Quitting for Good: Find What Works for You
For: Wellness Fact, October 2002
If you smoke, or if somebody you care about smokes, you
may already know from personal experience or observation how hard it is
to quit. The majority of smokers want to quit, and it's thought that
half of all smokers try to quit each year. Alas, only a small number succeed
in quitting.
Quitting smoking successfully takes some orchestration.
Your determination to quit is the most important element in eventual success,
and while that's the foundation of your effort, you may need outside
help. Supportive friends and family can be a plus. Encouragement and advice
from your doctor and your pharmacist can be key. Support groups may be
the right thing for you. Planning activities that distract you from your
desire to smoke is an excellent idea. Some people add up the money they'll
save over six months and promise themselves a special treat. Others quit
for the benefit of their children or grandchildren—or because they
feel like outcasts. Some people swear by acupuncture, others eat jelly
beans. Most successful quitters quit abruptly, but some succeed by gradually
reducing nicotine.
Health professionals now believe that smokers must choose
their own route. In recent years pharmaceutical aids—in the form
of nicotine replacement devices, as well as antidepressant drugs—have
come on the market. One or more of them may be well worth considering,
particularly if you've tried the cold-turkey method without success.
Devices that deliver
Nicotine replacement devices, which put nicotine (the addictive
drug in cigarette smoke) in your blood, can buffer withdrawal symptoms.
If you have heart disease, particularly angina or arrhythmias, talk to
your doctor before trying nicotine replacement. Nicotine gums and patches
pose some risk, though not as much as continuing to smoke.
Here's what's available:
• Nicotine
gum, sold over the counter, is convenient and supplies nicotine
faster than a patch. There are two formulations: 4 milligrams (for very
dependent smokers) and 2 milligrams (for average smokers). Most people
chew 10 to 15 pieces a day and settle at half that amount after the first
couple of weeks. You can't eat or drink within 15 minutes after chewing
the gum, because that reduces its effectiveness. You chew the gum slowly
until you experience a peppery taste, then park it between your gums and
cheek, continuing the process for about half an hour. Ten pieces (about
one day's supply) of the stronger version costs about $7, and the
2-milligram formulation about 50 cents less.
Drawbacks: You may not like to be seen chewing gum.
It may cause indigestion. And it's hard for some people to give up
the gum. You should wean yourself off it after you've quit smoking,
but chewing the gum long term is less harmful than cigarettes.
• The
nicotine patch, sold over the counter, can take two to four hours
to deliver nicotine. But it's less obtrusive than gum, and provides
a steady blood level of nicotine. It's also less likely to result
in addiction. If you weigh under 110 pounds or smoke fewer than 10 cigarettes
daily, you should use a lower-dose patch. After a couple of months, most
people are able to switch to lower doses and finally taper off. The patch
can be combined with other forms of nicotine replacement—for example,
with an inhaler. This may be recommended if you've failed to quit
with other methods, but talk to your doctor before combining nicotine
products. The patch costs about $4 a day.
Drawbacks: Possible skin irritation. You shouldn't
smoke while using the patch, since that can cause a heart attack.
• The
inhaler, by prescription only, looks like a cigarette (it has a
mouthpiece and a porous plug containing a nicotine cartridge) and may
help people who miss the act of smoking as much as the nicotine. You may
need from 6 to 16 cartridges a day, for up to six months. You are supposed
to taper off during the last three months. As with gum, you must not eat
or drink within 15 minutes after using the inhaler. It is expensive—about
$11 for 10 cartridges.
Drawback: Possible throat and mouth irritation, coughing.
• The
nasal spray, by prescription only, is the fastest nicotine-delivery
system. You use about two doses an hour for the first eight weeks, then
reduce the dose and daily frequency for the next four to six weeks. Cost:
$5.40 for 12 doses. Like the inhaler, this can be costly.
Drawbacks: Possible nose and throat irritation, sneezing,
coughing, and watery eyes—but most people develop a tolerance. Also,
some people find it embarrassing to use the spray in public.
Drugs that may kick in
Certain prescription antidepressant medications can help
some smokers quit, particularly when combined with some type of nicotine
replacement. The only drug approved by the FDA for this use is Zyban,
the quit-smoking version of the antidepressant Wellbutrin (generic name:
bupropion hydrochloride). Zyban alters brain chemistry to reduce cravings
and depression. Combined with nicotine replacement, it has the highest
quit rate in studies—and the combination is more effective than either
method alone. It's not a magic bullet, but it can help.
If you decide you want to try Zyban, talk with your doctor.
This is important if you also plan to use the patch, since the combination
can raise your blood pressure. You'll need to plan a quit date, then
begin taking the drug one or two weeks beforehand, continuing for 7 to
12 weeks. If you have a history of eating disorders, are a heavy drinker,
or are taking other antidepressants, you should not take Zyban. It poses
a slight risk of seizures. Pregnant and nursing women should avoid it.
Cost: about $3.50 a day. Medical insurance often does not pay for it.
Drawbacks: Possible dry mouth and insomnia. You'll
need to have your blood pressure checked periodically. While Zyban is
the best drug treatment, it doesn't work for everyone. In case it
doesn't work for you, your doctor may want you to try an older antidepressant,
Pamelor. It's less expensive, but has not been approved by the FDA
as a quit-smoking aid. Clonodine, used to treat high blood pressure, may
also work as a quit-smoking aid, but also is not approved for this purpose.
Your doctor must closely monitor you if you take this drug because its
side effects can be significant.
Bottom line: If you can quit
cold-turkey, that's the safest way. But if you can't, try the
methods above. Remember, it's not too late to kick the habit at any
age.
UC Berkeley Wellness Letter, February 2001
