Many smokers feel they have already tried everythingâ€¦..cold turkey, hypnosis, patches, acupunctureâ€¦..but still find they are smoking heavily and have almost lost hope of being able to quit. Lets take a not atypical exampleâ€¦.a 2 pack per day smoker who smokes their first one of the day within 5 minutes of waking, and sometimes wakes at night and smokes. This particular case is in their 60s, has already had cancer and cardiovascular problems and some prior quit attempts have lasted for as long as 6 months, but ended with relapse to cigarettes when they stopped taking the patch. If this type of smoker felt ready to have a serious attempt to quit, what might make this one succeed in the long term?
The first suggestion would be to think of quitting as a process rather than a single event. But importantly, go into it with the view that they will continue with the process nomatter what. It doesn't end when they have quit for a month or for six, it doesn't end when they stop their meds, and it certainly doesn't end if they have a cigarette or a pack after a period of abstinence. You will succeed if you decide that you are going persist with this and keep on itâ€¦basically forever. Sure after six months, then a year then 6 years it will require much less effort, but from time to time it will require renewed effort to stay abstinent.
My second suggestion is to initiate the quit attempt along with counseling from a reliable source. By "a reliable source" I mean a health professional who has been trained to help smokers quit, is familiar with all the smoking cessation meds and how they work, and who has been doing this kind of work for at least a year. I feel that quitting along with a group of other smokers is often the best way to get structured support in the first few weeks that are very important, but seeing a health professional for individual weekly appointments can also help, as can regular telephone contacts from a telephone "quitline" where face-to-face is not available. Many people are skeptical about "counseling" or "group therapy" but there is very good evidence that this can increase your chances of getting off to a good start. For the type of case I described above, quitting smoking may be a life-or-death intervention so you have to use all the help that you can get.
Thirdly, a heavy smoker who has already tried most standard treatments should be speaking to their doctor about using "extended combination pharmacotherapy". This means rather than using just one of the effective medicines, like the patch or Chantix, for a couple of months, they should be considering using more than one medication for at least 6 months, and possibly longer. This could be a combination of the patch and 4mg gum or lozenge, or varenicline (Chantix) and bupropion, or bupropion plus patch plus nicotine inhaler. Dr Michael Steinberg and colleagues at UMDNJ in New Jersey conducted a randomized trial comparing standard duration nicotine patch with patch plus bupropion plus nicotine inhaler for up to 6 months. At 6 months the combination extended duration had a significantly higher quit rate (35% v 19%), and it was found to be safe even though all the trial participants had a pre-existing medical condition.
So initiating a quitting process, with counseling plus extended combo meds is worth considering for smokers who have tried many of the standard methods. Keep at it and you will succeed.
I don't believe that e-cigs are nearly as harmful as regular cigarettes. Regular cigarettes deliver smoke with over 4000 chemicals to the lungs, whereas e-cigs deliver a few chemicals without smoke. The main problem is that we currently have insufficient information and quality control data on e-cigs. Here is a brief video on our e-cig study .View Thread
Many smokers who have tried unsuccessfully to quit smoking on their own start to consider seeking help to quit. Of course a quick internet search reveals that there are plenty of treatments, clinics and gadgets out there on the market, professing to have the best treatment for nicotine addiction….at a price. But let us assume that you are really serious about quitting smoking, and willing to attend a specialist service for treatment. What are the characteristics of treatment services that are associated with higher quit-rates? A study of this question was recently published by Dr Leonie Brose and colleagues at University College London. They examined the characteristics of services in the UK and the outcomes of 126,890 treatment episodes, in order to try to identify the most effective characteristics. They found that those treated at specialist smoking cessation services had higher quit rates compared with those treated at their family practice or pharmacy, and that those treated in group treatment also did better than those receiving individual counseling. They also found that quit rates were highest in those using combination nicotine replacement therapy (e.g. patch plus gum), or varenicline (Chantix), which were higher than a single NRT (eg patch only) as compared with those using no cessation medications. It is reassuring that these results are entirely consistent with the recommendations in the U.S. Clinical Practice Guideline for Tobacco Treatment, and also consistent with data published by colleagues working in tobacco treatment services in the USA.View Thread
Many visitors to this site have commented on the close association between smoking and caffeine consumption, most commonly involving smoking while having a cup of coffee. I have seen lots of good advice being shared about trying to reduce the cigarette cravings that can be triggered by a coffee break by changing the routine, drinking a different drink etc. But I would like to mention a few other ways that caffeine consumption can interact with smoking cessation. When people quit smoking, their metabolism of certain drugs slows down, and caffeine is one of those drugs. This means that if you normally drink 6 cups of caffeinated coffee per day and you continue with the same consumption after quitting smoking, your blood caffeine levels will build up more and remain higher for longer than before you quit smoking. For example, you may feel like you have consumed 9 cups, even after you had 6. This would not matter very much if it wasn't for the fact that too much caffeine can have some unpleasant effects. For example, even moderate caffeine consumption can cause palpitations, sweating, feelings of anxiety and difficulty sleeping. Sometimes people who were heavy caffeine consumers experience these symptoms when they quit smoking and assume it is caused by the stopping smoking or the smoking cessation aids they are taking, when it is really the caffeine that is causing the symptoms. It is fairly typical for caffeine metabolism to slow down by around 40% on stopping smoking, but the change appears to be proportional to how heavy a smoker the person was (i.e. bigger effect for heavier smokers) and also subject to large individual differences (e.g. some people will have very little change in caffeine metabolism on stopping smoking, and some people will experience a four-fold slowing in their caffeine metabolism). My advice to people who are planning to quit smoking is to reduce their caffeine consumption by at least 50%, and to avoid drinking your usual caffeinated beverage completely in situations where cigarettes are available (note, caffeine is present in many common drinks other than coffee, check this link ). So if you feel like you need a caffeine kick to get you going in the morning, and after lunch, that's fine, but change your usual habit. I suggest against stopping all caffeine consumption suddenly as that will likely cause caffeine withdrawal symptoms such as headache and fatigue. Don't buy your morning cup at the usual place that also sells your cigarettes, and don't go for the coffee/smoke break with your smoking buddies at work. Try drinking tea, or some other low calorie drink, or decaf at other times, and don't drink any caffeinated drinks after 4pm in the afternoon unless you specifically want it to keep you awake at night. Stopping smoking can feel stressful enough without experiencing symptoms of anxiety, sleeplessness and having cigarette cravings triggered by unnecessary cups of coffee.View Thread
A recent study reviewed all the evidence on acupuncture (and laser therapy etc) for smoking cessation. The conclusion from 33 studies was, "There is no consistent, bias-free evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but lack of evidence and methodological problems mean that no firm conclusions can be drawn. "For a more detailed summary, click here. View Thread
We all know that when you stop smoking your appetite increases, and often people get a particular craving for sweet foods. It seems as though smoking (or more specifically nicotine) curbs carbohydrate craving, and when you quit it increases. A number of recent studies have found that glucose tablets (as compared with artificial sweeteners) reduce cigarette cravings, withdrawal symptoms and increase quit rates. Quite a few patients have spontaneously mentioned to me that they found that hard candies such as Jujubes or Halls Montholyptus seemed to help soothe their cigarette cravings. The theory of how glucose may be helpful is that when the smoker quits, part of their cravings are actually for carbs. If these carb cravings are quickly satiated (e.g. by a glucose tablet), then the overall craving for a cigarette will also seem to be lower. If you want a little more detail on the recent research on this, check out this link . I'd be interested to hear if any readers found that they developed a sweet tooth when they quit smoking, or if anyone found any particular foods to help them stay quit.View Thread
Many recent ex-smokers who quit smoking at the beginning of January and are now considering the next challenge....staying quit. I'd recommend taking a look at the "Forever Free" relapse prevention booklets on Smokefree.gov
There are 8 booklets each covering a different topic (e.g. coping with urges, managing weight gain etc). They can be accessed online (and read there or printed out) via this link.View Thread
New year is a peak time for quitting smoking. Around now many are planning on quitting in the New Year but aren't so sure about quitting right at midnight on December 31st (as they may be partying at that moment). When January 1st and 2nd come around and they are still smoking, many feel that they have missed the moment and give up on the idea for another year. To me, that is a great pity, so here is how I suggest you approach New Year quitting. First of all, I recommend that you have a plan with a specific date on which you will stop smoking completely. And of course midnight on December 31st is a perfectly good time to quit. However, it is also reasonable to have a plan to START THE PROCESS on the first of January, but accept that it may take a little time to really crack it. So it is reasonable for each person to choose their own "line in the sand" and figure out their own best way to get there. Some people find the New Year period too busy with family things going on to focus on quitting completely that day. Some prefer to cut down gradually. And some who had planned to use a stop smoking medicine like varenicline (Champix) or bupropion (Welbutrin) are just realizing that these medicines require a prescription and should be taken for seven days prior to the quit day. So there may be reasons to take a little more time to get your plan sorted out and quit. But I think it is important to start the process on New Year's day if you havn't already started. Decide when your target quit day is going to be, decide what medicines, if any, you are going to use and do a bit of research on them. But have a clear day that you are definitely going to quit by, and don't make it too far in the distance. For example….Monday January 24th is plenty of time to get over the holiday rush, get any medicines you may want to use, and start cutting down towards that quit date if you want to do it that way. Anything much later than that is just putting it off, and sooner would be better. But the key is to think of stopping smoking as a process, and something you are going to stick at until it really sticks. If you go into it with that attitude you will likely still be smoke-free by the time December 2011 comes round.View Thread
While many smokers are planning to quit after the holidays, those recent ex-smokers should be aware that the holiday season presents its own set of relapse risks: 1. Holiday parties...with alcohol/groups of smokers huddled outside 2. The stress of family get-togethers, tight budgets etc. 3. Feeling that you deserve some reward after all the hard work So how can you increase your chances of keeping your quit going strong? - remind yourself of all the good reasons you decided to quit - remember all the hard work it has taken to get this far - give yourself a pat on the back and some other treat for your success - just before you go to holiday events, remind yourself to be careful with alcohol, and being around other smokers and that its a success if you come back from the party still a non-smoker. For some more detailed discussion of ways to avoid relapse, check out theselinks .View Thread