Best ways to quit smoking

Step-by-step tips to help you quit smoking

Smoking cigarettes adds to almost 1 in 5 deaths. The three main smoking-related causes of death are: cardiovascular disease (narrowing or blocking of blood vessels that can lead to a heart attack, chest pain (angina) or stroke); lung cancer and a long-term lung disease that causes blocked airflow from the lungs, called chronic obstructive pulmonary disorder (COPD). According to an American Lung Association report, smoking causes 80 percent of COPD deaths. 

In addition to the three main causes, smoking is also linked to a number of other cancers, an increased likelihood of getting more colds and infections, diabetes, osteoporosis and hip fractures, problems in pregnancy, difficulty with erections, stomach ulcers, gum disease, and the list goes on.

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Quitting smoking can add years to your life. Though the earlier the better, it’s never too late to quit. The benefits of quitting are real.

However, quitting smoking is challenging, but you’re most likely to succeed if you take the right steps to prepare yourself.  So, what’s the best way to quit?

 

Prepare yourself mentally

No matter what method you choose to quit smoking, it's essential that you are mentally ready. To be successful at quitting cold turkey, you will need to mentally prepare for what's often called "junkie thinking".  This is, the many thoughts and rationalizations that can derail your quit-smoking plan (for example, Just one cigarette or one drag won't hurt).

One way to do this is to start jotting down the many reasons (both big and small) why you decided to quit smoking in the first place. Write them down on a piece of paper that you can carry with you at all times, or in the notes section of your smartphone, so you can add to and easily access the list when a moment of weakness hits.

 

Set a quit date

If think you're prepared mentally and ready to quit, pick a date two to four weeks in the future when you plan on quitting. Pick a quiet time of year when you have less on your calendar.

Stress can be a big trigger for smokers, making you reach for a cigarette, so don't try to quit around the time you have final exams, a big project due at work, or have other major stress-inducing events in your life.

Alternatively, if you're a social smoker, try to avoid a date around any festivities, like a wedding or class reunion.

 

Going “cold turkey” might be better

You can choose to cut down on your cigarettes gradually before your quit date, or smoke as you normally do, up until your quit date.  Either is fine, but it seems that quitting all at once or going “cold turkey” might be better, as it increases your chances of stopping for good.  This is probably because among the reasons people give for going cold turkey is the desire for a clean break from their habit.

A recent study randomly assigned about 700 participants to either gradually cut back on smoking over two weeks or quit suddenly on a set quit date. Both groups were offered counseling support as well as nicotine patches and other forms of short-acting nicotine replacement. The group assigned to cold turkey was significantly more successful at quitting smoking, both at the 4-week follow-up (49% vs. 39%) and the 6-month follow-up (22% vs. 15%).

 

Seek out support

Like nicotine withdrawal, psychological urges can be better managed if you understand and plan for them. Knowing that these urges do pass, in some cases, within moments, can really help.

Still, seeking support from your close friends and family is also important.  Chances are, they are thrilled that you're quitting smoking. Let them help motivate and encourage you to stick with your stop-smoking plan.  Ask them to help distract you from cravings by being available during your trigger moments for quick pep talks. Plan activities in smoke-free places like the mall, movie theater and many restaurants.  Be understanding if you experience any irritability.

Though some people are successful on their own, many have a hard time and often make several attempts to quit for good.  Ask for help. There are many ways to get support, from one-on-one in person, to telephone call support, to mobile phone apps. Many counseling programs are free, and will even provide nicotine patches without charge.

Your doctor or other healthcare professional can help you take positive steps toward quitting smoking.  In addition, you may check with your local hospital to see if they offer a program; or call any of the national quit-smoking lines, such as the National Cancer Institute (NCI).  They offer support over the phone and can help with different ways of quitting. Here are their contact details, including toll-free number:

An online support forum can be a powerful tool to help you stay nicotine-free.   You can depend on it 24/7 if, say, a craving strikes at 2 a.m. In-person support groups are also valuable, as you can meet local people who are going through the same experiences. Even reading or hearing about others' quit-smoking experiences can motivate and help you stay on track.

 

Treatments available

Treatment with medications (nicotine replacement, varenicline, or bupropion) increases quit-rates, especially when combined with counseling. These medications may help with cravings, withdrawal symptoms, and other side effects of quitting smoking.  All of these treatments can be used even if a person has not completely stopped smoking. Varenicline and bupropion take some time to work, so they should be started a week to several weeks before the quit date, depending on the medication. Talk to your doctor about which treatment is suitable for you, especially if you suffer from depression.

If these various treatments don’t work, they may also be tried in combination.  In addition, there are other alternative treatments, like acupuncture and hypnosis, but success has been less clear with them.  Here are the various treatments you may try to use:

 

Nicotine replacement 

Using nicotine replacement doubles the quit-rate. It helps with withdrawal symptoms and cravings, and can be tapered off easily as withdrawal symptoms improve.  There are many forms available over-the-counter or with prescription: patches, gum, lozenges, nasal spray, and inhaler. The highest dose patch (21mg) should be used if the smoker smokes more than 10 cigarettes a day.  The patch delivers nicotine through the skin over 24 hours, but can also be removed at bedtime. The other short-acting forms of nicotine replacement can be used alone, or used with patches as needed for cravings or on a regular schedule at first (e.g. hourly while awake).

 

Varenicline (Chantix)

Varenicline works by binding to nicotine receptors in the body, partly turning them on to reduce withdrawal symptoms, but also blocking them from the nicotine in cigarettes and thus making smoking less pleasurable.  So far, varenicline has shown the highest quit-rate in studies.

 

Bupropion (Zyban, Wellbutrin SR)

Bupropion is felt to work by working on the brain’s hormones.  It has the added benefit of minimizing the initial weight gain with stopping smoking.  Treatment for longer duration may help prevent relapse in those who have quit. It cannot be used in those who have a history of seizure disorders.

 

Vaping

The use of e-cigarettes or vaping are not approved by the FDA as a quit-smoking aid.

However, supporters of vaping have promoted it as a way to help cigarette smokers to quit. Although giving up nicotine products altogether might be the ultimate goal, there may be health benefits to a smoker who becomes a long-term vaper instead, though this remains unproven; as well as health benefits of gradually reducing nicotine content of vaping liquids to zero-nicotine.

A new study compared vaping with other common nicotine replacement approaches as a way to help smokers quit. The findings support the idea that vaping may help some smokers.

Researchers recruited nearly 900 people who wanted to quit smoking, and randomly assigned half to receive e-cigarettes and the other half to receive other nicotine replacement products (such as nicotine patches and gum). All of the study participants received weekly individual counseling for four weeks. After one year, smoking cessation was confirmed by measures of exhaled carbon monoxide (which should be low if you’ve quit but high if you’re still smoking).

Here’s what they found:

  • Among those assigned to vaping, 18% had stopped smoking, while about 10% of those using nicotine replacement therapy had quit.
  • Among successful quitters, 80% of those in the e-cigarette group were still vaping; only 9% of those in the nicotine-replacement group were still using those products.
  • Reports of cough and phlegm production dropped more in the e-cigarette group.

So, while vaping was associated with nearly twice the rate of smoking cessation, more than 80% of smokers entering this study continued to smoke a year later. One other caution to note: the e-cigarettes used in this study contained much lower levels of nicotine than found in some common brands used in the US (such as Juul). The importance of this difference is unclear, but a higher nicotine level could contribute a higher rate of addiction to the e-cigarette.

 

References

  1. Harvard Health Publishing, What’s the best way to quit smoking? [website] 2016, https://www.health.harvard.edu/blog/whats-best-way-quit-smoking-201607089935, (accessed November 1, 2019).
  2. MEDICALNEWSTODAY, Five ways to quit smoking, [website] 2017, https://www.medicalnewstoday.com/articles/319460.php#1, (accessed November 1, 2019).
  3. WebMD, 13 Best Quit-Smoking Tips Ever, [website] 2017, https://www.webmd.com/smoking-cessation/ss/slideshow-13-best-quit-smoking-tips-ever, (accessed October 31, 2019).
  4. EVERYDAYHEALTH, How to Quit Smoking Cold Turkey, [website] 2014, https://www.everydayhealth.com/quit-smoking/guide/cold-turkey/, (accessed October 31, 2019).
  5. Verywellmind, How to Quit Smoking Cold Turkey, [website] 2019, https://www.verywellmind.com/i-quit-smoking-cold-turkey-this-is-how-i-did-it-2824494, (accessed October 31, 2019).

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