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Smoking cessation: New ways to quit

By now, even the tobacco companies agree: smoking is bad for your health — very bad, in fact. And secondhand smoke is an important cause of death and disability in people who never light up.

We are making progress. Over 45 million Americans have quit, and many communities prohibit smoking in public places. But more than 20% of adults still smoke, and the habit remains more prevalent in men than women. Tragically, thousands of teenagers take up smoking every day.

We can do better. Fortunately, there are more ways to kick the habit than ever before.

How to quit

There are four basic strategies for quitting. Look them over and decide which is best for you. Most smokers start by trying to quit on their own, but many end up needing several methods and several attempts before they kick the habit.

Kicking the habit: Do it yourself

Don’t kid yourself by trying to cut down; nearly everyone who tries slides back up to their usual dose of nicotine. Cold turkey is the way to go, but it takes preparation. And even without professional help, cooperation from family and friends can be important. Here are some tips:

  • Make a list of reasons to quit and another list of people who have kicked the habit. The first list will remind you why quitting is important, and the second will show you that folks who are no stronger or smarter than you have succeeded. Keep your lists handy and refer to them whenever you begin to waver.
  • Pick a quitting date and stick to it. Plan to quit on a special day, such as a birthday or the American Cancer Society’s Great American Smokeout event on the third Thursday of each November. Steer clear of stressful periods, and avoid holidays if you are likely to be invited to smoke-filled parties.
  • As your quit date approaches, throw out your ashtrays, clean your house, car, and clothes, and clean your teeth. Once you’re away from it, you’ll see that smoking stinks.
  • Anticipate withdrawal symptoms such as grumpiness, restlessness, irritability, hunger, headache, anxiety, and drowsiness or insomnia. The discomfort usually peaks one to three weeks after you quit, and then it gradually diminishes. To get through the rough patches, stock up on low-calorie snacks and sugarless gum or candy to keep your mouth busy. Plan enjoyable diversions to keep your mind busy. Think of ways to keep your hands busy.
  • Stay away from secondhand smoke. Don’t even think about smoking “just one” — even a single puff will set you back.
  • Reward yourself. Put your tobacco money aside in a kitty, and then spend it on a special treat.

Kicking the habit: Behavioral support

Quitting is your responsibility; it may be hard, but it doesn’t have to be lonely. Many employers, health plans, and hospitals offer individual or group counseling. Your doctor or your local chapter of the American Lung Association or American Cancer Society can refer you to a program in your area. Telephone support can also help; you can try it for yourself by calling the National Smoking Cessation Hotline at 800-QUIT-NOW. Hypnosis is another alternative that has helped some smokers break free.

Kicking the habit: Nicotine-replacement therapy

Nicotine replacement is safe. You’ll get less nicotine than from cigarettes, and you won’t get any of the tar, carbon monoxide, and other damaging substances in tobacco. Plan to start nicotine-replacement therapy on the day you quit smoking. If you are a heavy smoker, you’ll need higher doses. Estimate how much nicotine you need based on an average of 1 to 2 milligrams (mg) of nicotine per cigarette. Start with the full dose, then gradually taper down over several months. Under-dosing is more common than overdosing, but you should not smoke while using nicotine-replacement therapy.

Here is a quick view of the options for nicotine-replacement therapy:

  • Nicotine patches are available over the counter.. Place a new patch on clean, unbroken, hairless skin each day; you can leave it in place all day. You can reduce the dose every one to two months as your nicotine addiction resolves. Mild skin irritation is the most common side effect.
  • Nicotine gum (Nicorette) is available over the counter. Chew a piece of the gum whenever the smoking urge surges, up to 30 pieces a day. Aim to wean off the gum in about three months if possible. Some people find the taste unpleasant, and some develop hiccups or indigestion.
  • Nicotine lozenges (Commit) are available without prescription. A typical schedule calls for one lozenge every one to two hours for six weeks, then every two to four hours for two weeks, and then every four to eight hours for the final two weeks. Side effects may include an unpleasant taste, nausea, indigestion, or mouth tingling.
  • Nicotine inhalers (Nicotrol inhaler) are available by prescription. Each cartridge delivers a “puff” of vapor containing 4 mg of nicotine. The average dose is six to 16 cartridges a day for up to 12 weeks, followed by a gradual reduction in dose over the next 12 weeks. Side effects may include mouth or throat irritation and cough.
  • Nicotine nasal sprays (Nicotrol NS) are available by prescription. Each spray delivers 0.5 mg of nicotine. Use one spray in each nostril whenever you feel the urge to smoke, up to a maximum of 10 sprays an hour or 80 a day for three months. Side effects may include nasal irritation, sneezing, tearing, and cough.

Remember that nicotine replacement works best when combined with behavioral support, prescription drugs, or both. And smoking cessation always requires a good dose of willpower.

Kicking the habit: Prescription drugs

  • Bupropion (Wellbutrin, Zyban) was initially approved to treat depression and was then approved for smoking cessation. It does not contain nicotine and can be used in combination with nicotine-replacement therapy. Start taking bupropion one to two weeks before your quit date. Possible side effects may include dry mouth and insomnia; seizures are very rare.
  • Varenicline (Chantix) is the newest drug approved for smoking cessation; although experience is still limited, it also promises to be the most effective. It blocks nicotine receptors in the brain while also partially stimulating these receptors to reduce nicotine withdrawal symptoms. Nausea is common, and bad dreams may occur. Reports of accidents and visual abnormalities are also being investigated by the FDA. More research is needed.
December 2008 update

Overcoming Addiction
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Overcoming Addiction: Paths to recovery

Overcoming Addiction describes a number of effective treatments for addiction, including self-help strategies, psychotherapy, medications, and rehabilitation programs. It also includes targeted advice on specific types of addiction, as well as information about coping with a loved one’s addiction. Read more

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