As anyone who has tried to quit smoking can attest, it is hard — terribly hard. In fact, it often takes smokers between seven and 11 times to successfully quit, according to the Massachusetts Tobacco Control program. Using a combination of methods — including counseling and medications — can dramatically increase the chance of a successful outcome.
The reason quitting smoking is so incredibly difficult is that nicotine — found in all tobacco products — is highly addictive. In fact, the U.S. Surgeon General stated in a 1988 report that nicotine was as addictive as heroin or cocaine.
Given the high level of cancer fatalities, African Americans have even more reasons to quit smoking. The American Cancer Society has reported that cigarette toxins take longer to clear from African Americans’ blood than other ethnic groups, and that although African Americans smoke less than other ethnic groups, they tend to smoke cigarettes with higher levels of tar and menthol, which are even more harmful.
Making a plan to quit
Whether your decision to quit smoking is motivated by health risks, for family, to save money or just to feel better, begin by making a plan to quit. The first step is to consult your doctor to find out which anti-smoking tools will work for you. Before your quit date, work with your doctor to decide if you are going to use medications, join a support group, or use a different plan to quit.
Once these questions have been answered, it is time to take action. The American Cancer Society advises people to pick a day to quit, and throw away all cigarettes and ash trays. Prepare by having substitutions available — things like gum and hard candies to put in your mouth, and activities to distract you from thinking about smoking.
Effective medications are an important tool
Despite nicotine’s addictive qualities, there are many effective treatments to help people quit. For more than 25 years, researchers have found clear evidence that several medications work well, especially in conjunction with certain types of counseling.
According to the American Cancer Society, the following drugs can effectively double the chances of quitting:
• Bupropion (Zyban® and Wellbutrin®), a prescription drug, works to reduce cravings but contains no nicotine. It was initially developed to deal with depression, but was inadvertently found to lessen the desire for nicotine when prisoners taking Zyban for depression smoked noticeably less.
• Varenicline (Chantix®) is a prescription drug that reduces the pleasure people get from smoking. It works by attaching to nicotine receptors in the brain, blocking nicotine from reacting with them.
• Nicotine replacements such as the patch, gum, inhaler or lozenge contain reduced amounts of nicotine to give a small, slow release supply of nicotine to lower cravings. Most are available over the counter, but some are obtained by prescription.
Your primary care doctor can work with you to decide the best medications to use. In some instances, a doctor may recommend a combination of prescription medication and nicotine replacement, but the various combinations each have their own specific requirements. It is important to check with your doctor if you are using a prescription drug, and an over-the-counter nicotine replacement product such as the patch.
Like most medications, anti-smoking medications can have side effects. On July 1, 2009, the Food and Drug Administration required that bupropion and varenicline carry a black box warning — the agency’s strongest safety warning — due to side effects including suicidal thoughts, suicidal actions, hostility and depression.
Counseling Is equally important
Individual and group counseling have proven to be very effective tools to help people quit smoking, especially when used in combination with medication. Support can come from health care providers, including anti-smoking groups at clinics, health centers and hospitals. Several support groups exist throughout the Boston area, including Dana-Farber Cancer Institute, Lahey Clinic and Boston Medical Center, so one of the first places to look for a support group is at your local hospital or health facility. Family and friends can also be very important sources of support.
There are a number of other no-cost or low-cost ways to find counseling support. Telephone counseling has been proven to double people’s success in quitting smoking for good. The Smokers’ Helpline at 800-TRY-TO-STOP (800-879-8678) is a free, confidential quit line, sponsored by the Massachusetts Department of Public Health and the JSI Research and Training Institute. This resource can answer your tobacco-related questions, refer you to tobacco treatment programs, and give counseling over the phone.
The Internet can also be a great resource and provides access to immediate help 24 hours a day. Quitnet (www.quitnet.com), one of the largest online quit-smoking communities, can connect you with experts or an online group of people chatting about their efforts to quit smoking. Quitnet also matches people with an online “quit buddy.”
Blue Cross Blue Shield of Massachusetts members can sign up for the MyBlueHealth Wellness portal at www.mybluehealthma.com and create a personalized program that includes Quitnet, community forums and other wellness tools.
New smoking cessation tools may be on the horizon
Although there are a few relatively new anti-smoking tools, such as Chantix, on the market, the search goes on for even more effective methods. For example, a tobacco vaccine has been in the testing process since 2006. The idea behind the vaccine is to keep nicotine from reaching the brain, making smoking less pleasurable. It is part of a new generation of treatments that are designed to attack the psychological dependency on nicotine.
Fighting cigarette cravings
No matter what tools you choose to quit smoking — medications, nicotine replacement therapy, online or telephone counseling — there are always moments when you still crave a cigarette. The American Cancer Society offers these tips to help stay on track:
• Stay busy.
• Be prepared to have other things to put in your mouth, such as peppermints, carrot sticks, cinnamon sticks or toothpicks.
• Think of the situations that trigger a desire to smoke and come up with alternative activities.
Tips on sticking to your plan to quit
Stopsmokingacademy.com recommends these five steps to stick to your plan to quit:
1. Once you have made the decision to stop smoking, the next step is to create a plan that works for you. Sticking to it will help you quit smoking.
2. Make a list of reasons why you have decided to quit.
3. Educate yourself on the impact of smoking and methods to help you quit.
4. Decide on a quit date — ensuring your timeline is right for you can be crucial.
5. Prepare your environment and change your habits to eliminate situations that would tempt you to smoke.
6. Keep a positive attitude.
Remember, if you can quit for one day, you can quit for one more and one more. But don’t forget, you’ll double your chance for successfully quitting smoking if you use the two proven ingredients — medication and counseling.
