Everybody knows that smoking is bad in all kinds of ways, but most smokers have found that it is extremely hard to stop! That’s because one’s body becomes both habituated and usually addicted to smoking and the nicotine it delivers. And smoking has become financially very expensive as well. In this article, I want to offer suggestions, based on decades of trying to help 100s if not 1000s of smokers, about what strategies seem to help people kick the habit.
At the risk of overkill, let me review quickly the damage smoking does. Most importantly it increases bronchitis and emphysema usually by age 50+ that then kills people by suffocating them over the next 10-15 years, unless they die from smoking-related lung/throat/gullet/bladder cancers, or heart disease, sooner. It markedly increases those diseases as well as asthma in adults and children living in the same house. Smokers die about 10+ years sooner than those who do not. Does smoking help anything? The answer is not much. It does keep smokers’ weights down about 5-10 lbs; a few patients with rare conditions like Crohn’s disease of the bowel get some disease suppression, and it transiently relaxes those who are habituated/addicted.
First some general principles on quitting: if possible, undertake quitting with others, friends or in a class; formal and informal social pressure helps (Maine Tobacco Helpline 800-207-1230, (link); and, Guide). Avoid situations that you habitually associate with smoking, like bars, a cup of coffee in your old smoking haunts, or old smoking companions not interested in quitting. Set a quit date and perhaps taper to it; quitting suddenly works for many, tapering for fewer; and stopping in the middle of a respiratory illness like a cold is often easier. Don’t be discouraged by relapses; most people who stop go back to smoking several/many times before succeeding.
Second, use some aids:
Hypnosis helps some people.
Medications (with a clinician’s prescription) help many succeed; there are 3 classes used and most health insurance, if you have it, cover some of the cost. Even though the last Maine legislature cut coverage for these prescriptions for MaineCare patients, I expect and hope that decision will be reversed soon next year.
•First and oldest, hence usually least expensive, are the various forms of low dose nicotine. The nicotine patch (Nicoderm, Habitrol, Prosten), changed every 24 hr and using 21 mg patches the first 2-3 wk, then 14 mg patches for another 2-3 wk, then 7 mg ones for a similar or longer period of time helps achieve cessation in about 25% at one year and costs about $100/month. The 2 or 4 mg gum pieces (Nicorette, and other brands I’m sure now) chewed up to 20 pieces a day, costs about the same and achieves similar cessation rates. Nicotrol inhalers and nasal sprays cost more but do as well as the gums and patches.
•Bupropion (as Zyban and generic, the long-acting forms) works when taken as 150 mg daily for the week before cessation then increased to twice a day when one stops and used for at least 2 months. Costs are in the same $100+/month range and success rates, when used alone, are also 25% at one year; but can be as high as 36% when used in combination with nicotine medications as described above.
•Varenicline (as Chantix, no generic) taken ½-1mg by mouth twice a day, started a week before quitting and for at least 3 months afterward, reportedly results in 43% stop rates at one year, but costs $250/month and can cause agitation and even suicide rarely.
Finally, work, play and eat, if you can, in places where newer state no-smoking laws prohibit it, including in outdoor eating and other public places
So it’s not easy and, most importantly, don’t be discouraged if you don’t succeed the first time. Most people don’t. The majority succeed over several years. So don’t give up; keep trying! It is the single most important thing you can do for your own and your family’s health.
Dan Onion, MD
Vienna Health Officer