Quit smoking: Your New Year's resolution

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By Joan M. Daughton and David Daughton

Smoking cessation is a popular topic this time of year. It is incredibly important to have all of the facts, as well as significant support, when you decide to quit. You must know that you are not alone.

Approximately 20 percent of adult Americans smoke cigarettes, 78 percent of them smoking daily. Of people who smoke daily, 40 percent have tried to quit in the last year, and of smokers age 18–24, 50 percent have tried to quit.

Our understanding of the nature of cigarette addiction has increased dramatically in the past few decades, and this has enhanced the number of effective interventions to assist in successful smoking cessation.

Each smoker has to find the strategy or combination of approaches that works best for him or her when developing their treatment program. Adequate preparation is critical and includes identifying your need to quit and what benefits smoking cessation will provide for you.

You should then devise a plan of attack, including a few things every smoker must do. The first is to set a quit date. This date should be the day you decide to completely quit smoking.

Quitting “cold turkey” is more successful than gradually reducing the number of cigarettes you smoke each day or choosing a brand of cigarettes that is lower in tar and/or nicotine.

Review what strategies have worked for you in the past when you have tried to quit. Examine what contributed to your relapse so you can prepare and have a counterattack for those challenges. You should tell family, friends and/or co-workers about your plan to quit and ask for their support.

Learn about the symptoms of withdrawal, which can be physical as well as emotional, and may include anxiety, frustration, restlessness, difficulty concentrating, depression and insomnia. These symptoms are almost always accompanied by an intense craving to smoke. Tell yourself that these symptoms reduce significantly after the first three days of total abstinence and gradually diminish within a few weeks.

Lastly, talk to a health care provider about your desire to quit smoking. At least 70 percent of smokers see a physician each year and report a desire to quit. Of smokers who try to quit on their own, 80 percent relapse within one month.

A health care provider can help tailor the ideal strategies for you and then follow up with you after your quit date to discuss your success and any difficulties you may be experiencing.

Three key aspects of your treatment program need to be considered: the support you receive during the time you are quitting, problem solving/skills training and medications.

Most success stories involve changing behavior and taking medications in order to quit smoking. Support can come from any number of sources, including health care providers, family, friends, telephone hotlines and support groups.

You will need encouragement as well as reassurance for all of the things you will experience. Most of all, you will need continued motivation, and your support network can remind you of the reasons you wanted to quit and why it is important to stay focused.

Some of these reasons may include saving money, gaining control of your life, improving the health of your children and other household members, and preventing or reducing symptoms of serious illnesses in yourself.

Group counseling can be helpful and often includes informational meetings, setting a quit date, improving coping skills and helping to prevent relapse. There can be costs associated with group counseling, although some centers offer this for free. Group support programs, when used alone, are associated with one-year quit rates of roughly 20 percent.

Furthermore, arming yourself with as much information as possible will help you know what to expect before and after your quit date. Telephone quit lines work. If you are serious about quitting, strongly consider using the Nebraska Tobacco quit line, 1-800-QUIT-NOW, as part of your total treatment program.

Many pamphlets, videos and Web sites exist to supply support and information. Examples include http://www.quitnow.ne.gov, http://www.lungusa.org, http://www.cancer.gov/cancertopics/tobacco, http://www.quitnet.com, http://www.ahrq.gov/consumer/index.html#smoking, http://www.naquitline.org, and http://www.becomeanex.org.

Behavioral changes are often the most difficult part of quitting. One proven approach is utilizing problem-solving/skills-training techniques to prevent relapse and improve understanding.

Once you have identified situations in which you could relapse and smoke, you must develop coping strategies for these situations. For example, some common triggers for smoking include having others smoking around you, stress and drinking alcohol. For some smokers, it is helpful to identify stress-reducing activities to be used in these situations, such as exercise or relaxation techniques.

To minimize being around others who smoke, you may need to have an alternate activity during breaks at work, such as calling a friend, listening to music or going for a walk. Also, you may need to request that other smokers in your household refrain from smoking in the house or car.

You may even be able to influence friends or family to help them quit smoking just because you are able to quit. A study in the New England Journal of Medicine in May 2008 showed that when your spouse quits smoking, you are 67 percent less likely to smoke. As a friend, you decrease your friend’s chance of smoking by 36 percent when you quit.

Using support and coping skills in conjunction with medication will likely provide the highest success rate. Various approaches are available to replace the nicotine provided in the cigarettes, which causes the addiction.

Nicotine gum can be used for three to six months after the quit date and can significantly reduce withdrawal symptoms. Nicotine lozenges work similarly to the gum and, since they do not require chewing, may be easier for some smokers to use. Nicotine patches come in several doses, depending on the amount of cigarettes you were smoking each day. Patches should be used for four to six weeks.

The above nicotine replacement strategies, when used in combination with support and coping skills strategies, can double your chances of quitting. A nasal spray also exists, which provides a more rapid rise of nicotine in your blood, but nasal irritation is very common and the spray can prolong nicotine addiction more than other forms of nicotine replacement.

A nicotine inhaler is the last option for nicotine replacement but is less likely to reduce cravings due to the slow absorption of nicotine. Furthermore, inhalers can cause irritation of the mouth, can be very costly, and have limited use in people with asthma or chronic cough, as those symptoms can be exacerbated by the inhaler.

One common approach to nicotine replacement is using a combination of two of the options listed above. For example, a nicotine patch can be worn to provide a consistent, low level of nicotine, while the nicotine gum can be used as needed for cravings.

If you choose to use the oral forms of nicotine replacement (gum, lozenge or inhaler), be aware that acidic beverages can change the pH of the mouth and reduce nicotine absorption. Thus, do not drink coffee or carbonated beverages prior to using these products.

Two prescription medications are also available. They are varenicline (Chantix) and bupropion (Zyban or Wellbutrin). Varenicline has been shown to be more effective than bupropion in helping smokers quit.

You should start taking varenicline one week before your quit date and continue it for 12 weeks. If you have successfully quit at 12 weeks, you may continue taking it for another 12 weeks. But if you have not successfully quit, you should revisit your health care provider to talk about options for further treatment.

Varenicline should be taken with a full glass of water. Common side effects include nausea and abnormal dreams. A very small portion of people who take varenicline may develop agitation, depression or thoughts of suicide. If this occurs, you should stop the medicine and contact your health care provider immediately.

Bupropion is an antidepressant medication that should be started approximately one to three weeks prior to your quit date and can be continued for up to 12 weeks. Common side effects include dry mouth and difficulty sleeping. You should not take bupropion if you have a seizure disorder, anorexia nervosa, bulimia, head trauma or excessive alcohol use. A very small portion of people who take bupropion may develop agitation, depression or thoughts of suicide. If this occurs, you should stop the medicine and contact your health care provider immediately.

Both medications can be used in conjunction with a nicotine replacement strategy to improve your chances of quitting.

You are probably well aware of the risks of continuing to smoke. You have double the risk of developing coronary heart disease. However, if you successfully quit smoking, one year later your risk of dying from coronary heart disease is reduced by one-half and will continue to decline.

You are at increased risk for long-term lung diseases, such as chronic obstructive pulmonary disease (COPD). While some of this damage may not be reversible, the symptoms of this disease, such as excessive sputum and chronic cough, may be reduced after quitting.

Asthma also can be more successfully treated in nonsmokers. Ninety percent of cases of lung cancer are caused by smoking.

Within five years of stopping, your risks are reduced, although still higher than those who have never smoked. Stopping smoking can reduce the risk of other cancers as well, including bladder, pancreas, esophagus, and

head and neck cancers.

Lastly, stopping smoking can reduce your risk of peptic ulcer disease, osteoporosis, premature skin wrinkling and impotence.

Nicotine dependence is a chronic condition and may require repeated interventions. Successful treatment programs to stop smoking entail adequate preparation, an effective combination of interventions and relapse prevention.

Your success relies on your motivation to quit and the steps you take to do so. Utilize every resource that seems helpful to you and celebrate every successful step you take.

 

Comments

Submitted by Singorama (not verified) on

You make it sound so easy, I would love to quit smoking, I mean I really really would, I wish I'd never started in the first place but it's not easy at all.

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