Tobacco is the single biggest cause of preventable death and disability in the United States. But nicotine is highly addictive, and quitting the cigarette habit can be extremely tough. L.J., a 55 year old man who gave up smoking after 35 years, proves that it can be done. In L.J.'s words, he was "sick and tired of being sick and tired." But he didn't do it alone; his success depended on the help of a counselor, smoking cessation classes, nicotine replacement patches and the support of a friend. Here are some things that helped L.J., as well as tips from Dr. Mary Mites-Campbell, a nurse with years of experience helping people quit.
Before you embark on your attempt, keep in mind that tobacco dependence is a physical and psychological addiction, not a personal failing. To succeed at quitting smoking, it's crucial to make a commitment, map out a strategy and get support. The National Cancer Institute has a helpful web page on tobacco cessation, as do the U.S. Centers for Disease Control and the American Lung Association.
1. To succeed at quitting, you first have to decide that this is something you really want to do. Medicine and classes won't work unless you have made a commitment. In L.J.'s case, a graphic video that his counselor played at his first stop smoking class made him resolve to quit. It showed pictures of smokers that he could not forget: a man missing an eye and part of his nose from mouth cancer. People breathing through tracheostomies, holes that doctors surgically cut in their throats when cancer prevented them from breathing. "You have to be willing to give it your all," L.J. told me. "But the pros outweigh the cons."
2. If you can, join a stop smoking group. This can be difficult to do, as these groups sometimes meet during working hours. But if you can find one at a time convenient for you, these groups can be very helpful in providing support and strategies and keeping you focused on your goal. L.J. attended seven classes in total, each of which took an hour, and describes them as crucial to his success. To find out about classes near you, call your local county health department or hospital and ask if they offer or know of a local smoking cessation program. The American Lung Association can direct you to smoking cessation classes in your region: 1-800-lung USA.
3. Set a quit date and prepare in advance for what you will do once you quit. This includes changing your environment by removing ashtrays and other smoking-related items from your home. It also includes telling your friends and loved ones about your plan and asking for their support. The first few weeks are the toughest, and the time when you will probably be most tense and irritable. Plan in advance about what you can do to alleviate the stress you will feel during that time, be it through exercise, meditation, using a stress ball or sharing your feelings with a friend (see #5).
4. If you plan to use medication, fill the prescription in advance of your quit date. Research indicates that the odds of succeeding are higher with medication. There are three different medications: varenicline, or "chantix," which helps treat nicotine withdrawal as well as smokers' cravings for tobacco after they quit; bupropion, or "zyban," which reduces cravings; and nicotine replacement, which is sold in the form of patches, inhalers and gum. Varenicline can be used alone, while bupropion and nicotine replacement are often used together. You will need a prescription for varenicline or bupropion, and they can have side effects. If you're paying for them on your own, none are cheap: at my local pharmacy, bupropion costs $62 a month, nicotine replacement patches run about $90 monthly and varenicline costs $156 a month. In considering cost, remember how much you will save by not buying cigarettes, which on average run from $4 to $8 a pack. Some state Medicaid programs and insurance plans cover these medications. For more information, check the American Lung Association's State Tobacco Cessation Coverage page. Occasionally, free or discounted medication may be available through some state telephone quit lines: call 1-800-QUIT NOW for more information.
What about those ubiquitous "e-cigarettes" that you may see at kiosks in your local shopping mall? Testing by the U.S. Food and Drug Administration has found that some contain cancer-causing chemicals and toxic compounds such as diethylene glycol, a component of anti-freeze. Suffice it to say, they aren't FDA-approved for smoking cessation.
If you are dead-set against pharmaceuticals, some people have succeeded with a tapering program that involves divvying up their cigarettes into sandwich bags and allowing themselves one bag per day, until they are down to zero. (This approach involves cutting the quantity by half every week or so). I haven't seen any research evaluating the effectiveness of this approach, however.
5. If you can, find a sponsor or a friend, who will be there for you when you are trying to quit. For some smokers, this is someone who listens when they feel frustrated; for others, it's someone who can be empathetic as they mourn the ending of a lifelong habit, which can feel like losing an old friend. In L.J.'s case, his sponsor was a non-smoking friend who rationed his cigarettes when he was tapering down and listened to him when he was withdrawing. "He was a good sponsor -- he didn't cut any corners or do me any favors," L.J. said. "In the beginning I would get aggressive, and he was somebody who was willing to be yelled at and ignored."
6. Know your smoking triggers, and take steps to avoid them. For L.J., being alone and isolated triggered him to smoke, so when he felt isolated, he would talk to his sponsor. He also has been in touch with friends and family, and has avoided places that he fears would make him go back to his old habits, such as his old apartment building.
7. Be aware that most people make many attempts to quit before succeeding. If you have tried before and failed, you aren't alone, and that doesn't mean you should give up. It takes five to seven attempts, on average, before succeeding. Some smokers succeed with far fewer attempts; others require many more. Mark Twain said it best: "Quitting smoking is easy. I've done it a thousand times."
8. Remember the Five D's. Dr. Mary Mites-Campbell recommends these in her smoking cessation class. They are: Drink water -- up to eight glasses daily, to cleanse your body of nicotine; Deep breathe, to help you relax; Do something else, to get your mind off smoking; Discuss, or talk about what you're experiencing (see #5); and Delay -- when you get the urge, count to 250. When L.J. got the urge to buy a pack of cigarettes, he would stash the money in a jar and after several weeks he had saved enough to buy an $80 pair of shoes.
9. Put something in your mouth other than food. Many people who are trying to quit miss the sensation of having something in their mouth. L.J. uses gum when he gets a craving (go sugar-free if you are going to do that); some people find the plastic twizzler sticks used to stir coffee to be helpful.
10. Quit lines may help.These are toll-free telephone lines, organized by the National Cancer Institute, that provide telephone counseling free of charge. L.J. found the lines very helpful when, in his words, he was "searching for ways to not focus on picking up a cigarette." The numbers are: 1-877-44U-QUIT and 1-800-QUIT NOW.
A similar version of this column originally appeared on the website of New America Media.
Follow Erin N. Marcus, M.D. on Twitter: www.twitter.com/ErinNMarcusMD