Quit Smoking: A New Year's Resolution

So you've decided to quit smoking.

Congratulations! You have taken the first steps toward better health. The first two steps to quitting are deciding to quit and then setting your quit date. Many people who have tried to quit before have not been successful beyond a few weeks or months, so if this is not your first time, you are not alone. A combination of methods of quitting is usually more successful than one alone.

There are three basic ways to quit smoking:

1. "Cold turkey—you go from smoking on a regular basis to not smoking at all.
2. Tapering off—you set your quit date and decrease the number of cigarettes each day until the quit date. It is better to quit over a few days, rather than weeks, since slow tapering tends to drag out the process. You also may decide to postpone the actual quit date to taper off even more slowly.
3. Postponing—delay your first cigarette by two hours each day until you are not smoking between the time you wake up and when you go to sleep. For example, if you normally have your first cigarette at 8 am, wait until 10 am the first day, noon the next, and so on.

There are also several pharmacologic methods (medicines available) to help you quit. The first are nicotine replacement medicines, which replace nicotine but do not have the other harmful chemicals that cigarettes do. They come in many over-the-counter forms such as gum, patches, lozenges, and prescription nicotine nasal sprays. All of these methods decrease your cravings for cigarettes as well as your withdrawal symptoms. If you choose to use one of these forms, you must NOT smoke. Smoking with the medications can cause heart attack or heart arrhythmia.

Whichever method of nicotine replacement medication you choose to use, each involves two steps. First, you must get over wanting to smoke, which may take four to six weeks of no cigarettes. Second, you must withdraw from the nicotine itself. That may take another four to eight weeks, during which time you will decrease the amount of nicotine replacement you are using.

The second types of medications are those that stimulate the nicotine receptors in the brain to decrease nicotine withdrawal symptoms. These drugs are bupropion (Zyban®) and varenicline (Chantix®). Varenicline helps to get rid of the desire to smoke by blocking nicotine from binding to nicotine receptors in the brain. Varenicline should not be used with nicotine replacements and should be started about one week before the quit date. Bupropion can be used with or without nicotine replacement. Both of these drugs are available by prescription only.

So what do you do when you are withdrawing from cigarettes? There are many things that happen to your body and you should learn how to handle them. Below are some strategies for dealing with the withdrawal.

Cravings for cigarettes

• Don't engage in the activity that causes the cravings (drink your coffee in a different room, etc.)
• Provide a distracting activity (take a walk, etc.)
• Take deep breaths
• Call someone who will talk to you about not smoking
• Visualize your lungs becoming cleaner

Hunger

• Drink water
• Take a walk
• Chew gum
• Eat low-calorie vegetables
• Chew a toothpick
• Talk to a dietician about healthy food substitutes

Irritability

• Talk to a friend
• Visualize a pleasant place
• Take a hot bath
• Drink a cup of tea
• Take deep breaths
• Schedule a fun activity

Depression

• Schedule a fun activity
• Talk to a support person
• Get lots of sleep (at least eight hours per night)
• Reward yourself for not smoking
• Talk to your health-care provider about the depression

If you have trouble sleeping, talk to your health-care provider if your insomnia lasts more than a week. If you relapse, don't be angry with yourself. Remind yourself why you decided to quit in the first place. Throw away the cigarettes and figure out what triggered your relapse so that you can avoid it the next time. Find a "non-smoking" support buddy whom you can call when you really crave a cigarette. Use a stress ball when you have the urge to smoke. Clean your house and your car to get rid of the "cigarette smell." Most important of all, avoid situations where you want to smoke. Save the money that you would have used to buy cigarettes and reward yourself in a month with something you really want—or save your "cigarette money" for a year and take a nice trip.

By using some of these strategies, you CAN successfully quit smoking. If you had a smoker's cough, it should gradually disappear. Your risk of vascular disease, cancer, and lung disease should decrease. Congratulate yourself and breathe more easily!