"It's easy to quit smoking; I've done it hundreds of times." -- Mark Twain
There are many different ways to give up smoking. Some experts advocate using pharmacological products to help wean you off nicotine, others say all you need is a good counselor and support group, or an organized program. To add to the confusion, you may find there is a study that says this way works better than that one, and then when you look again, you find there is another study that says, no, that one works better than this one.But one thing most experts agree on is that a combination works best. For example, nicotine replacement therapy on its own, or counseling on its own is not as effective as a combination of the two.
In this article you can read about some of the more common elements of successful quit smoking programs. And at the end is a list of Top Tips to Quit Smoking.
Elements of Successful Quit Smoking Programs
If you are looking to put together or select a quit smoking program, I suggest you consider four elements in your "combination":
- Appropriate use of pharmacological products. If you feel you are severely addicted to smoking, you may wish to consider nicotine replacement products so your body gradually gets used to living without nicotine: always talk to your doctor, pharmacist, or qualified quitting expert first before using these drugs.
- Advice and support. Advice and support can help you become more self-aware, identify your triggers and when moments of weakness may occur, develop strategies and contigencies, keep you realistically grounded and on track with your plan, and prevent relapse. Examples include one-to-one or in-person counseling, telephone counseling, internet programs, group support, mentoring, and coaching.
- Measuring and recording. To help you see in black and white how much you smoke, how much it costs you, how much you could save; also keeping a journal of your quitting journey.
- Improving your knowledge: Read the science, talk to experts, and learn for yourself how smoking damages your health and the health of those around you. Learn how others tackled the challenge.
Pharmacological quit smoking products
Nicotine patches are a popular choice for people wanting to quit smoking.
There are more than 4,000 harmful chemicals in tobacco. Nicotine is the one that makes you addicted to smoking.
The idea of nicotine replacement products is to help you gradually wean yourself off nicotine. They deliver a small amount of nicotine to relieve the symptoms of withdrawal. Giving up the replacement product is easier than giving up smoking.
Nicotine replacement products come in many forms, the main ones being:
- Nicotine gum,
- Nicotine patch,
- Nicotine nasal spray, and
- Nicotine inhaler.
Proper use of such products can often be the key to successfully quitting for good. Here is an example of how it works:
- Stage 1: Stop smoking (NEVER use nicotine replacement products if you are still smoking).
- Stage 2: Use nicotine replacement therapy (having first consulted an expert about the best product and dose for you) to help manage your cravings. Gradually reduce the dose in line with the program you are following.
- Stage 3: Meanwhile, seek out and start on a support program, such as counseling or group therapy. Make sure you discuss your use of nicotine replacement products in your counseling so the two therapies work with each other.
Aim to be free of both cigarettes and the nicotine replacement product within three to six months.
To decide which product is most likely to help you, talk to a qualified expert. Go and see your doctor, he or she may advise you, or refer you to a smoking cessation expert who knows about appropriate use of nicotine replacement products.
Do you smoke your first cigarette as soon as you wake up?
Knowing how dependent you are on nicotine can help you decide whether you wish to use replacement products. Some quitting centres may ask you to fill in a short questionnaire, such as the "Fagerstrom Test" to assess your nicotine dependence. This asks you:
- How soon do you smoke your first cigarette after waking up?
- Do you find it difficult to abstain from smoking in places where it is forbidden?
- Which cigarette would you most hate to give up?
- How many cigarettes do you smoke a day?
- Do you smoke more frequently in the morning (in the hours after getting up), than the rest of the day?
- Do you smoke even if you are so ill you have to stay in bed?
Your answers generate a score that indicates how dependent you are on nicotine. The higher your dependence, the more likely you are to benefit from pharmacological products to help you cope with withdrawal symptoms and quit smoking.
You can see an example of the Fagerstrom Test as part of online Quitting Smoking resources offered by the government of New South Wales in Australia.
Other products are also available, such as bupropion hydrochloride, that target the biologic basis of tobacco addiction. Bupropion is sold under various brand names, eg Zyban, Wellbutrin, and is available on prescription. The drug has a similar effect on the brain as nicotine, it boosts levels of dopamine and norepinephrine to create a sense of wellbeing and vitality. Like all nicotine substitutes, the drug is intended for use with a quit smoking behavior change program.
Advice and Support for Giving Up Smoking
Evidence suggests that advice and support from others makes a difference to long-term success in quitting smoking. Randomized controlled trials of commonly used techniques, including one-to-one, group, and telephone counseling, show they help smokers quit and remain abstinent. Even brief advice from a doctor has an effect on cessation rates.
The World Health Organization (WHO) takes the view that any professional trained in the appropriate skill should be involved in helping smokers quit: that it is an activity for the whole health care system, providing as many access points as possible for smokers to connect with and benefit from support to help them quit.
Many quitting practitioners employ techniques from cognitive behavioural therapy (CBT). These help you change your habitual thinking and behavior around smoking: for example, identifying and managing triggers (the things that make you want to smoke), developing and reinforcing alternative "good habits" such as exercise, relaxation, or self-rewards for each day without a cigarette or each cigarette or packet not smoked.
The techniques should focus not only on the period leading up to and during quitting, but also afterwards, helping you sustain changes in thinking and behavior to remain abstinent.
You don't have to go to a cognitive behavioral therapist to benefit from CBT techniques. Many other care professionals are trained in CBT because it complements how they deliver their own service. I have met doctors, nurses, social workers, physiotherapists, hypnotherapists, business coaches, Reiki healers and yoga teachers trained in CBT.
An effective program also offers several ways or "modalities" to help you stay connected and on track. For instance, as well as offering one-to-one advice and support, such a program might include group discussions, access to online materials and knowledge bases where you can read articles on smoking cessation, tips and stories from successful quitters, as well as the opportunity to pair up with a buddy or a mentor.
In the UK, under the NHS Smokefree campaign, there are free local services that provide expert advice, information and support to smokers who want to quit. They can help you get stop smoking aids such as nicotine patches and gum, or other prescription products from your GP such as Champix or Zyban if they are suitable for you.
One such example is in Buckinghamshire, where support centres throughout the county offer confidential sessions for a minimum of six weeks. They also work with local employers and set up free workplace groups for staff who find it difficult to get to support centres.
On the next page we look at measuring and recording your success at giving up smoking, a timeline for the differences it will make to your health, 'do it yourself' quit smoking kits and some top tips to quit smoking.