Smoking: Four Ways to Quit

Kicking the habit: Do it yourself

Don't kid yourself by trying to cut down; nearly everyone who tries slides back up to their usual dose of nicotine. Cold turkey is the way to go, but it takes preparation. And even without professional help, cooperation from family and friends can be important. Here are some tips:

• Make a list of reasons to quit and another list of people who have kicked the habit. The first list will remind you why quitting is important, and the second will show you that folks who are no stronger or smarter than you have succeeded. Keep your lists handy and refer to them whenever you begin to waver.
• Pick a quitting date and stick to it. Plan to quit on a special day, such as a birthday or the American Cancer Society's Great American Smokeout event on the third Thursday of each November. Steer clear of stressful periods, and avoid holidays if you are likely to be invited to smoke-filled parties.
• Try to get other smokers in your household or circle of friends to join you in quitting. A 2008 study found that smoking behavior spreads through both close and distant social ties; your resolve and success can help your friends and, ultimately, your community.
• As your quit date approaches, throw out your ashtrays, clean your house, car, and clothes, and clean your teeth. Once you're away from it, you'll realize how much smoking stinks.
• Anticipate withdrawal symptoms such as grumpiness, restlessness, irritability, hunger, headache, anxiety, and drowsiness or insomnia. The discomfort usually peaks one to three weeks after you quit, and then it gradually diminishes. To get through the rough patches, stock up on low-calorie snacks and sugarless gum or candy to keep your mouth busy. Plan enjoyable diversions to keep your mind busy. Think of ways to keep your hands busy.
• If you feel tense, try meditation, deep breathing, or yoga.
• Begin an exercise program. It will relieve tension, promote good sleep, and help control weight gain. Walking for 30 minutes a day can really help.
• Eat a healthy diet.
• Stay away from secondhand smoke. Don't even think about smoking "just one"—even a single puff will set you back.
• Reward yourself. Put your tobacco money aside in a kitty, and then spend it on a special treat.
• Think positively—you can quit. Take it one day at a time. And if you slip, try, try again—either on your own or with one or more of the other strategies for quitting.

Kicking the habit: Behavioral support

Quitting is your responsibility; it may be hard, but it doesn't have to be lonely. Many employers, health plans, and hospitals offer individual or group counseling. Your doctor or your local chapter of the American Lung Association or American Cancer Society can refer you to a program in your area. Telephone support can also help; you can try it for yourself by calling the National Smoking Cessation Hotline at 800-QUIT-NOW. Hypnosis is another alternative that has helped some smokers break free.

Kicking the habit: Nicotine-replacement therapy

Cigarette smoke contains thousands of chemicals. Many are harmful, but nicotine is the most addicting. Like other addicting substances, it acts on receptors in the brain's "reward center," creating a sensation of pleasure and a craving for more nicotine. The craving has made billions of dollars for Big Tobacco, but it has cost the public much more, in health and money. Nicotine-replacement therapy can short-circuit the craving without introducing the other disease-producing chemicals.

Nicotine replacement is safe. You'll get less nicotine than from cigarettes, and you won't get any of the tar, carbon monoxide, and other damaging substances in tobacco. Plan to start nicotine-replacement therapy on the day you quit smoking. If you are a heavy smoker, you'll need higher doses. Estimate how much nicotine you need based on an average of 1 to 2 milligrams (mg) of nicotine per cigarette. Start with the full dose, then gradually taper down over several months. Under-dosing is more common than overdosing, but you should not smoke while using nicotine-replacement therapy.

Five types of nicotine replacement are available in the United States. Nicotine patches deliver a steady dose of nicotine throughout the day, providing round-the-clock protection from craving. The other products deliver a higher dose of nicotine faster, but protection also declines faster. The short-acting products can be used on demand to counter a sudden nicotine craving. If you wear a patch, you can also use short-acting nicotine products to suppress breakthrough craving.

Kicking the habit: Prescription drugs

• Bupropion (Wellbutrin, Zyban) was initially approved to treat depression and was then approved for smoking cessation. It does not contain nicotine and can be used in combination with nicotine-replacement therapy. Start taking bupropion one to two weeks before your quit date. The usual dose is 150 mg once a day for the first three days, then 150 mg twice a day for eight to 12 weeks, or longer if needed. Bupropion can reduce weight gain after quitting. Possible side effects may include dry mouth and insomnia; seizures are very rare.
• Varenicline (Chantix) is the newest drug approved for smoking cessation; although experience is still limited, it also promises to be the most effective. It blocks nicotine receptors in the brain while also partially stimulating these receptors to reduce nicotine withdrawal symptoms. The usual dose is 0.5 mg once a day for the first three days, then 0.5 mg twice a day for four days, followed by the full dose of 1 mg twice a day for 12 weeks or longer. The dose should be lowered in patients with severe kidney disease. Nausea is common, and bad dreams may occur. Mood disturbances and behavioral problems have developed, particularly in smokers with psychiatric problems, but it's not clear that these are caused by the medication. Reports of accidents and visual abnormalities are also being investigated by the FDA. More research is needed.

Top priority

Smoking is Public Health Enemy Number One—so if you smoke, quitting should be your top priority. It will take willpower and hard work, but lots of help is available. You may gain a few pounds, you may go through a rough spell as your body adjusts to life without tobacco, and you may have to try several times before you finally kick the habit. Don't be discouraged. Over 45 million Americans have quit smoking, and you can, too.