Quit While You’re Ahead

We are aware that addiction to nicotine is one of the most difficult addictions to overcome. Let’s say you’re a smoker and you’d like to quit or someone important to you is in that position. Consider the information included here.

It’s not unusual for smokers to make 3 or more attempts to quit before they are successful. A combination of counseling and pharmacologic approaches has the greatest chance of working. The latter includes both nicotine replacement therapy (patches, lozenges, gum, and nasal and oral inhalers) as well as pills like varenicline (Chantix) and bupropion (Zyban).

Talking about changing that habit is a good first step. Start the conversation! Then set a quit date – today might not be the day, but what about next week, or a special occasion. Think about what you can do INSTEAD of taking a cigarette when you get that urge – get up for a minute and walk around, chew on something, repeat a mantra – anything that can help you reach your goal. Make a plan to check in with someone in a week and then every other week or so as incentive to stick with your plan. This can be a friend, coworker, relative, a help line or … your doctor! Think of it as the equivalent of Weight Watchers for smokers.

Then consider the nicotine replacement therapies (NRT) and the medications that are available. They all have similar success rates, so choose something that seems like it would work best for you. Most of the NRTs are over the counter now, except for the inhaler, Nicotrol, which is available as a plastic cigarette or nasal spray. All the various forms provide nicotine to relieve the symptoms of nicotine withdrawal, while for the most part avoiding the tar and other cancer-causing components of cigarettes. The patches are long-acting and can be kept on for 24 hours or removed at bedtime. They provide a slow, steady release of nicotine, whereas the inhalers, gum and lozenges have a faster onset and are used to quiet the intermittent craving for nicotine. 

Any of these delivery systems can increase the quit rate by 1.5 – 2 times versus not using any NRT. They are sometimes combined for their different effects, but you should check with your doctor before trying that. Smoker preference determines which form should be used. If one doesn’t work, it is always worth trying another … and another. If you’re free of cigarettes at 6 months, remain diligent with checking in with your ‘coach’. With any of these methods, about 50% of the 20-30% of those who initially quit are likely to re-start by 1 year out. When former smokers tell me that they “can’t stand the smell of smoke”, I know we’re home free.

Some people may experience nausea or dizziness from NRTs, especially from the gum, lozenges or inhalers if they are consumed too quickly, or a rash from the patches, but they are certainly safer than cigarettes. There is not enough data, however, to recommend NRT in acute coronary syndromes, when people may be admitted to the hospital for chest pain, and need to stop smoking immediately because they’re confined in a smoke-free zone. Sometimes the scare of chest pain is enough to make a smoker quit ‘cold turkey’. Check with your physician regarding your personal situation.

Nicotine can also be delivered via e-cigarettes, previously reviewed on this site. The US Preventive Services Task Force put out a statement in September, 2015 that there is not “… enough information to recommend in favor of or against the use of Electronic Nicotine Delivery Devices…”  In brief, the concerns are that the propylene glycol or glycerol and the flavorings may be harmful when heated and inhaled. There are variable concentrations of nicotine as well as other chemicals found in the liquid that is vaporized. The FDA has the authority to regulate them, but to date the contents and sales are largely unregulated. Although there are ads that imply that they are effective for smoking cessation, and some people have successfully quit using them, more trials are needed to confirm their efficacy and safety.

The medications that are FDA approved to help with quitting are varenicline (Chantix) and bupropion (Zyban). Both carry a ‘black box warning’ because of the risk of suicidal ideation, but are effective in smoking cessation.

Varenicline binds to the nicotine receptors. This reduces the perceived rewards of smoking by blocking the nicotine effect, but at the same time reduces withdrawal symptoms by attaching to those receptors and causing a partial effect. When taken with food and a lot of water, it is generally well tolerated without nausea. The major side effects are changes in behavior or mood, as well as changes in dreams or vision, nausea and dizziness. Many physicians will avoid this if there is a history of depression.

Bupropion increases norepinephrine and dopamine release, and is used in other situations as an anti-depressant (Wellbutrin). As noted above, however, it may cause an increased risk of self-injury, so patients should be monitored closely. It cannot be used if there is a history of seizure or eating disorders. It may blunt the weight gain associated with smoking cessation – about 8 pounds over the year compared with 11 pounds.

Although cigarette use has declined over the years, 18% of the adult US population continues to smoke, including 1 in 6 pregnant women. It’s the leading preventable cause of disease, disability and death here in the US – not only related to lung diseases like bronchitis, emphysema and lung cancer, but also due to cancers of the head and neck, gastrointestinal tract and bladder. Smoking also contributes to heart attacks, strokes and other severe circulation problems.

If you or someone you love smokes, make it your gift to them or their gift to you to stop smoking this season. Encourage them to use recommended therapies to quit and then reward their efforts – it’s VERY difficult. And they may not be successful the first time. Keep trying! They will save money in the long run, improve their longterm health, and be very proud of their accomplishment. For tips on quitting, see www.cdc.gov/tips.

For more info on e-cigarettes:

http://betobaccofree.hhs.gov/about-tobacco/Electronic-Cigarettes/