Within just 7-10 seconds of inhaling
cigarette smoke, nicotine begins affecting your brain. Nicotine acts
on cells in the reward center of the brain. This results
in feelings of pleasure and alertness- the "hit" that your body
comes to expect. When bloodstream nicotine levels are at their peak,
the brain is highly stimulated. However, within just 30 minutes, your
body has cleaned out most of the nicotine. You then feel tired, jittery,
depressed, or fatigued. You begin to crave another cigarette, and the
cycle continues. This cycle, which increases in intensity and frequency
over time, is part of what makes cigarettes so addictive. Essentially,
smoking becomes a never-ending battle of trying to stay within the comfort
Addiction or Habit
Ever wonder how cigarettes got to
be such an important part of your life? Heres one explanation:
Ivan Pavlov was a Russian physiologist who studied behavior change
in the early 1900s. He observed that dogs normally salivate when they
are given food. In his experiments, he rang a bell just before he fed
his dogs. As a consequence, the dogs began to associate the bell with
the presentation of food. Over time, they would salivate if he simply
rang the bell without putting out any food. They had learned Hey
when the bell rings, it means Im going to be fed.
The same thing can happen with smoking. After smoking many, many cigarettes,
various things become paired with cigarettes and can bring on
the urge to smoke. For example, if you smoke every time you drive in
your car, simply getting into the car can trigger powerful cravings.
Its like your brain says, Hey, Im in the car now, looks
like Im getting nicotine soon! Likewise, if you smoke each
morning when you first get up, this time of day can lead to powerful cravings
for cigarettes, even long after youve quit smoking. For most people,
breaking these connections is one of the most important steps in quitting.
Want a few other explanations for
your habit? B.F. Skinner did a series of animal experiments to study
how habits are formed. Although it doesnt seem like rocket science
these days, Skinner found that when behavior is reinforced or rewarded, it
is more likely to be repeated; similarly, if a behavior is punished, it is
less likely to be repeated. This makes it easy to see why smoking is
tough to stop: there are many powerful reinforcers involved in
smoking. The kick of nicotine is probably the strongest
reinforcer, but social acceptance from other smokers and the perception that
smoking is relaxing are other reinforcers to consider as well. Likewise,
many people who try to quit are punished by withdrawal symptoms
and give up their efforts to quit.
the Smoking Equation:
People have varying difficulties
with either the physical or psychological aspects of quitting smoking.
Maybe you smoked to experience the hit of nicotine or to avoid
strong withdrawal symptoms. If so, physical addiction will underlie
many of your triggers. Or
perhaps being in certain places or experiencing
certain emotions often made you want to smoke; thus, psychological or behavioral
elements will be behind your triggers. Most likely, though, youll
find both areas are involved in your smoking patterns to some degree.
It is important to think about why you smoke each time you have a cigarette.
QuitNet members use the Why do You smoke tool to figure this out.
This will help you identify your triggers. Once you have identified
your reasons for smoking and your triggers, you can go about breaking them
one by one. Nicotine replacement medicines can be an important part
of this process.
The two keys to quit-success are:
Commitment- you make up your mind to quit and are willing to go to any lengths
to do so; and: Preparation- you take the time to develop a quit-plan that
works for you, and to prepare for nonsmoking life. What we know from
over 30 years of research is that different combinations of quit-tools work
for different people. The people who succeed are likely to use many tools
together, not just one thing.
A panel of physicians and researchers appointed by the Surgeon General
of the United States reviewed more than 6000 studies of quitting and issued
a set of guidelines in June 2000.
They made some powerful conclusions and recommendations.
They said "Use medicine:"
Research has shown that Zyban
and nicotine replacement therapy helped people succeed more than trying without
medication. Nicotine replacement therapy comes in a number of forms: gum,
a skin patch, inhaler or nasal spray.
They said "Get counseling and
Counseling and behavioral approaches
are especially effective and should be used by all people trying to quit smoking.
The experts said: Dont quit alone. Get expert counseling and social support.
In fact, they found a strong dose effect; that means the more
support people had the more likely they were to succeed. We have found the
same thing on QuitNet. Members who used its support and counseling more frequently
were more likely to report success in quitting than those who used it less.
Research has also shown that people who took medications and also participated
in a support program were more likely to succeed than people who just took
medicine. Specific behavioral approaches that help people quit include problem
solving and skills training, and using social support.
& Behavioral Interventions:
Well review different kinds
of medicine and behavioral interventions first since they are the most effective
treatments available. For people who are interested in other types of
quit smoking methods, well review these as well.
Nicotine replacement therapy is
an effective way to wean yourself off nicotine. Although
not the magic pill that it was thought to be when first introduced,
nicotine replacement therapy (NRT) has been shown to be very effective and
is now recommended for all smokers attempting to quit (when medically appropriate).
On average, all nicotine replacement products are equally effective,
roughly doubling the chances of quitting successfully.
The basic idea is to give you time to break the cigarette habit before attempting
to actually get off nicotine. NRT minimizes withdrawal symptoms and
helps control cigarette cravings to allow you to concentrate on using behavioral
techniques to stay smoke-free. There are 4 different types of nicotine
replacement therapies: the nicotine patch and nicotine gum are available over
the counter without a prescription, while the nicotine spray and nicotine
inhaler require a prescription from your physician.
What NRT does not do:
· It doesn't work equally well for
· It doesn't eliminate withdrawal
· It doesn't give you any more willpower.
What NRT does do:
· It does let you concentrate on
your habit before breaking the physical addiction to nicotine.
Zyban is a prescription medication
that was originally used to treat depression. The idea to use it for
smoking came from physicians who saw that their patients being treated for
depression spontaneously quit smoking. Numerous trials have shown Zyban
to be at least, if not more, effective than the nicotine patch. Zyban
is thought to work by blocking nicotine withdrawal, making smoking less reinforcing
by stimulating certain centers of the brain, and improving mood. Use
of Zyban should begin 2 weeks before quitting smoking to allow blood levels
to reach a therapeutic level. Side effects can include tremor, rash,
headache, insomnia and dry mouth.
Counseling Individual or
Group, Telephone or Internet:
Many smokers find it helpful to have the support of other smokers who are
trying to quit. Properly run group, telephone and internet programs
help you understand your smoking habits, develop new coping strategies, and
set a target quit date; theyre also a good way to learn tips and strategies
that other smokers find helpful. Most good group programs meet for a
few weeks after the quit date so members can get support before, during, and
after quitting. One-year quit rates for group programs usually range
from 25% - 40%. The cost of these programs varies, and can range from
$15 to several hundred dollars. Remember
more expensive programs
are not always more successful.
There is a strong association between the duration of treatment and also the
length of each session. The more intensive and longer the program, the
more likely you are to succeed. When choosing a counseling program,
look for one that has sessions that are at least 20 to 30 minutes long; offer
at least 4 to 7 sessions; and last for at least 2 weeks. The group leader
should be specifically trained in smoking cessation. The QuitNet National
Directory can give you information about programs in your community.
Good telephone programs usually make between three and five followup calls
to provide support during the months after a quit date.
QuitNet members participate in the online program an average of 13 times,
for about 20 minutes each visit, during the first three months of their
quit; they return frequently after that to help others, celebrate their success
or reinforce their quit.
Rate fading and brand
fading are two strategies of gradually reducing the amount of nicotine
in your system before you quit. They are different than the approach
of cutting back since the ultimate goal is quitting, not continued smoking
at a lower level. Smoking fewer cigarettes and smoking low nicotine
cigarettes are still hazardous to your health.
Many people use these strategies to prepare for quitting using medicines like
the nicotine patch or nicotine gum. There are a number of benefits of
these strategies: they may make withdrawal symptoms less intense after quitting,
and they provide mini practice opportunities for coping with mild withdrawal
symptoms and for giving up cigarettes which may help later on. The downside
to these strategies is that people often go too slow or too fast: reducing
nicotine intake by more than 30% at any time may lead to intense withdrawal
symptoms and relapse, whereas reducing nicotine too slowly may result in a
loss of motivation and relapse. If you decide to try nicotine fading,
follow the instructions below carefully and use the NICOTINE FADING CHART
to help you track your progress.
Some people swear by this approach.
Its a no-nonsense, low-cost approach
the Just Do It
method for quitting smoking. About 85% of smokers who try to quit do
it cold turkey; however, this strategy has been shown to be far
less effective than active approaches like nicotine replacement therapy and
behavioral counseling. The problem is that, for most people who quit
cold turkey, nothing changes except the smoking. Daily routines are
still the same, methods of coping with stress and frustration are still the
same, and the bodys dependence on nicotine is still the same.
With all these powerful triggers to deal with throughout the day, its
no surprise why many people relapse within just 3 days after trying to quit
Many smokers believe that just cutting
back on the number of cigarettes is enough to avoid the dangerous health problems
associated with smoking. It just doesn't work that way. There
is NO safe level of smoking. Over time, most people go back to smoking
their regular amount anyway. Cutting back is not an effective or recommended
approach to quitting smoking.
Even though alternative therapies like acupuncture, hypnosis, and herbal remedies
are more readily available and have gained some recent popularity, their effectiveness
is still unproven in clinical studies. The Surgeon Generals Guidelines
of June 2001 did not recommend any of the following approaches as effective
ways to quit smoking. Any effect that these therapies produce is most
likely due to positive expectations
in other words, belief in the value
of the treatment. We review them here for informational purposes only
and do not recommend any of these:
Acupuncture is based on ancient
Chinese medicine. Nerve endings located near the surface of the skin
are thought to be connected to certain organs and body functions. For
example, specific spots on the ears, nose, and wrists are thought to be related
to the urge to smoke. The few studies that have been done on acupuncture
have found few differences between active acupuncture and sham
Hypnosis tries to change your
attitudes about smoking to help you quit. While hypnotized, youre
given certain suggestions that might include: reminders to relax when you
are having a craving and to feel good when you successfully resist the urge
to smoke, or, unconscious commands to be acutely aware of the
stench of tobacco smoke, its harsh taste, etc. In general, research
studies have shown that while hypnosis may be credited anecdotally with
helping in the early stages of the quitting process, its not an effective
Tobacco-free cigarettes contain
a mixture of various herbs like jasmine, ginseng, and clover. Although
they may seem like the best of both worlds (smoking without
the dangers), these products still contain damaging tar and carbon dioxide
just like regular cigarettes, as well as many chemical compounds released
by the burning process.
In the past few years, herbal medications such as Kava Kava, a natural anti-anxiety
medication, and St. Johns Wort, an anti-depressant, have been used
by ex-smokers. Often touted as natural substitutes for other synthetic quit-tools
like Zyban, clinical research hasnt demonstrated the same degree of
effectiveness for these medicines. However; some ex-smokers swear by them.
all medications, natural or synthetic, have side-effects
and potential risks, so be informed and aware before you use them. If you're unsure about any medication, check with your physician.
Preparing For Quit
Getting prepared for your Quit Day
is as important as the day itself. The more prepared you are to quit,
the more likely it is that you will quit successfully and comfortably.
All too often, people make the mistake of jumping into quitting, thinking
that they have to sink or swim. It doesnt need to be like that,
and shouldnt be if you really want to quit successfully. With
a little preparation, you can make giving up cigarettes a lot less difficult.
Each of these strategies is designed to help you unlearn your smoking habit
and quit safely.
to Your Doctor
Smoking may impact the way your
body processes certain medications. Nicotine and the other chemicals in cigarettes
speed up the metabolism of many drugs. This means when you are smoking,
these medications are eliminated from your body more quickly than if you were
not smoking. Once you quit, your current dose of medicine may become
too strong. If you are currently taking any medications, especially
for psychological problems, consult your doctor before you quit smoking.
You should not change how you take your medications until you talk to your
Getting positive support from friends
and family is one of the most important things you can do to improve your
chances for success. Unfortunately, many smokers pride themselves on
being independent and strong-willed and try to quit smoking by toughing it
out alone. People who actively arrange a support system for their quitting
efforts are more likely to succeed, and they succeed with greater comfort.
. For example, QuitNet buddies exchange thousands of e-mail support messages
every day and Q members help each other in the forums 24X7. Ask for
the support of several family members and friends. Ideally, you should
have a support person at home, at work, and in social situations. Tell
each of these people about your plan to quit and ask for their support.
Its a good idea to tell them specifically how they can be helpful to
you; some people may think that nagging and checking up on you
is helpful, for example, when in fact this may cause you more stress.
This is a two step process, sort
of like fighting a battle. First you have to know who your enemy is;
then you have to plan an effective attack strategy. By keeping a record
of when you smoke, you can start to identify triggers. Once you know
what your triggers are, you can figure out how to manage triggers without
Quitting smoking is a big change
in your life. Don't downplay it -- in fact, you should have a clear
line between your life as a smoker and your new life as a non smoker. Anything
you can do to help draw this line will not only make quitting easier, but
will also make it more likely that you stay smoke free. Think of it
as a clean start!
- Throw away all your cigarettes.
Look through every possible place you might have cigarettes: jacket pockets,
the bottom of your purse, the glove compartment, your nightstand, etc.
- Throw away your ashtrays, give
them away, or at least wash them and hide them away somewhere.
- Get a hair cut.
- Clean house. The car,
your clothes, even the furniture. You may not be able to smell the smoke
right now, but you will after you quit.
- Drink lots of water -- it will
help flush the nicotine from your system and reduce the intensity of withdrawal
- Reduce your caffeine intake
by at least half. Cut back some or start mixing in decaf well before you
quit. Nicotine makes caffeine metabolize much more quickly in the
body. If you consume the same amount of caffeine when you stop smoking,
it can lead to caffeine toxicity
nervousness, anxiety, restlessness.
All powerful triggers for smoking again.
- Get some exercise. Not
only will it make controlling your weight easier, but it will also give
you more energy and keep your mind off smoking. Walking, running,
even bowling are all very helpful.
- Visit QuitNet and find a buddy
who has a quit date near yours.