If you are a smoker, giving up could be the single best action you have ever done for your health. Also known as smoking cessation or quitting, it generally refers to the inhalation of tobacco smoke, which for many people can be extremely difficult because they have a strong physical addiction to a substance found in tobacco smoke – nicotine. If manufacturers of cigarettes, cigars and pipe tobacco were not allowed to include any nicotine in their products, most experts agree that the number of smoking addicts would plummet.

The vast majority of regular smokers fail in their first attempt to give up. Even after developing serious smoking related diseases, a considerable number of individuals find it so hard to quit that they continue puffing away.

Half a century ago there were more regular smoking adults than non-smokers. Today, especially in developed nations, smokers make up a minority of the adult population (around 20%). According to the NIH (National Institutes of Health), USA, in 2010 there were 46 million smokers and 47 million non-smoking people who used to smoke in America.

Although there are several aids to help you give up, the majority of current ex-smokers managed to break free without any help – either by gradually tapering off (cutting down and then stopping) or going cold turkey.

Predicting whether a person might succeed in giving up is not easy. Several factors may influence, such as their physical makeup, motivation, commitment, lifestyle, home environment, socioeconomic status, education, and even gender. People who live in households with other smokers generally find it harder to give up. If you work in a UK hospital, finding somewhere to smoke is difficult, making it easier to stop. On the other hand, gardeners or farm workers can light up virtually whenever they want. If you move into an apartment on the fifth floor and the building has no elevator you may soon start wondering whether those stairs, especially of you are laden with shopping, might not be easier if you did not smoke, and decide to try to give up. When you find those stairs easier, your motivation may last longer, increasing your chances of long-term success.

The National Health Service (NHS), UK, says that people wishing to give up smoking should see their GP (general practitioner, primary care physician). Doctors are trained to help patients, give them proper advice and refer them to support services. Getting into a support group has been shown to considerably improve your chances of succeeding both in the short- and long-term. Even if you do not want to join a group, your doctor can still be an important factor in getting you to quit properly and permanently.

NRT (Nicotine Replacement Therapy) – if your addiction to nicotine is particularly severe, you may find that a steady release of nicotine into your bloodstream helps take the edge off those powerful cravings and bouts of anxiety and irritation. NRT provides you with nicotine, but spares you all that smoke which contains poisonous chemicals, tar and carbon monoxide.

Examples of NRT include:

  • Nicotine patches – also known as transdermal patches. They stick to your skin which absorbs nicotine for 16 or 24 hours.
  • Nicotine gum – these are available in 2mg or 4mg doses per gum. Some people prefer the gum to patches because they also give your mouth something to do. Smoking is partly an oral experience, as are the gums. The nicotine is absorbed through the mucous membrane inside your mouth, and into your bloodstream.
  • Nicotine inhalators – these look like cigarette holders and have a replaceable nicotine cartridge inside. You suck and inhale; this action provides a dose of nicotine, but without the smoke. When you first use it you may find it stings the back of your throat. After some practice they can help significantly. Inhalators provide the patient with a similar experience to smoking cigarettes. There is something to hold, something to suck, inhalation is involved, and a feeling of a “kick” when inhalation occurs, as well as the nicotine. As in the other NRT cases, the patient is not inhaling smoke.
  • Tablets and lozenges – these are placed under the tongue. The nicotine is absorbed into the bloodstream.
  • Nasal spray – the patient blasts a nicotine-containing spray into the nostrils. As with the inhalator, many say it also provides them with that “kick” (buzz sensation) they miss so much when quitting. This is the fastest acting form of NRT – the nicotine gets to the nicotine receptors in your brain more quickly.

In the majority of countries you can buy NRT products at your local pharmacy without a prescription.

According to the NHS, no evidence so far has favored one type of NRT over another in effectiveness. It really is a matter of personal choice.

Doctors advise people to do a 12-week NRT course, which tapers off towards the end. Particularly addicted people, usually those who were very heavy smokers, may have to go on for longer.

Possible side effects from NRTs, which are usually light to moderate, may include:

  • Patches may cause skin irritation
  • Nasal sprays may irritate the eyes, throat, or nose. Sprays may also make you sneeze. Experts say you should not apply the spray while driving or just before you drive.
  • There may be very vivid dreams
  • Some patients experience disturbed sleep. In most cases this symptom settles down after a week or two
  • Headaches
  • Lightheadedness

If you find the side effects particularly uncomfortable, tell your doctor. There may be a problem with dosage, or the type of NRT may not suit you.

Doctors advise smoking women who become pregnant to quit without NRT. If you are particularly addicted, tell your doctor who may consider NRT. Although nicotine is not good for the fetus, nicotine mixed with cigarette smoke is even worse.

Medications – there are currently two drugs designed to help a smoker quit.

Varenicline – known worldwide as Chantix (USA) and Champix. It is the only drug specifically designed to help addicted smokers give up. It is a nicotinic receptor partial agonist – it prevents nicotine from binding to parts of the brain that respond to nicotine (receptors), this reduces cravings and the pleasurable and rewarding effects of nicotine.

The US FDA requires that verenicline products carry a black box warning because of possible side effects including depression, suicidal thoughts and actions. A black box warning is the FDA’s strongest safety warning.

You start taking Varenicline tablets before you give up and should aim to quit within days 7 to 14, giving the drug time to start working. Treatment usually lasts about 12 weeks. In some cases the doctor may advise the patient to continue treatment for another 12 weeks if he/she is still smoke free.

The following individuals should not take Varenicline – those under 18, pregnant women, breastfeeding mothers, patients with advanced kidney disease, and people with epilepsy.

Varenicline side effects may include:

  • Disturbed sleep, even insomnia
  • Extremely vivid dreams, sometimes unpleasant and frightening nightmares. I took varenicline and in one night woke up three times – during the last nightmare I dreamt that some creatures had got hold of me in bed and were grunting loudly and shaking me. It was incredibly vivid and frightening (I persevered with treatment and gave up smoking)
  • Headaches – if you do get them, they tend to go away after a while.
  • A desire to nibble – doctors call it an increased appetite. I have talked to dozens of people who had received varenicline therapy, most comments described a desire to nibble all day rather than wanting huge meals (this last comment is anecdotal, a casual observation on my part, not a scientific study)
  • Altered bowel behavior – either constipation or diarrhea
  • Bloated stomach
  • Digestion may be slow
  • Wind, flatulence (more farting)
  • Dry mouth – I would often wake up in the morning with a very dry mouth. On a couple of occasions this woke me up in the night
  • Fatigue
  • Light-headedness
  • Some people may feel drowsy – if this happens to you do not operate heavy machinery or drive

Bupropion – this is an antidepressant which has been found to help some patients give up smoking. The patient smokes during the first 7 to 14 days of treatment so that the drug has time to work. Treatment usually lasts from 7 to 9 weeks. Its brand name is Zyban.

Studies have shown that both Varenicline and Bupropion can significantly increase your chances of long-term success in your attempts to give up smoking.

When you cease smoking your body starts enjoying better health immediately. Within a month your skin is brighter, more supple (hydrated) and clearer. Within three to nine months your cough or wheezing will be gone, your breathing will be much better, and you will enjoy a likely 10% improvement in lung function. Your risk of a heart attack or heart disease will drop by approximately 50% after one year. Within one decade your risk of developing lung cancer would have gone down by half. By year 15 after giving up you will have the same heart disease or heart attack risks as a lifetime non-smoker.

That initial feeling of gloom and hopelessness which can grip many smokers who try to give up really does eventually go away. You need to give it time. Eventually, you start to realize you truly can enjoy your life without nicotine. It is not a life of sacrifice and doing without. Happiness without nicotine does eventually arrive. And when it does – you are free! Millions of us have gone through it. You are not alone. Good luck!

Written by Christian Nordqvist