I want to quit smoking, but my family may hate me
It’s probably safe to say that nobody smoking cigarettes today thinks they are improving their health. But knowing it’s bad for you doesn’t seem to make it easier to quit. That’s because nicotine affects our brains in a profound way.
Dr. Michael Fiore
“The way nicotine is delivered through the alveoli of the lungs, within 10 seconds of taking a puff off a cigarette, the psychoactive substance within tobacco smoke crosses the blood brain barrier and results in a unique combination of both stimulation and relaxation among other actions that are related to the endorphin release that nicotine triggers,” said Michael Fiore, Hilldale Professor of Medicine at the University of Wisconsin, and director of the University of Wisconsin Center for Tobacco Research and Intervention. “Most smokers, by the time they quit, have been taking puffs of smoke and delivering those substances for 10, 20, 30, 40, 50 or more years.”
The immediacy of that effect (an average of 10 times per cigarette) coupled with consistent long-term use makes it almost diabolically difficult to quit smoking. In addition to the physical addiction that underlies the rush smokers feel is the emotional dependence created by habitual use.
There are basically five ways to quit — cold turkey, behavioral therapy, nicotine replacement therapy, medications and combinations of these four. “I think it’s really important to acknowledge that one size definitely does not fit all for smoking and tobacco dependence and smoking cessation,” Fiore said. “People have extraordinarily varied responses to quitting.”
The DSM-IV lists the following as symptoms of going cold turkey: Abrupt cessation of nicotine use or reducing substantially the amount that a person smokes within 24 hours is often followed by irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, increased heart rate, increased appetite and often weight gain, dysphoria or depressed mood and insomnia. That’s the bad news.
The good news is
- not everyone experiences all those;
- there are medications that can blunt those effects;
- you don’t have to do it alone; and
- you will feel better and life will improve surprisingly quickly.
“The goal is to quit and I’m not a purist about what method a person uses,” Fiore said. “However, I tell my patients that the evidence indicates that combining counseling and medicine substantially boosts the likelihood of success.”
According to Fiore, there are seven types of medication that have been approved by the FDA but two are better than the others in terms of their quit rates. One, called nicotine replacement therapy (NRT), combines the nicotine patch with the nicotine mini-lozenge. “This gives the person some round the- clock nicotine, and then they have the lozenges to turn to when they’re having the urge,” he said. The other effective option is Varenicline (Chantix®), a prescription medicine.
In addition to the physiological dependence NRT and Chantix help to neutralize, there’s the psychological dependence or habit side of the addiction to smoking: Perhaps it is a cigarette after a meal or lighting up on the way to work or with a cup of coffee or a glass of wine. “Often this behavior has become so ritualized, people don’t even realize that they’ve lit a cigarette because they’ve done it time after time over the years,” Fiore said.
To neutralize habits, he suggests changing the routine: If you have a cigarette with coffee, switch to tea. If you smoke on the way to work, go a different way, so you’re not prompted to light up at the first traffic light or the left turn near your office. “Changing your routines helps to break habits,” Fiore said. “That’s why some people choose to quit when they’re on a trip or on a weekend versus on the weekday. You’ve got to be really planful about your quit episode.” Another place counseling could be helpful.
As for not doing it alone, in addition to finding a local counselor, there are other resources. Fiore points to two — 1-800-QUITNOW and smokefree.gov.
“Anyone anywhere in America can call a toll-free number, and no matter what state they live in, they get access to telephone quit-line counseling services,” Fiore said. “Each state varies in terms of the counseling they provide, but every state has to give at least some counseling, and some even send a couple of weeks of free nicotine medicine to the caller.”
The government website has plenty of helpful information and resources. There are programs for women and pregnant women, adolescents, veterans and the elderly. There are phone apps and an app for building your quit plan as well as access to experts. There are web-based programs and text-based programs.
“I tell all my patients that after you get over the acute withdrawal, you’re going to feel better,” Fiore said. “We know, for example, that there is less depression among people who successfully quit than those who continue to smoke. There’s decreased risk of suicide for people who quit. Anxiety improves after you’ve overcome the withdrawal syndrome, and finally, we know that your social network improves and increases. We tell people you can mitigate your emotional and other withdrawal symptoms with medication and counseling, and once you get over that, on average — and it’s not guaranteed for everybody — but on average, you’re going to feel better.”
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