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Smoking: Quitting for quits

If you're really serious about quitting smoking, there is help at hand.

Posted: April 4, 2008 6:35 p.m.
Updated: June 5, 2008 5:02 a.m.
 
If you are one of the 46 million Americans who smoke, you've probably thought about quitting more than once. You may have even tried to on a few occasions, possibly without success.

According to the American Heart Association, about 23 percent of all adult men smoke and about 19 percent of women do. Roughly a quarter of those people say they want to quit, and approximately 1.3 million of them actually do every year.

Though the success rate for quitting is low, it is imperative that people at least try if they are at all concerned about their health, experts say. The dangers of smoking have been known for many years, but they bear repeating because often the message goes in one ear and out the other.

The 2004 Surgeon General's Report says that tobacco smoking is the number one cause of preventable disease and death in the United States. Among the possible adverse consequences of puffing are coronary heart disease, chronic obstructive pulmonary disease, emphysema, stroke and, of course, cancer.

But quitting greatly increases your chances of living a long and healthy life, even if you have smoked for a long time. The AHA notes that after one year of not smoking, your risk of coronary heart disease is reduced by 50 percent, and after 15 years your risk is the same as that for people who never smoked. And five to 15 years after quitting, your risk of stroke returns to the same level as it is for non-smokers.

However, quitting is not easy, which is why experts recommend taking specific steps to raise your chances of success during what is often a long and difficult process.

Why it's hard
Since smoking involves both a physical and neurological addiction as well as ingrained habits and behaviors, it is not something that can just be put aside, like a novel you are finished reading.
Nicotine addiction occurs in the pleasure/reward center of the brain, when receptor cells bind with nicotine and release serotonin and dopamine. These two substances gives a sense of pleasure, a feeling that is recreated by continuing to smoke.

"People begin to crave it, and then they want more and more," said Peter Jaeger, the manager of Henry Mayo Newhall Memorial Hospital's Tobacco Cessation Program.

Jaeger emphasizes that nicotine is an addiction that can have a serious vice-like hold on users, and is not simply a bad habit.

"Nicotine is a very addictive drug," he said. "The physical cravings are the toughest part to get over. People can get off heroin and cocaine easier than nicotine."

The withdrawal symptoms that come with quitting can be annoying at best, and distressing at worst, and constitute a huge barrier to quitting. The discomfort, irritability, headaches, night sweats and intense cravings can drive most quitters back to cigarettes within a matter of days.

Quitting is also hard because smoking can temporarily reduce stress, and stress does not just go away when someone quits. Smokers also typically associate smoking with dozens of routine activities they indulge in throughout the day, for example drinking coffee, driving to work, or having a beer at the end of the day. Divorcing the smoking habit from other activities can be extremely difficult, especially without help.

How to ensure success
Though it is possible to try to quit cold turkey without professional assistance, Jaeger does not advise it, for a number of reasons.

"It's difficult for people to quit on their own," he said. "Only two to three percent of people have success when going it alone. And the longer you smoke, the harder it is to quit."

One reason for failure is the incorrect use of nicotine patches or gum. Too small an amount of nicotine will fail to satisfy cravings and can lead to a relapse.

"People who buy these products without being in an active smoking cessation program will fail because they underdose themselves," he said. "A one-pack-a-day smoker gets 20 to 40 milligrams of nicotine every 24 hours, but the strongest nicotine patch only provides 21 milligrams a day."

Jaeger, who is a respiratory therapist, said that joining a formal smoking cessation program that offers a multi-faceted approach to quitting can be much more effective than going it alone. The Henry Mayo program offers a unique one-on-one approach that has a good success rate.

"Being in an active program with counseling and therapy, including psychological and medical alternatives, is an excellent idea," he said. "Our program is tailored specifically for the needs of each individual, including behavior modification to help minimize smoking urges, and numerous coping strategies."

Medications, methods
Many smokers find that using drugs like Wellbutrin or Chantix can help take the edge off of their cravings and can set the stage for success at quitting.

"These medications can be very successful at treating nicotine addiction," Jaeger said. "We have a lot of positive reaction to Chantix in particular."

Chantix works by affecting the nicotine receptors in the brain, thus reducing the need to inhale nicotine to get the feeling of well-being it produces. Wellbutrin (also known as Zyban or bupropion) is an anti-depressant that affects the dopamine levels in the brain and eases nicotine cravings and withdrawal symptoms.

Jaeger works with his patients' doctors to get prescriptions for these drugs if they decide to go that route, but warns that taking the drugs alone does not guarantee success in quitting.

The counseling aspect of the Henry Mayo program addresses the habitual behaviors associated with smoking, and offers strategies for coping with triggers. Jaeger suggests that people participate in the program for at least six weeks for maximum effect.

"The first two weeks are usually the toughest, because that's when the physical adjustment is happening," he said. "After that, the psychological adjustment can take several more weeks."

During the quitting process, Jaeger encourages patients to break up their normal routines and habits, which may lead to relapse.

"If the first thing you do in the morning is have a cigarette, try to jump in the shower instead," he said. "If you usually have a smoke with your morning coffee, drink fruit juice as a substitute. If you drive the same way to work every day and smoke while you drive, try a different route. People are systematic with what they do when they smoke, so creating new habits can help people avoid the urge to smoke."

As for dealing with stress, a common trigger, Jaeger acknowledges that it will always exist, so they key is for quitters to change their response to it.

"If you get some bad news or have a fight with your spouse, take a walk or a run around the park instead of lighting up - anything that distracts you from where you are at and gets you out of that situation," he said.

The support aspect of the program is very important for times when quitters are tempted to puff and is something that is generally not available to those who are trying to quit by themselves.

"I normally tell people to call me if they feel they are going to relapse, or call a smoker support hotline," he said. "We try to give them as much support as possible. If you are going it alone, it is extremely difficult."

Though psychological counseling combined with medication therapy does make it more likely that a smoker will eventually quit for good, it is important to remember that relapse is par for the course. Instead of beating themselves up over it, which is counterproductive, smokers should jump back in the saddle and just keep trying.

"For most smokers, it takes six to eight attempts to quit," Jaeger said.

"There is a large amount of relapse. Over the last two or three years we've seen hundreds come through the program and fail. Only 20 to 28 percent will succeed the first time."

The payoff
In addition to the obvious health benefits of quitting, which are numerous, there are other pluses that can enhance your quality and enjoyment of life.

"Your senses of smell and taste become clearer after a couple of weeks," Jaeger said. "People who quit are thrilled that they can taste again."

And as your blood oxygen levels return to normal and the excess carbon monoxide and nicotine from cigarettes leaves your system, you may also find that you function at a higher level than before, since your thought processes are improved.

"People think more clearly when nicotine comes out of their system," Jaeger said.

Despite the numerous incentives to quit and the existence of excellent cessation programs such as Henry Mayo's, the first step to successfully quitting is to get into a mindset where you are ready, willing and able to put down your butts once and for all.

"Unless you really, really want to quit, there's no point trying," Jaeger said.

For more information about Henry Mayo Newhall Memorial Hospital's Tobacco Cessation Program, call (661) 253-8243 or visit www.henrymayo.com/html/cancerweb/tobacco.asp.

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