You Can Quit Smoking

If you have tried to quit smoking, you know how hard it can be. That is because nicotine is a very addictive drug. For some people, it can be as addictive as heroin or cocaine. Within seconds of taking a puff of smoke, nicotine travels to the brain. It tells the brain to release chemicals that make you want to smoke more.

Quitting is hard. Usually people make 2 to 3 tries, or more, before finally being able to quit. Studies have shown that each time you try to quit, you will be stronger and will have learned more about what helps and what hurts.

Anyone can quit smoking. It does not matter about age, health, or lifestyle. The decision to quit and your success is greatly influenced by how much you want to stop smoking.

Half of all people who have ever smoked have quit.

Purpose Of This Web Page

This web page tells about how you can improve your chances of quitting smoking and overcoming addiction to nicotine. It explains how you can work with health care providers to find the best way for you to quit. It tells about ways to avoid relapses and talks about concerns you may have about quitting, including weight gain. It also lists names and addresses of organizations that can offer help and information.

You Can Quit Smoking Help Is All Around You!

Many types of health care providers can help you quit --- your family doctor, dentist, or pediatrician; nurses, psychologists, pharmacists, respiratory and physical therapists; and others.

Programs are given by health care providers who specialize in helping people stop smoking. Your regular health care provider can help you find a program.

Methods For Quitting

Experts say three methods work. You have the best chances of quitting if you use them together:
· Use the nicotine patch or gum or other nicotine replacement therapy
· Ask you doctor to prescribe medication to help you quit smoking
· Get support and encouragement
· Learn how to handle urges to smoke and stress
· Call a Telephone Quitline for help
Log onto an Internet website for tips and assistance in quitting

1. Use the Nicotine Patch or Nicotine Gum or other Nicotine Replacement Therapy

The patch and gum help lessen the urge to smoke. The nicotine in the patch and gum passes through the skin. This reduces the craving for nicotine when you stop smoking. It is important to follow the directions carefully when using the patch or gum. Ask your health care provider for advice or read the information in the package.

While you may still get cravings to smoke, don't smoke while using the patch or gum!
Who should use the nicotine patch or nicotine gum?
Research shows that almost everyone can benefit from using the patch or gum.
If you are pregnant or have heart or blood vessel problems, your health care provider will be especially careful about giving you the patch or gum.

How do I know what strength is right for me?

The Patch: Most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks and then use a weaker patch for another 4 weeks (5-14 mg of nicotine).

The gum: Many smokers should start using the 2-mg dose. However, you may want to use 4-mg gum if you:

· Smoke more than 20 cigarettes a day
· Smoke as soon as you wake up in the morning
· Have severe withdrawal symptoms when you don't smoke
· Have tried and failed to quit on a lower dose.
· If you are a very light smoker (less than 10-15 cigarettes a day) or have health problems, a health care provider can help you select the right dose.
· Should I use the nicotine patch or the nicotine gum?

Both treatments can help once you are ready to quit. The choice is up to you. Some people don't like the taste of the gum or don't like chewing in public and prefer the patch. Others have been unable to quit on the patch and want to try the gum. Here is some information to help you decide which one is right for you.

Using the nicotine patch or gum about doubles your chances of quitting.

NICOTINE PATCH

Directions for use:

At the start of each day, a new patch is placed on a part of the body between the neck and waist. Each day, the patch is moved to a new spot to lessen skin irritation.

Treatment period:
The patch is usually used for up to 8 weeks.

Side effects:
Some people who use the patch get a rash on their body where the patch is placed. Skin rashes are usually mild and easily treated. Moving the patch to another area of the body helps.

How to get it:
Currently, the patch is prescribed by a doctor. (Check with your health insurance to find out if the cost is covered.)

NICOTINE GUM

Directions for use:

The gum must be chewed in a special way to make it work. It is chewed slowly until a "peppery" taste comes out. Then, the gum is placed between the cheek and gum. Each piece of gum should be used for about 30 minutes.

Treatment period:
People often chew too few pieces of gum per day and for too few weeks to get the most benefits from using it. A fixed schedule (at least one piece every 1-2 hours for at least 1-3 months) may give the best results.

Side effects:

Some people develop mild side effects such as hiccups, upset stomach, or jaw ache. Most of these side effects go away if the gum is used correctly.

How to get it:

The gum is newly available without a doctor's prescription. To be safe, carefully read and follow directions inside the package. Also, you can talk to your health care provider about how to use it and for how long.

If you have any side effects from the patch or gum, be sure to tell your health care provider right away.

As this booklet went to press, nicotine nasal spray was approved for use in the United States by the Food and Drug Administration. It joins the patch and gum as useful aids for quitting smoking.

Nicotine Replacement Therapy:

Through research and testing, tobacco treatment specialists have discovered that you may double your chances of quitting if you combine Nicotine Replacement Therapy (NRT) such as the nicotine patch, gum or lozenge with behavioral changes. Although these products may seem expensive, you are spending more now on tobacco. Your health insurance may cover the cost of NRT. Now is the best time to quit!

Wellbutrin, Zyban or Chantix:

Wellbutrin SR (also known asZyban) , may be prescribed by your doctor to help you quit smoking. When used correctly, people who begin taking Wellbutrin SR one to two weeks prior to their quit date may find they are not as interested in smoking, and when they stop smoking, they may notice that the irritability and anxious feelings associated with nicotine withdrawal are lessened or not present.

Pfizer scientists developed CHANTIX™ (varenicline) specifically to help smokers quit. And it comes with a support plan that can help you learn to break the smoking routine. CHANTIX™ (varenicline) works by activating these receptors and blocking nicotine from attaching to them. However, CHANTIX does not contain nicotine.

2. Get Support And Encouragement

Counseling can help you learn how to live as a nonsmoker. Brief counseling or advice from your health care provider can help. Also, you may want to join a quit smoking program. Studies of people who have quit show the more counseling you have, the greater your chance of success. Here is what to look for in a quit smoking program:

· Session length: at least 20-30 minutes long
· Number of sessions: at least 4-7 sessions
· Number of weeks: at least 2 weeks

Don't be afraid to talk about how you feel---fears of not being able to quit or problems with family or friends. Your family, friends, or health care provider can offer encouragement and support. Self-help materials and hotlines are available.

If you get the urge for a cigarette, call someone to help talk you out of it---preferably an ex-smoker. Write down the names and phone numbers of people you can call on a piece of paper and keep it with you.

3. Learn How To Handle Urges to Smoke and Stress

Be aware of things that may cause you to want to smoke. For example:

· Being around other smokers
· Being under time pressure
· Getting into an argument
· Feeling sad or frustrated
· Drinking alcohol

Avoid difficult situations while you are trying to quit. Try to lower your stress level. Take time to do things you enjoy. Exercise, such as walking, jogging, or bicycling can also help. Write down on a piece of paper the events, feelings, or activities that make you want a cigarette. You may want to talk about them with your health care provider or support group, or with a friend.

The key to handling an urge is to distract yourself from thoughts of smoking:

· Talk to someone
· Get busy with a task
· Read a book
· Write down on a piece of paper 3 things that will work for you.

Call a Telephone Quitline for Help

There are many telephone quitline available. Almost every state has one. The National Cancer Institute also has a quitline. Call NCI's Smoking Quitline: 1-877-44U-QUIT

Log onto an Internet Quit Site

Internet quit sites can provide very useful information as well as support.

Here is one site to explore -- http://www.way2quit.com/

Other Methods

Other methods are sometimes used to quit smoking. While some people may find these methods helpful, there are not enough studies to prove that they work. Such methods include:

· Hypnosis
· Acupuncture

Special Care Required!

Pregnant women / new mothers:
Smoking puts your baby at risk for sudden infant death syndrome (SIDS), poor lung development, asthma, and infections.

Hospitalized patients:
Smoking slows recovery from illness and surgery. It slows bone and wound healing. Most
hospitals do not allow smoking.

Heart Attack patients:
Second heart attacks are more common in people who continue to smoke.

Lung, head, and neck cancer patients:
Smoking can cause a second cancer, even after successful treatment.

Children and adolescents:
Young people who smoke become addicted faster than adults. Those who live with smokers
are at special risk of health problems from breathing others' smoke.

· Set Goals
· Set a quit date.
· Tell your family, friends, and coworkers that you are going to quit and when.
· Ask them for support and understanding.
· Make and keep appointments with health care professionals---within 1 or 2 weeks after your quit date.
· Make Change Before You Quit
· Change your environment. Get rid of cigarettes and ashtrays in your home, car, and place of work. Get rid of the smell of cigarettes in your car and home. Avoid other tobacco products, such as cigars, pipes, and chewing tobacco.
· Begin to change habits. Avoid smoking in places where you spend a lot of time, such as your home or car.
· Review your past attempts to quit. Think about what worked and what did not.
· Remember: Stop smoking on your quit date...not even a single puff

Questions To Think About

Think about the following questions before trying to stop smoking. You may want to talk about your answers with your health care provider. Write down each question and answer it on a sheet of paper:

1. Why do you want to quit?
2. When you tried to quit in the past, what helped and what didn't?
3. What will be the most difficult situations for you after you quit? How do you plan to handle them?
4. Who can help you through the tough time? Your health care provider? Family? Friends? Ex-smokers?
5. What pleasures do you get from smoking?
6. Why do you think you will be able to give them up?

Here are some questions to ask your health care provider. Write them down or print this Web page and take them with you when you visit your health care provider.

1. How will I feel when I stop smoking? What will withdrawal be like?
2. How can you help me be successful at quitting?
3. What should I do if I need more help?

Try to think of some more questions to ask on your own.

Facts About Smoking, Quitting, And Gaining Weight

Weight gain varies from person to person. The average person gains less than 10 pounds.

The weight gained is a minor health risk compared to the risks of smoking

Women tend to gain slightly more weight than men. African Americans, people under age 55, and heavy smokers are at greater risk for major weight gain, but your personal experience may be different.

Exercising, eating plenty of fruits, vegetables, whole grain cereals and pasta, avoiding a lot of fats, and getting enough sleep can help.

Nicotine gum appears to help prevent or delay weight gain.

Looking good is a lot more than how much you weigh. Smelling clean and having your clothes free of smoke, having fresh breath, and feeling healthier and good about yourself can make you more attractive.

Focus on quitting before worrying about possible weight gain.

Snuff and Chew Are Bad For You

Using smokeless tobacco can be as harmful as smoking. Using it can quickly lead to addiction.

Like smoking, dipping or chewing has serious health effects, including oral cancer, gum problems, loss of teeth, and heart problems.

Like smoking, the use of smokeless tobacco can be treated by counseling, help in handling difficult situations, and perhaps the nicotine patch or nicotine gum.

How To Avoid Relapse

Most relapses occur within the first 3 months after quitting. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Explore different ways to break habits. You may have to deal with some of the following triggers that may cause relapse.

Alcohol. Consider limiting or stopping alcohol use while you are quitting smoking.
Other smokers at home. Try to get your spouse or housemates to quit with you.
Work out a plan to cope with others who smoke, and avoid being around them.
Weight gain. Tackle one problem at a time. Work on quitting smoking first. Consider using nicotine gum to delay weight gain. (You will not necessarily gain weight.)
Negative mood or depression. If these symptoms persist, talk to your health care provider. You may need treatment for depression.

Severe withdrawal symptoms. Your body will go through many changes when you quit smoking. You may have a dry mouth, cough, or scratchy throat, and feel on edge. The patch or gum may help with cravings.

Thoughts. Get your mind off cigarettes. Exercise and do things you enjoy.

Keep a list. Keep a list of "slips" and near slips, what caused them and what you can learn from them.

You Can Quit Smoking!
Additional Resources

You may want to contact these organizations for information on smoking and how to quit:

For general information:
American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
(800) AHA-USA1 (242-8721)

American Cancer Society
1599 Clifton Road, NE
Atlanta, GA 30329
(404) 320-3333

American Lung Association
1740 Broadway, 14th Floor
New York, NY 10019
(212) 315-8700

National Cancer Institute
Bethesda, MD 20894
(800) 4-CANCER (422-6237)

For pregnant women:

American College of Obstetricians and Gynecologists
409 12th Street, SW
Washington, DC 20024
(202) 638-5577

Programs are given at local hospitals and health centers. Call your local health department for information about programs in your State.

Make your own list of local/State services, support groups, hotlines or helplines, and other resources.

For More Information

The information in this Web page was taken from the Clinical Practice Guideline on Smoking Cessation. The guideline was developed by a non-Federal panel of experts sponsored by the Agency for Health Care Policy and Research (AHCPR), a U.S. Government agency. Additional support came from the Centers for Disease Control and Prevention (CDC). Other guidelines on common health problems are available from
AHCPR, and more are being developed.

For more information about other guidelines, or to get more copies of this booklet, call toll free:

800-358-9295

Or write:

Agency for Health Care Policy and Research
Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907

These and other guidelines are available online through AHCPR's web site at:

http://www.ahcpr.gov/

Copies of this booklet and other consumer booklets are free through Instant FAX, which operates all day every day. If you have a fax machine equipped with a touch-tone telephone, dial (301) 594-2800, push 1, and then press the start button for instructions and a list of publications.

US Department of Health and Human Services
Public Health Service
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 501
Rockville, MD 20852

AHCPR Publication No. 96-0695
April 1996

For General Information About The Effects Of Smoking:
Center for Disease Control Information http://www.cdc.gov/health/tobacco.htm

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