How Can I Quit Smoking?

I want to quit smoking. What is the best way to quit?

Question:

Answer:Good for you for making this important decision to quit. Stopping smoking or chewing tobacco helps prevent disease, including cancers of the lung, bladder, head and neck, esophagus and kidney as well as cardiovascular and respiratory diseases, ulcers and low bone density.

Nearly half of all tobacco users continue their habit even after being diagnosed with cancer, and many who do quit relapse after therapy. But studies have also shown that former smokers and nonsmokers respond better to cancer treatment than smokers, so it’s never too late to quit.

It’s important to realize that smoking is not just a bad habit—it’s extremely addictive. You don’t have to “tough it out”—there are helpful treatments. Smoking is an addiction and should be treated as such. You should enlist the help of your doctor, who can help develop a quit plan and prescribe cessation medication. Many private insurers, as well as Medicare and Medicaid in most states, offer coverage for certain medications.

Nicotine replacement therapies are designed to give patients a small yet safe dose of nicotine to reduce withdrawal symptoms. These drugs help wean smokers off nicotine and spare the smoker from the harmful effects of carbon monoxide, tar and carcinogens found in tobacco products that cause lung cancer, heart disease and chronic obstructive pulmonary disease. Nicotine gum and lozenges are available over the counter, as well as the many nicotine patch varieties. Nicotrol comes in either a prescription-only nicotine nasal spray or inhaler, but offers faster-acting and higher levels of nicotine.

You don't have to "tough it out" — there are helpful treatments.

Therapies without nicotine include Zyban (bupropion), an oral medication that is also prescribed for depression, and Chantix (varenicline), the newly approved cessation drug that works by blocking some of the rewarding effects of nicotine while at the same time reducing withdrawal symptoms. Chantix partially activates the nicotine receptor in the brain, reducing craving and withdrawal symptoms. In addition, if a person smokes while using Chantix, the pleasure associated with smoking is diminished. In research studies, Chantix was more effective than Zyban and well tolerated.

Investigational therapies include several nicotine vaccines, including NicVAX, which stimulates the development of nicotine antibodies. When a smoker inhales, the antibodies bind to the nicotine molecules, making it too large to pass through the blood-brain barrier. This, in turn, blocks the nicotine pleasure sensation in the brain.

While medications can reduce cravings and the desire to smoke, there is no magic pill to turn smokers into nonsmokers. Studies have shown that medication combined with behavioral therapy and social support show the best response. Smokers who call the National Tobacco Quitline (800-QUIT-NOW) are significantly more likely to quit than those who try to quit without support. Quitline coaches help smokers through each step of the process, including an individual quit plan for each person. In addition, coaches can provide support and coping skills during nicotine cravings.

Other behavioral tips include throwing away all cigarettes, ash trays and lighters. Make a list of reasons why you want to quit and keep it handy as a reminder when the urge hits. Change your routine; for example, many smokers exercise in place of times they smoked in the past. Deep breathing and drinking a glass of water can also help people work through an urge. Reminding others about your commitment to quit smoking and asking for support also helps. Experts also advise avoiding alcohol and other smokers—two factors closely linked to relapse.

For most people, the hardest part is the first few days or weeks. Stay focused on your list of reasons why you want to quit. Remember, most people who quit for good try several times before succeeding, so don’t get discouraged if it takes more than one attempt.

—Michael Fiore, MD, is a professor of medicine at the University of Wisconsin and is the founder and director of the UW Center for Tobacco Research and Intervention. He practices internal medicine and is a national expert on tobacco dependence.