The Centers for Disease Control lists tobacco use as the single most important preventable risk to human health, and one out of every five people in the United States are addicted to cigarettes, or about 61 million people. Smoking and tobacco use has been proven to cause heart disease, strokes, emphysema, chronic obstructive lung disease, and cancer of the lungs, bladder, throat, mouth, and pancreas.
Quitting smoking is extremely difficult for most smokers. Some studies have compared the difficulty of quitting smoking as similar to that of quitting heroin or cocaine. Some people can just go ‘cold turkey’ and quit immediately. Many more have attributed their success in quitting by using nicotine replacement products, such as gums, lozenges, or patches, which allow the person to gradually wean themselves off nicotine while avoiding the toxic byproducts of smoking and helping them resist the urge to smoke. However, recent research has shown that these products may offer help with temporarily quitting, but eventually over 90% of the smokers relapse within six months.
Recently, the popularity of ‘e-cigarettes’ or electronic cigarettes has increased, which allows the smoker to ingest nicotine in water vapor, without the added tar and smoke byproducts from cigarettes. However, the World Health Organization has not approved these devices as a legitimate smoking cessation aid as studies on their effectiveness is limited.
There are prescription drugs that have been successful with helping people quit as well (Wellbutrin, Chantix), however like with any medication, there are the possibilities of side effects. Like the approach for many other mental health and behavioral issues, the approach of medication along with counseling (cognitive behavioral therapy, motivational interviewing) is more effective than either medication or counseling alone.
Community interventions such as making workplaces and public places smoke free have had a definite impact on smoking cessation, as well as increased pricing and taxation of tobacco products. It has been estimated that for every 10% increase in price, smoking decreases by 3%-5%. Alternative therapies such as hypnosis and acupuncture have been used with some degree of individual success, with 12 month success rates similar to behavioral therapy and nicotine replacement.
There is no question that quitting smoking greatly improves the health of the smoker, and it is never too late to quit. Within one year of quitting, the risk of heart disease is cut in half. Within 5 years, the risk of stroke is comparable to someone who never smoked.
Smoking doesn’t just affect the person who smokes. People who do not smoke are exposed to “secondhand smoke,” which comes from both the exhaled smoke and from the smoke floating from the end of a cigarette, cigar, or pipe. Inhaling secondhand smoke increases a person’s risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. In fact, secondhand smoke is estimated to contribute to as many as 40,000 deaths related to heart disease and about 3,000 lung cancer deaths per year among people who do not smoke. Secondhand smoke also causes respiratory problems in people who do not smoke, like coughing, phlegm, and reduced lung function.
Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear problems, and more severe asthma. And, believe it or not, dropped cigarettes are the leading cause of residential fire fatalities, leading to more than 700 such deaths each year.
Each year, almost half a million Americans die from tobacco use. One of every five deaths in the United States is a result of tobacco use, making tobacco more lethal than all other addictive drugs combined.
Foremost among the cancers caused by tobacco use is lung cancer. In fact, cigarette smoking has been linked to about 90 percent of all lung cancer cases, the number-one cancer killer of both men and women. Tobacco abuse is also associated with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, ureter, and bladder.
Tobacco abuse harms every organ in the body. It has been conclusively linked to leukemia, cataracts, and pneumonia, and accounts for about one-third of all cancer deaths.
Extensive research has shown that treatments for tobacco addiction do work. Although some smokers can quit without help, many individuals need assistance with quitting. This is particularly important because smoking cessation can have immediate health benefits. For example, within 24 hours of quitting, blood pressure and chances of heart attack decrease. Long-term benefits of smoking cessation include decreased risk of stroke, lung and other cancers, and coronary heart disease. A 35-year-old man who quits smoking will, on average, increase his life expectancy by 5 years.
Medications
Nicotine replacement products are the most common forms of medication for smoking cessation.
Do nicotine replacement products relieve nicotine cravings and withdrawal symptoms?
Yes. Nicotine replacement products deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit smoking. Nicotine replacement products are effective treatments that can increase the likelihood that someone will quit successfully.
Five forms of nicotine replacement products have been approved by the U.S. Food and Drug Administration (FDA):
The nicotine patch is available over the counter (without a prescription). A new patch is worn on the skin each day, supplying a small but steady amount of nicotine to the body. The nicotine patch is sold in varying strengths, usually as an 8- to 10-week quit-smoking treatment. Typically, the nicotine doses are gradually lowered as treatment progresses. The nicotine patch may not be a good choice for people with skin problems or allergies to adhesive tape. Also, some people experience the side effect of having vivid dreams when they wear the patch at night. These people may decide to wear the patch only during the daytime.
Nicotine gum is available over the counter in two strengths (2 and 4 milligrams). When a person chews nicotine gum and then places the chewed product between the cheek and gum tissue, nicotine is released into the bloodstream through the lining of the mouth. To keep a steady amount of nicotine in the body, a new piece of gum can be chewed every 1 or 2 hours. The 4-milligram dose appears to be more effective among highly dependent smokers (those who smoked 20 or more cigarettes per day). Nicotine gum might not be appropriate for people with temporomandibular joint disease or for those with dentures or other dental work, such as bridges. The gum releases nicotine more effectively when coffee, juice, or other acidic beverages are not consumed at the same time.
The nicotine lozenge is also available over the counter in 2 and 4 milligram strengths. The lozenge is used similarly to nicotine gum; it is placed between the cheek and the gums and allowed to dissolve. Nicotine is released into the bloodstream through the lining of the mouth. The lozenge works best when used every 1 or 2 hours and when coffee, juice, or other acidic beverages are not consumed at the same time.
Nicotine nasal spray is available by prescription only. The spray comes in a pump bottle containing nicotine that tobacco users can inhale when they have an urge to smoke. Nicotine is absorbed more quickly via the spray than with other nicotine replacement products. Nicotine nasal spray is not recommended for people with nasal or sinus conditions, allergies, or asthma or for young tobacco users. Side effects from the spray include sneezing, coughing, and watering eyes, but these problems usually go away with continued use of the spray.
A nicotine inhaler, also available by prescription only, delivers a vaporized form of nicotine to the mouth through a mouthpiece attached to a plastic cartridge. Even though it is called an inhaler, the device does not deliver nicotine to the lungs the way a cigarette does. Most of the nicotine travels only to the mouth and throat, where it is absorbed through the mucous membranes. Common side effects include throat and mouth irritation and coughing. Anyone with a breathing problem such as asthma should use the nicotine inhaler with caution.
Experts recommend combining nicotine replacement therapy with advice or counseling from a doctor, dentist, pharmacist, or other health care provider. Also, experts suggest that smokers quit using tobacco products before they start using nicotine replacement products. Too much nicotine can cause nausea, vomiting, dizziness, diarrhea, weakness, or rapid heartbeat.
Are nicotine replacement products safe?
It is far less harmful for a person to get nicotine from a nicotine replacement product than from cigarettes because tobacco smoke contains many toxic and cancer-causing substances. Long-term use of nicotine replacement products has not been associated with any serious harmful effects.
Are there products to help people quit smoking that do not contain nicotine?
Yes, a doctor may prescribe one of several medicines that do not contain nicotine:
Bupropion, a prescription antidepressant, was approved by the FDA in 1997 to treat nicotine addiction (under the trade name Zyban®). This drug can help to reduce nicotine withdrawal symptoms and the urge to smoke and can be used safely with nicotine replacement products. Several side effects are associated with this product. Discuss with your doctor if this medicine is right for you.
Varenicline, a prescription medicine marketed as Chantix®, was approved by the FDA in 2006 to help cigarette smokers stop smoking. This drug may help those who wish to quit by easing their nicotine cravings and by blocking the pleasurable effects of nicotine if they do resume smoking. Several side effects are associated with this product. Discuss with your doctor if this medicine is right for you.
Therapies
Behavioral therapies play an integral role in smoking cessation treatment, either in conjunction with medication or alone. A variety of methods can assist smokers with quitting, ranging from self-help materials to individual cognitive-behavioral therapy. These interventions teach individuals to recognize high-risk smoking situations, develop alternative coping strategies, manage stress, improve problem solving skills, and increase social support. Research has also shown that the more therapy is tailored to a person’s situation, the greater the chances are for success.
Traditionally, behavioral approaches were developed and delivered through formal settings, such as smoking cessation clinics and community and public health settings. Over the past decade, however, researchers have been adapting these approaches for mail, telephone, and Internet formats, which can be more acceptable and accessible to smokers who are trying to quit. In 2004, the U.S. Department of Health and Human Services (HHS) established a national toll-free number, 800-QUIT-NOW (800-784-8669), to serve as a single access point for smokers seeking information and assistance in quitting. Callers to the number are routed to their State’s smoking cessation quitline or, in States that have not established quitlines, to one maintained by the National Cancer Institute.
Quitting smoking can be difficult. People can be helped during the time an intervention is delivered; however, most intervention programs are short-term (1–3 months). Within 6 months, 75–80 percent of people who try to quit smoking relapse. Research has now shown that extending treatment beyond the typical duration of a smoking cessation program can produce quit rates as high as 50 percent at 1 year.
Are there alternative therapies to help people quit smoking?
Some people claim that alternative approaches such as hypnosis, acupuncture, acupressure, laser therapy (laser stimulation of acupuncture points on the body), or electrostimulation may help reduce the symptoms associated with nicotine withdrawal. However, in clinical studies these alternative therapies have not been found to help people quit smoking. There is no evidence that alternative approaches help smokers who are trying to quit.
Which health care professionals can help me quit smoking?
Many health care professionals can be good sources of information about the health risks of smoking and the benefits of quitting. Talk to your doctor, dentist, pharmacist, or other health care provider about the proper use and potential side effects of nicotine replacement products and other medicines. They can also help you find local resources for assistance in quitting smoking.
How can I help someone I know quit smoking?
It’s understandable to be concerned about someone you know who currently smokes. It’s important to find out if this person wants to quit smoking. Most smokers say they want to quit. If they don’t want to quit, try to find out why.
Here are some things you can do to help:
- Express things in terms of your own concern about the smoker’s health (“I’m worried about…”).
- Acknowledge that the smoker may get something out of smoking and may find it difficult to quit.
- Be encouraging and express your confidence that the smoker can quit for good.
- Suggest a specific action, such as calling a smoking quitline, for help in quitting smoking.
- Ask the smoker for ways in which you can provide support.
Here are some things you should not do:
- Don’t send quit smoking materials to smokers unless they ask for them.
- Don’t blame or criticize the smoker for their addiction to tobacco.
- Don’t criticize, nag, or remind the smoker about past failures.
What are some of the withdrawal symptoms associated with quitting smoking?
Quitting smoking may cause short-term problems, especially for those who have smoked heavily for many years. These temporary changes can result in withdrawal symptoms.
Common withdrawal symptoms associated with quitting include the following:
- Nicotine cravings (nicotine is the substance in tobacco that causes addiction).
- Anger, frustration, and irritability.
- Anxiety.
- Depression.
- Weight gain.
- Studies have shown that about half of smokers report experiencing at least four withdrawal symptoms (such as anger, anxiety, or depression) when they quit. People have reported other symptoms, including dizziness, increased dreaming, and headaches.
The good news is that there is much you can do to reduce cravings and manage common withdrawal symptoms. Even without medication, withdrawal symptoms and other problems subside over time. It may also help to know that withdrawal symptoms are usually worst during the first week after quitting. From that point on, the intensity usually drops over the first month. However, everyone is different, and some people have withdrawal symptoms for several months after quitting.
What can I do about nicotine cravings?
As a smoker, you get used to having a certain level of nicotine in your body. You control that level by how much you smoke, how deeply you inhale the smoke, and the kind of tobacco you use. When you quit, cravings develop when your body wants nicotine. It takes time to break free from nicotine addiction. Also, when you see people smoking or are around other triggers, you may get nicotine cravings. Cravings are real. They are not just in your imagination. At the same time, your mood may change, and your heart rate and blood pressure may go up.
The urge to smoke will come and go. Cravings usually last only a very brief period of time. Cravings usually begin within an hour or two after you have your last cigarette, peak for several days, and may last several weeks. As the days pass, the cravings will get farther apart. Occasional mild cravings may last for 6 months.
Here are some tips for managing cravings:
- Remind yourself that they will pass.
- Avoid situations and activities that you used to associate with smoking.
- As a substitute for smoking, try chewing on carrots, pickles, apples, celery, sugarless gum, or hard candy. Keeping your mouth busy may stop the psychological need to smoke.
- Try this exercise: Take a deep breath through your nose and blow out slowly through your mouth. Repeat 10 times.
- Ask your doctor about nicotine replacement products or other medications
What are the immediate benefits of quitting smoking?
The immediate health benefits of quitting smoking are substantial:
- Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal.
- Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide reduces the blood’s ability to carry oxygen.)
- Within a few weeks, people who quit smoking have improved circulation, produce less phlegm, and don’t cough or wheeze as often.
- Within several months of quitting, people can expect substantial improvements in lung function.
- In addition, people who quit smoking will have an improved sense of smell, and food will taste better.
What are the long-term benefits of quitting smoking?
Quitting smoking reduces the risk of cancer and other diseases, such as heart disease and COPD, caused by smoking.
People who quit smoking, regardless of their age, are less likely than those who continue to smoke to die from smoking-related illness:
Quitting at age 30: Studies have shown that smokers who quit at about age 30 reduce their chance of dying prematurely from smoking-related diseases by more than 90 percent.
Quitting at age 50: People who quit at about age 50 reduce their risk of dying prematurely by 50 percent compared with those who continue to smoke.
Quitting at age 60: Even people who quit at about age 60 or older live longer than those who continue to smoke.
Does quitting smoking lower the risk of cancer?
Yes. Quitting smoking reduces the risk of developing and dying from cancer. However, it takes a number of years after quitting for the risk of cancer to start to decline. This benefit increases the longer a person remains smoke free.
The risk of premature death and the chance of developing cancer from smoking cigarettes depend on many factors, including the number of years a person smokes, the number of cigarettes he or she smokes per day, the age at which he or she began smoking, and whether or not he or she was already ill at the time of quitting. For people who have already developed cancer, quitting smoking reduces the risk of developing a second cancer.
What are some of the triggers for smoking?
In addition to nicotine cravings, reminders in your daily life of times when you used to smoke may trigger you to smoke. Triggers are the moods, feelings, places, or things you do in your daily life that turn on your desire to smoke.
Triggers may include any of the following:
- Being around smokers.
- Starting the day.
- Feeling stressed.
- Being in a car.
- Drinking coffee or tea.
- Enjoying a meal.
- Drinking an alcoholic beverage.
- Feeling bored.
Knowing your triggers helps you stay in control because you can choose to avoid them or keep your mind distracted and busy when you cannot avoid them.
Smoking cessation cannot be diagnosed because it is the process of discontinuing the practice of inhaling a smoked substance. Those suffering from tobacco addiction are often the ones attempting smoking cessation. Diagnosis information for tobacco addiction is listed below.
Nicotine dependence is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence — also referred to as tobacco dependence — means you can’t stop using the substance, even though it’s causing you harm. While it’s the nicotine in tobacco that causes nicotine dependence, the toxic effects come mainly from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than do nonsmokers.
Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and lead to dependence. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety.