RISK FACTOR" contributing to early death in the United States, accounting for 400,000 deaths annually. It has been estimated that about 1/2 of smokers will be killed by their habits, and that a person in their 20's will live one-quarter less than a non-smoker of the same age. Let's look at quitting from the following angles, and see if there aren't some strategies that will help YOU quit.

The leadoff: What does smoking do to your health?
Why should I quit?

Why is it so hard?
Besides the addiction to nicotine, what else keeps me smoking?
But I've smoked so long . . . why bother quitting now?

Some numbers about smoking

What are the methods of quitting?
Which is the best way for me to stop? (Take our test)
How about if I just cut back or use one of the low-tar & nicotine brands?

Are there any programs that can help?

But aren't I going to gain weight if I stop?

What about nicotine patches?

What about nicotine gum?

What about nicotine spray?
What about the nicotine inhalers?
What about these anti-depressant drugs I hear about?
How about hypnosis or acupuncture?

I'm afraid I might relapse after I stop.  What can I do?

What about "second hand smoke"?

How do I help my teenager quit?

The Big Points


The leadoff: What does smoking do to your health?

Surely you've heard by now that smoking damages your health (if you're tired of hearing it, skip this section).  If you already have one of the diseases listed below, you may be virtually certain that the cigarettes you have smoked contributed, perhaps greatly. Furthermore, you can also count on stabilizing or reversing the problems if you quit.

The fact that smoking causes problems for the heart arteries is not surprising when you consider that smoking has been demonstrated to:

Why should I quit?

 Well, obviously to avoid the problems above. But beyond this, consider

Why is it so hard?

 You'll see it even more clearly when you stop . . . you're addicted to a drug. It is a potent addiction. It is amazing how this addiction works its way into you, convincing you that you need another cigarette. One of the amazing things I discovered after stopping smoking, and I did it for a long time, was that I felt I had less stress. The addiction spoke to me, convincing me I needed some help dealing with a stressful situation. In fact, after I quit smoking, there suddenly didn't seem to be as many problems that required so much thinking!

Nicotine is the addictive agent in tobacco. A smoker delivers an average of 200-300 discrete doses of nicotine to their brain each day (a heroin addict generally only delivers 2 doses and a cocaine addict 5-15 doses of their drug). Nicotine does have a euphoric effect which makes people feel better in the short run. As in all addictive drugs, this effect decreases over time, and increasing doses are needed to obtain lesser feelings of well-being. As in all addictive drugs, there are symptoms of withdrawal that are well known to smokers (and perhaps underestimated by non-smokers). These symptoms include

Stories from those who have quit other addicting drugs like alcohol, cocaine, and others, they will tell you that smoking ranks right up there as one of the most difficult drugs to quit.

Smokers who are given differing amounts of nicotine in "study cigarettes" show a remarkable ability to adjust their intake to maintain a stable level of nicotine intake over a day. In addition, there is an addictive component to the intermittent increases in nicotine levels which accompany smoking a cigarette. This is important when considering some of the means used to quit smoking.

Besides the addiction to nicotine, what else keeps me smoking?

The addiction to nicotine certainly makes it hard to quit, but so do some of the behavioral aspects of smoking. Smoking also provides other side benefits which are real. These are some of the other reasons it's hard to stop. See which of the following areas seem to be important to you, and then note some of the solutions to minimize their importance as you plan to quit.

Stimulation. It helps you wake up, get organized, and get going.

Plan ahead. Organize the day so you won't need a cigarette to get going. Go to bed early, plan some early exercise.
Chew on gum, brush your teeth to give your mouth some stimulation.
Avoid fatigue

Handling. You enjoy some of the rituals of smoking.

Handle a coin or rock.
Clean or polish your fingernails
Wear a rubber band around your wrist and snap it.

Pleasure. If you enjoy the "luxury" of the feeling that smoking gives you, then

Keep a list of the pleasures of non-smoking.
Keep a list of the displeasures that smoking already or will cause.
Begin an enjoyable exercise program.
Treat yourself to something special.

Relaxation. Smoking can be the classic "crutch" in times of discomfort. You may find it much easier to stop when things are going well, but particularly difficult when things are going poorly.

Try to find other relaxing alternatives, such as listening to music, a walk or a talk.
Take up a hobby or sport.
Take deep breaths. Learn other relaxation techniques..

Craving. Join the club! That's the combination of the physical, mental, and psychological components of this complex and powerful addiction.

Change your routine. Take a different route to work. Drink tea if you're a coffee drinker, etc.
You may benefit particularly from nicotine replacement therapies noted below.

Habit. You smoke automatically. Chances are you don't enjoy many of them.

Throw away your cigarettes, ashtrays, etc.
If your spouse or friends smoke, designate a part of your home as "smoke-free".
Go to places where smoking is prohibited, such as theaters, libraries, etc.
Always sit in the non-smoking parts of restaurants.
Have your car cleaned.

But I've smoked so long . . . why bother quitting now?

 Because the benefits begin IMMEDIATELY.

You see, it really does not matter how long you've smoked. These are reliable changes which you will enjoy.

Some numbers about smoking

25% of Americans smoke, and 70% of them would like to quit. 30% of them try to quit in any given year. About 2.5% succeed in a given year (this is all comers, whether they try and get help at all or not). Eventually, 50% of all smokers quit.

The percentage of smokers fell quite a bit with initial public education attempts in the 70's and 80's. In 1965, 52% of men and 34% of women were smokers. By 1991, these percentages were 28% for men and 24% for women. The numbers are not falling as quickly now.

Smoking costs are estimated at $50 billion dollars per year. To cover these costs, the taxes on a pack of cigarettes should be about $4.

3000 teenagers start smoking every day.

The medical costs of smoking are $50 billion dollars each year. If you add the lost productivity, the costs rise to $97 billion dollars per year.

What are the methods of quitting?

There are many . . .

"Cold Turkey". That world famous sudden cessation. The advantage is getting it over with. It is still quite effective for many, many people.

"Gradual Tapering". Seems to make the most sense in that it addresses cutting down the level of craving before totally stopping. My own experience with people trying to quit is that it is one of the least effective ways. The commitment is to eventually stopping, and most people will go ahead and have an extra cigarette.

"Cutting back" may sound like a very good idea, but actually probably doesn't do much to lower your health risks substantially. Most people go back to their previous levels rapidly. If it's a first step towards quitting that has a limited time frame (say, one month) with a commitment to stop after this, then it may be a useful technique for a very few people.

Nicotine replacement therapy has a proven record of aiding in quitting. There are numerous forms available these days. There are two main types: patches (which provide a continuous supply of nicotine, aiding in losing the addiction to the "spike" of nicotine which occurs with smoking) and others which replace nicotine in "doses" delivered by gum, nasal spray, or other products.

Antidepressants such as Zyban may be useful as an aid for quite a few people.

Stop smoking clinics and programs, both commercial and non-profit are available.

Self-help tapes and books (and this website) are available as guides.

Which is the best way for me to stop?

You can use the test to give yourself some idea of the major factors which stimulate your smoking behavior.

How about if I just cut back or use one of the low-tar & nicotine brands?

There is only a minimal decrease in risk from these brands. Additionally, since the other toxins in the cigarettes are unchanged, and since more cigarettes are smoked to obtain the same amount of the addictive nicotine, there have been suggestions that the incidence of diseases associated with smoking actually increase.

There is little difference in mortality between those who smoke filtered or non-filtered brands.

Are there any programs that can help?

 The American Cancer Society generally sponsors several different types of programs at a modest cost ($40-65), as does the American Lung Association. SmokeEnders and Schick Centers are commercial programs generally charging $250-350. The Seventh Day Adventist Church offers retreats in many areas. Your own physician or local hospital may have programs available.

Other sources of information include:

American Cancer Society

Nicotine Anonymous

SmokEnders, Inc

American Lung Association

Nursing Center for Tobacco Intervention


Amer Public Health Assoc

SmokeFree Educational Services



But aren't I going to gain weight if I stop?

Not everyone gains weight when they stop smoking. The average amount of weight gained is generally around 8-12 pounds in most clinical studies. Even though being overweight increases health risks, stopping smoking is so important that some weight gain is a small issue in comparison.

What about nicotine patches?

Nicotine patches are generally very effective when used by a motivated smoker. Most people note a very substantial decrease in their withdrawal symptoms. These symptoms will not totally disappear, but instead of being overwhelming and almost all-encompassing, the symptoms often become manageable.

There are several manufacturers and several strategies for the use of the nicotine patches. Many come in 7, 14, and 21 mg strengths. Most people who smoke one pack per day find that the 21 mg patch is the most effective in diminishing their withdrawal symptoms. Most physicians recommend using the 21 mg patch for 6 weeks, the 14 mg patch for 2 weeks, and the 7 mg patch for 2 weeks, and then discontinuing. I generally add to this to keep one or two of the 7 mg patches around if the person's not quite ready to quit so they can slap one back on and buy some more patches.

Patches may be worn during the day only, or throughout the 24 hour period. Use of the patches at night is often associated with sleep disturbances, restlessness, vivid dreams or nightmares. Taking them off at night may be associated with withdrawal symptoms when one wakes up in the morning.

The patch itself may cause some skin irritation. This can be minimized by using the patch on an area of the skin that is thick (such as the shoulder, back or thigh). Apply it to a hairless are of skin, hold it for 10 seconds. You should wash your hands after doing this to avoid getting chemicals in your eyes. To avoid skin irritation, move the patch around. If irritation does develop, some of over-the-counter steroid cream is usually effective in quieting it down.

One should avoid smoking while the patch is on and within 15 minutes of taking the patch off. This is felt to be dangerous due to the additive nicotine levels. It also simply defeats the purpose of the patch.

There are three manufacturers of patches:

Use of patches generally double the success rates of other programs. They are not a panacea. There is not one milligram of will-power contained in the patch or any other nicotine replacement therapy. Lot's of people fail, and others relapse. It can be very helpful for some people however. I think that patches have an additional advantage of having a constant level of nicotine in the blood, as opposed to the peaks and valleys associated with smoking and with other nicotine replacement strategies.

What about nicotine gum?

Nicotine bound to a resin which is chewable can be helpful. It is somewhat difficult to use.

The gum should not really be chewed continuously as one would chew a stick of gum. The intent is to have the nicotine absorbed in the lining of the mouth. If chewed too quickly, it can often lead to an upset stomach. After a few chews, it can then be "parked" between the cheek and gum.

Levels of nicotine increase and decrease with the amount of chewing that is going on. This duplicates the changing levels found when a person is smoking. The peak nicotine level is only about 40-50% of that obtained with smoking, so withdrawal symptoms are decreased but not totally eliminated.

When used in the proper settings, nicotine gum can double quit rates. Some people get "hooked" on the gum, but this is probably preferable to smoking with all of the other chemicals that are ingested. Most people will use the gum for 3-6 months before totally stopping nicotine intake.

What about nicotine spray?

A nicotine nasal spray is available. It provides probably the highest serum levels of nicotine of all of the nicotine replacement techniques. 95% of people note nasal irritation within 48 hours of starting its use and this will generally continue throughout the period of time it is used.

This form of replacement can be fairly effective in minimizing withdrawal. This is due to the rapid rise of nicotine which occurs. This can be addictive, too.

What about the nicotine inhalers?

Nicotine inhalers are a plastic mouthpiece with a nicotine-containing cartridge which is punctured when placed in the mouthpiece. The nicotine is inhaled not through the lungs as with a cigarette, but through the tissue lining the mouth. Nicotine levels are therefore somewhere around that delivered by nicotine gum. This is available by prescription. Smoking cigarettes is to be stopped while using these devices.

Dosing is for a minimum of 3 weeks to a maximum of 12 weeks. It has only been studied for 6 months as the maximum duration. It is suggested that at least 6 cartridges be used per day, with a maximum of 16. Gradual tapering over the next 6-12 weeks is then suggested. No specific tapering schedule has been found to be superior to others in trials.

People who use these generally experience mild irritation of the mouth or throat or a cough when first using these products.

This product does replace the actions of smoking as well as the nicotine and can be quite effective for some people.

What about these anti-depressant drugs I hear about?

Buproprion is an agent used as an antidepressant for many years. It was noted that people on this agent found it easier to discontinue smoking. A long-acting or sustained release form of the agent was developed an is called Zyban which is promoted to aid in the discontinuation of smoking.

It is appealing to some since smoking is continued at the beginning of therapy.

It can be even more effective when used in combination with nicotine replacement products. The blood pressure should be monitored when these two are used together since blood pressure may increase.

Zyban is given as 150 mg daily for 3 days, and then 150 mg twice daily (at least 8 hours apart) for 6 weeks-3months. The person continues to smoke as Zyban therapy is started. A quit date should be set during the second week of therapy. The drug should be stopped if the person is still smoking by the seventh week of therapy.

Zyban is definitely to be avoided at higher doses, and the dose needs to be adjusted for people with some kidney and liver diseases. It should not be used by people with seizure disorders or those taking medications known as "MAO Inhibitors". The use of alcohol is to be avoided. Potential side effects include restlessness, dry mouth, insomnia and other emotional disturbances, as well as gastrointestinal side effects such as nausea, constipation and diarrhea. It is available by prescription.

How about hypnosis or acupuncture?

These are popular remedies. Hypnosis in particular seems to be easy because one would hope that the post-hypnotic suggestion would ease the urge to smoke and virtually prevent one from lighting up. It does not quite work that well. Results with both acupuncture and hypnosis generally are about as effective as the nicotine replacement strategies. Success will tend to be somewhat better with some therapists than others.

If these are techniques that you may feel are helpful, you should give them a try. Just like with any of the other techniques, if it doesn't work, realize it isn't for everyone . . . and try another technique that may be right for you.

I'm afraid I might relapse after I stop. What can I do?

This is a well placed fear. Relapse is common, and often related to some fairly easy things to control.

Learn to recognize dangerous situations:

 Being around smokers

 You will often feel more need to smoke if you're under time pressures

 Getting into an argument.

 Experiencing urges or negative moods.

 Using alcohol

Remember, don't smoke even one cigarette . . . don't take even a single puff! You only have to say no to one cigarette to be a success.

Take some positive steps to decrease your stress.

There will be a few tough spots for every one. They need not be causes for failure. Here are some of the most common problems and their solutions.

 Irritable? Just about everyone will be. Take a walk, enjoy a hot bath, practice relaxation techniques.

 Can't sleep? Avoid caffeine after 6 PM. Don't use alcohol to help.

 Fatigue? Take a nap. Don't push yourself right now.

 Constipation or gas? Drink plenty of fluid, eat fruits and vegetables and whole grains.

 Craving? Wait out the urge . . . it will only be there a few minutes. Distract yourself.

Remember, talk to your physician, your buddy or your counselor if you're having problems. A brief visit might just help you over the hump.

What about "second hand smoke"?

Talk about a touchy subject! As an ex-smoker, I do remember what it feels like to hear about possible effects on non-smokers from people who smoke. Smoking has as part of its appeal the sense of individualism and personal choice. Smokers in general do not wish to harm others, but do wish to be "left in peace" to do their smoking. It has been particularly difficult for some long-term smokers to adjust to newer, and more restrictive policies regarding public smoking. Spouses who wish to be supportive may find it difficult to tolerate their partner's habit that could be shortening their life as well.

Nevertheless, the data is pretty convincing that there is an effect from "passive smoking". It really makes sense that it would if you're honest about the statistics associated with "active smoking" -- these are really nasty chemicals, nasty enough that they don't need to be inhaled directly from the cigarette to cause problems.

Studies have shown a pretty consistent 20% increase in the risk of coronary artery disease for spouses of smokers. Some studies have shown a doubling of the risk.

The risks are actually about the same for those exposed to smoke in the workplace.

By the way, this should also be an answer to all of those who say "I mostly just let them burn up in the ashtray". If they are in that room, that burning cigarette is still causing disease!

How do I help my teenager quit?

Indeed, this is a good place to expend some effort. The length of addiction is shorter, and this can make things a little easier. Don't kid yourself however. Addiction can be strong even if it hasn't been going on for long. Additionally, the average teen is under different stresses and has developed fewer coping skills to help themselves.

The National Cancer Institute has developed a strategy called the "Five A's"

o        Parents, friends or siblings who smoke.

o        Poor self image

o        Poor academic performance

o        Risk-taking behavior

o        Exposure to media influences

o        Bad breath

o        Yellow teeth

o        Smelly clothes

o        Keep a 1 week diary of tobacco use

o        Make a list of reasons to quit

o        Figure rewards for success.

o        Help develop skills to refuse peer pressure.

Two resources directed at teens for stopping smoking are:

Stop Teenage Addiction to Tobacco (STAT)
511 East Columbus Avenue
Springfield, MA 01105

National Federation TARGET Program
P.O. Box 20626
Kansas City, MO 64915-0626


It is difficult, but extremely possible, to quit smoking

The benefits of quitting begin almost immediately and continue to increase over time.

You owe it to your health to really consider this, work on a plan now, and implement it very soon.

It does not matter how long you've smoked. The benefits of quitting begin quickly . . . and last the rest of your life.

Take our test to see which method you should consider when quiting smoking

©COPY;1997 HeartPoint   Updated August 1999

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