INTRODUCTION
Quitting and staying away from cigarettes is difficult, but not impossible. This topic review discusses the benefits of stopping smoking, treatments that can aid in the process of quitting, and the difficulties of relapse for those who try to quit.
BENEFITS OF QUITTING SMOKING
Quitting smoking has major and immediate health benefits for men and women of all ages. The earlier you quit, the greater the benefits. People who quit smoking before age 50 reduce their risk of dying over the next 15 years by one-half, as compared to those who continue to smoke. Quitting smoking is also important to those who do not smoke since being exposed to second-hand cigarette smoke is responsible for a number of serious health conditions.
Cardiovascular disease — Cigarette smoking doubles the risk of developing coronary heart disease, and quitting smoking can rapidly reduce this risk.
Pulmonary disease — Smoking increases the risk of long-term lung diseases such as chronic obstructive pulmonary disease.
Asthma and sudden infant death syndrome (SIDS) are more common among children exposed to smoke. Cigarette smoking makes it more difficult to treat asthma.
Cancer — Cigarette smoking is responsible for almost 90 percent of cases of lung cancer. Stopping smoking may also reduce the risk of other cancers, such as cancers of the head and neck, esophagus, pancreas, and bladder.
Peptic ulcer disease — Cigarette smoking increases the risk of developing peptic ulcer disease.
Osteoporosis — Smoking increases bone loss and increases the risk of hip fracture in women.
Other diseases — Smoking also causes or worsens many other conditions. Smoking causes premature skin wrinkling and increases the risk of sexual problems (eg, impotence). Stopping smoking probably reduces the risk of these conditions.
RISKS OF QUITTING SMOKING
Generally, any risks of quitting smoking are far outweighed by the benefits. Nevertheless, it is reasonable to prepare for the discomforts of stopping smoking:
- Symptoms of withdrawal are common while attempting to stop smoking. Symptoms generally peak in the first three days and decrease over the next three to four weeks. Withdrawal symptoms can include difficulty sleeping, irritability, frustration or anger, anxiety, difficulty concentrating, and restlessness. Episodic cravings for cigarettes, which can be intense, may persist for many months. Cravings may be brought on by situations associated with smoking, by stress, or by drinking alcohol. These cravings are a common time for ex-smokers to relapse. The cravings will go away if ignored.
- Depression: Some people who stop smoking experience depression; this can be severe enough that it requires counseling or antidepressant medication and it can cause the person to start smoking again. Depression may also be a side effect of some medications taken to help quit smoking. Symptoms of sleeplessness, irritability, sadness, difficulty concentrating, or other signs of depression should be discussed with a healthcare provider.
- Weight gain can occur while stopping smoking because people tend to eat more after quitting. Typically, people gain two to five pounds in the first two weeks, followed by an additional four to seven pounds over the next four to five months. The average weight gain is 8 to 10 pounds. An exercise program and eating a reasonable diet can minimize weight gain. The benefits of quitting smoking are much greater than the risk of gaining weight.
PREPARING TO QUIT
Smoking is recognized as a chronic addictive disease. Smokers, however, can differ markedly in the way in which they smoke.
- After deciding to quit smoking, the first step is usually to set a quit date. This is the day when you will completely quit smoking. Ideally, this date should be in the next two weeks, although choosing a special date (eg, birthday, anniversary, or holiday) is another option.
- Tell family, friends, and coworkers about the plan to quit and ask for their support.
- Avoid smoking in the home and car and other places where you spend a lot of time.
- Review other quit attempts. What worked? What did not work? What contributed to relapse?
- Prepare to deal with nicotine withdrawal symptoms, including anxiety, frustration, depression, and intense cravings to smoke. Recalling previous quit attempts may help anticipate these symptoms. Withdrawal symptoms usually become manageable within a few weeks of stopping completely.
- Prepare to deal with things that trigger smoking. Examples include having smokers in the household or workplace, stressful situations, and drinking alcohol. A vacation from work may be an easier time to quit, particularly if you smoke during work breaks.
- Talk with a healthcare provider about ways to quit smoking. Changing behaviors and taking a medication are the two main methods of quitting smoking. You are more likely to quit if you use both methods together.
BEHAVIORAL CHANGES TO HELP YOU QUIT
You can make changes in your behavior to help you quit smoking on your own or you can participate in individual or group sessions. Using behavioral changes with a medication increases your chances of success.
- Problem solving/skills training— When preparing to quit, it is important to identify situations or activities that increase your risk of smoking or relapse. After identifying these situations, you may need to develop new coping skills. This may include one or more of the following:
- Make lifestyle changes to reduce stress and improve quality of life, such as starting an exercise program or learning relaxation techniques. Vigorous exercise can enhance the ability to stop smoking and avoid relapse and also helps to minimize or avoid weight gain.
- Minimize time with smokers. People who live with smokers can consider negotiating with them to stop smoking at home or in the car.
- Recognize that cravings frequently lead to relapse. Cravings can be prevented to some degree by avoiding situations associated with smoking, by minimizing stress, and by avoiding alcohol. Cravings will subside. Keep oral substitutes (such as sugarless gum, carrots, sunflower seeds, etc.) handy for when cravings develop.
- Avoid thoughts like “having one cigarette will not hurt”; one cigarette typically leads to many more.
- Have as much information as possible about what to expect during a quit attempt and how to cope during this time. Self-help materials such as pamphlets, booklets, videos, or audio tapes; information from a healthcare provider; a counselor; a telephone hotline; the internet; and support groups can be helpful. Some medical centers have patient resources or learning centers with self-help materials.
- Support— Support can be very helpful in quitting smoking and staying off cigarettes. Support can come from family and friends, a healthcare provider, a counselor, a telephone hotline or support groups. In addition to getting encouragement, it is important to have someone to discuss any problems that develop while trying to quit, such as depression, weight gain, lack of support from family and friends, or prolonged withdrawal symptoms.
MEDICATIONS FOR QUITTING
There are several medications that may help you stop smoking.
RELAPSE
Most smokers make many attempts to quit before they are able to quit completely. Smoking is a “relapsing” condition, and relapse should not be thought of as failures. Each quit should be regarded a victory, and the longer it lasts, the better.
However, if relapse occurs, it is important to understand why so that your next attempt will be more successful. Keep this in mind when attempting to quit for the first time. If you have success for a while, you can learn what helped and what did not and try again. Try to figure out the reasons that led to start smoking again, and determine if you used the methods (medication, counseling) correctly. Then explore solutions to use next time. Consider trying different methods or combinations of methods.
Most relapses occur in the first week after quitting, when withdrawal symptoms are strongest. Try to mobilize support resources (eg, family, friends) during this critical time. Consider rewards for not smoking; use the money saved on cigarettes for a special treat such as a massage, a movie, a new outfit, or a special dinner.
Later relapses often occur during stressful situations or with social situations that are associated with smoking, often combined with drinking alcohol. Being aware of these high-risk situations may help.
If other problems, such as depression or alcohol or drug dependency, make it more difficult to quit, consider getting professional help from a healthcare provider or counselor
