COMMUNITY HEALTH AND COUNSELING SERVICES HEALTH SERVICES DEPARTMENT SMOKING CESSATION

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1 COMMUNITY HEALTH AND COUNSELING SERVICES HEALTH SERVICES DEPARTMENT SMOKING CESSATION You probably started smoking because it was cool or everyone around you was doing it. Now you think you should quit, but don t know how, or can t seem to do it. Why? Because smoking is both a physical and psychological addiction. Quitting smoking isn t easy, but it s not impossible either. The proof is in the millions of people who have kicked the habit. In fact, according to the National Cancer Institute, nearly half of all adult smokers have already quit. Learn from those who have succeeded: get motivated, create an individualized plan, and get support from medications and/or non-medication alternatives. WHY QUITTING IS SO HARD Why is it so hard to quit smoking? You ve probably hard many times about the hazards of smoking. Not only does smoking harm nearly every organ in the body and cause a host of health problems, but it reduces physical well-being in general. Among the many diseases for which smokers are at an increased risk include lung and other types of cancers, emphysema, heart attack, stroke, pneumonia, high blood pressure, and cataracts. This makes tobacco use the most preventable cause of death in the United States and the second major cause of death in the world. Even more sobering, the World Health Organization reports that half the people that smoke today will eventually be killed by a smoking-related illness. But despite being well aware of the health consequences of smoking, and despite a strong desire to quit, kicking the habit is very hard for many smokers. This is because smoking is both physically and psychologically addictive. If you re going to successfully stop smoking, you ll need to understand both types of addiction and recognize the role each plays in the underlying reasons why you ve smoked. PHYSICAL ADDICTION TO SMOKING Nicotine, the highly addictive chemical found in cigarettes and other tobacco products, is at the root of your physical addiction to smoking, as well as the withdrawal symptoms you experience when you quit. And while nicotine is a legal substance, the American Cancer Society reports that it is just as addictive as heroin or cocaine. When you puff on a cigarette, nicotine peaks in the bloodstream and enters the brain within seconds. Once in the brain, nicotine triggers a number of biochemical changes, including the release of adrenaline and dopamine. The stimulating effects of smoking, such as feeling more focused and alert, are caused by this shot of adrenaline. At the same time, the increase in dopamine the brain s pleasure chemical creates a feeling of satisfaction and relaxation. But nicotine s levels in the brain, as well as the pleasurable effects the drug causes, dissipate within a

2 matter of minutes. This fuels the cycle of addiction, as you need another cigarette in order to keep feeling good. If you stop smoking and break the cycle, you will experience a number of physical symptoms as your body withdraws from the drug. Nicotine withdrawal begins quickly, usually starting within thirty minutes to an hour of the last cigarette and peaking about 2 to 3 days later. Withdrawal symptoms can last for a few days to several weeks and differ from person to person. Common nicotine withdrawal symptoms include: Cigarette cravings Insomnia Irritability, frustration, or anger Tremors Anxiety or nervousness Increased coughing Difficulty concentrating Fatigue Restlessness Constipation or upset stomach Increased appetite Depression Headaches Decreased heart rate PSYCHOLOGICAL ADDICTION TO SMOKING In addition to being physically addicting, smoking is often psychologically addicting as well. If you ve been smoking for any length of time, lighting up has become habitual and ingrained in your daily routine. It may be an automatic response for you to smoke a cigarette with your morning coffee, while taking a break from work or school, or during your commute home at the end of a long day. Perhaps friends, family members, and colleagues smoke, and it has become part of the way you relate with them. Because of nicotine s feel good effect on the brain, you may also have become accustomed to smoking as a way of coping with stress, depression, anxiety, or even boredom. If you ve been using cigarettes to regulate your emotions and maintain a steady keel, giving up smoking may be particularly difficult. In order to successfully do so, you will need to explore and understand your motives for smoking so that you can create an effective plan that incorporates alternative coping strategies. TIPS FOR QUITTING SMOKING Stopping smoking requires effort, determination, and commitment, but the more you learn about your options and prepare for quitting, the easier the process will be. While there is no one best way to quit smoking, you will be most successful if you are aware of the challenges ahead and make a plan to keep yourself on track. While some smokers successfully quit by going cold turkey, most people need a more elaborate treatment plan. A smoking cessation program is a plan of action that weans you off smoking both physically and psychologically. Having a solid plan in place can greatly increase your chances for success. A good program addresses both the short-term challenge of quitting smoking and the long-term challenge of preventing relapse.

3 SmokeFree.gov outlines five basic steps that will help you get ready to quit: S = Set a quit date T = Tell family, friends, and co-workers that you plan to quit A = Anticipate and plan for the challenges you ll face while quitting R = Remove cigarettes and other tobacco products from your home, car and work T = Talk to your doctor about getting help to quit Other important aspects of a stop-smoking plan include: Identify your smoking triggers Keep a log of where you are when you smoke and who you re with. Identify situations or emotions that trigger your cravings for a cigarette. Preparing for cravings Once you ve identified your triggers, you can make a plan for avoiding them. You can also draw up a list of coping techniques to use when you re tempted to smoke. Getting your loved ones involved Quitting is tough, and having the right people around you can make all the difference. Let your friends and family know that you are planning to quit smoking and would appreciate their support and encouragement. PREPARING FOR QUIT DAY 5 Days Before Your Quit Date: Think about your reasons for quitting Tell your friends and family you are planning to quit Stop buying cigarettes 4 Days Before Your Quit Date: Pay attention to when and why you smoke Think of other things to hold in your hand instead of a cigarette Think of habits or routines to change 3 Days Before Your Quit Date: What will you do with the extra money when you stop buying cigarettes Think of who to reach out to when you need help 2 Days Before Your Quit Date: Buy the nicotine patch or nicotine gum Or see your doctor to get the nicotine inhaler, nasal spray, or the non-nicotine pill 1 Day Before Your Quit Date: Put away lighters and ashtrays Throw away all cigarettes and matches Clean your clothes to get rid of the smell of cigarette smoke Quit Day: Keep very busy Remind family and friends that this is your quit day Stay away from alcohol Give yourself a treat or do something special Source: US Surgeon General

4 MEDICATIONS FOR QUITTING SMOKING While medical aids for smoking cessation won t help with the psychological side of addiction, they can help ease nicotine withdrawal symptoms and reduce cigarette cravings. In fact, the American Cancer Society states that using a medication to help you stop smoking can double your chances of successfully quitting. However, these medications are most effective when used as part of a comprehensive stop-smoking program that is supervised by your doctor. The US Food and Drug Administration (FDA) has approved a number of anti-smoking medications. These medications fall under two broad categories: nicotine replacement therapy and non-nicotine medications. Nicotine Replacement Therapy Nicotine Replacement Therapy involves replacing cigarettes with other nicotine substitutes, such as nicotine gum or the patch. According to an FDA article on smoking cessation products, nicotine replacement therapy works by delivering small, steady doses of nicotine into the body to relieve some of the withdrawal symptoms, without the buzz that keeps smokers hooked. In addition, these products don t contain the cancer-causing chemicals and toxins found in cigarettes. By relieving the unpleasant symptoms of nicotine withdrawal, nicotine replacement products help smokers focus on breaking their psychological addiction and free them to concentrate on learning new behaviors and coping skills. Non-Nicotine Medication Like nicotine replacement therapy, non-nicotine medications for stopping smoking help by reducing cravings and withdrawal symptoms. Currently, bupropion (Zyban) and varenicline (Chantix) are the only two medications that don t contain nicotine which are approved as smoking cessation aids. These anti-smoking pills are intended for short-term use. As with nicotine replacement products, they allow you to focus on the psychological aspects of quitting smoking while the physical symptoms of withdrawal are minimized. MEDICATIONS TO HELP YOU QUIT SMOKING Nicotine Replacement Therapy Type Brand Names Availability Description Nicotine Patch Nicotrol Prostep Habitrol Nicoderm Over the Counter Skin patch worn on the upper body. Delivers a steady stream of nicotine through the skin and into the bloodstream. Typically worn all day and changed every 24 hours. Nicotine Gum Nicorette Over the Counter Gum that gradually releases nicotine into the mouth. Nicotine Lozenge Commit Over the Counter Lozenge in hard candy form that releases nicotine into the mouth as it dissolves.

5 Nicotine Nasal Spray Nicotrol NS Prescription Nasal spray that delivers nicotine through the nasal passages into the bloodstream. Works quicker than nicotine gum or the patch. Nicotine Inhaler Nicotrol Inhaler Prescription Inhaler releases nicotine into the mouth when puffed on. For use when you have a cigarette craving. Non-Nicotine Medication Type Brand Names Availability Description Bupropion SR Zyban Wellbutrin SR Budeprion SR Prescription Antidepressant medication that reduces nicotine cravings and withdrawal symptoms. Treatment usually lasts for 7 to 12 weeks. Varenicline Chantix Prescription Smoking cessation medication that blocks the pleasurable effects of nicotine and reduces withdrawal symptoms. Typically taken for 12 weeks. Talk to your doctor about your options and whether anti-smoking medication is right for you. If you decide to try nicotine replacement therapy or another smoking cessation drug, remember that they are not intended to be the only method used to help you quit smoking. They should always be combined with other methods that address the psychological side of smoking. ALTERNATIVES TO MEDICATION FOR SMOKING CESSATION There are several aids for quitting smoking that don t involve nicotine replacement therapy or prescription medication: Hypnosis Smoking cessation is one of the most popular medical uses of hypnosis. Hypnosis works by getting you into a deeply relaxed state where you are open to suggestions that strengthen your resolve to quit and increase your negative feelings toward cigarettes. Ask your doctor if he or she can recommend a qualified hypnotherapist in your area. Acupuncture One of the oldest medical systems, acupuncture is believed to work by triggering the release of endorphins (naturally-occurring pain relief substances) that allow the body to relax. As a smoking cessation aid, acupuncture can be helpful in managing withdrawal symptoms. Behavioral Therapy Because so much of nicotine addiction is related to the habitual behaviors (the rituals ) involved in smoking, behavior therapy that focuses on breaking those habits and learning new coping skills is essential. The American Lung Association offers a free online smoking cessation program that focuses on behavioral change. You can join the program at Freedom From Smoking Online.

6 Nicotine Vaccination A number of vaccines for the prevention and treatment of nicotine addiction are currently being developed and tested in clinical trials. NicVax, for example, works by triggering the body s immune system to block nicotine from reaching the brain, and is expected to work for a year following injection. MANAGING CIGARETTE CRAVINGS AFTER QUITTING What can I do to manage cigarette cravings after I quit? Cigarette cravings will come and go, so if you re tempted to light up, remember that the craving will pass and try to wait it out. When you re dealing with a strong craving, this is the time to get out your stop-smoking plan and put your coping strategies to good use. Having a plan to cope with cravings in advance will help keep you from giving in. Remind yourself why you quit Distract yourself Get active Brush your teeth Drink water Find an oral substitute Try to relax Get out of a tempting situation Light something else Reward yourself Coping with Cigarette Cravings Focus on your reasons for quitting, including the health benefits, improved appearance, money you re saving, and enhanced selfesteem. Get your mind on something else until the craving passes. Do the dishes, concentrate on a crossword puzzle, take a shower, or call a friend. The activity doesn t matter as long as it gets your mind off cigarettes. Go for a walk, do some jumping jacks or push ups, try some yoga stretches, or run around the block. The just-brushed clean feeling can help get rid of cigarette cravings Slowly drink a large glass of cold water. Not only will it help the craving pass, but staying hydrated helps minimize the symptoms of nicotine withdrawal. Keep other things around to pop in your mouth when you re craving a cigarette. Good choices include mints, hard candy, carrot or celery sticks, gum, and sunflower seeds. Do something that calms you down, such as taking a warm bath, meditating, reading a book, or practicing deep breathing exercises. Where you are or what you re doing may be triggering the craving. If so, a change of scenery can make all the difference Instead of lighting a cigarette, light a candle or some incense Reinforce your victories. Whenever you triumph over a craving, give yourself a reward to keep yourself motivated.

7 AVOIDING WEIGHT GAIN WHILE QUITTING SMOKING Can I quit smoking without gaining weight? Weight gain is a common concern of smokers who are contemplating quitting. Some people even let this concern deter them from giving up the habit. But while it s true that many smokers put on weight when they quite, the gain is usually small. According to the California Smokers Helpline, the average weight gain is only five pounds. Additionally, giving up smoking does not mean that you will automatically gain weight. Weight gain is not the direct result of quitting smoking. Instead, people usually gain weight when they quit because they start eating more. In essence, they are substituting one form of self-soothing or oral gratification for another. But weight gain can be avoided or minimized if smoking cessation is accompanied by a moderate increase in physical activity and a plan that incorporates alternative coping strategies. So eat a healthy diet, stay active, and don t let weight gain distract you from your main goal: quitting smoking. Here are some tips to help you keep the weight off after you ve quit: Nurture yourself. Instead of turning to cigarettes or food when you feel stressed, anxious, or depressed, learn new ways to soothe yourself. Eat healthy, varied meals. Eat plenty of fruits and vegetables and limit your fat intake. Seek out low-fat options that look appetizing to you and you will actually eat. Avoid alcohol, sugary sodas, and other high-calorie drinks. Drink lots of water. Drinking lots of water at least six to eight 9-oz glasses will help you feel full and keep you from eating when you re not hungry. Water will also help flush toxins from your body. Take a walk. Walking is a great form of exercise. Not only will it help you burn calories and keep the weight off, but it will also help alleviate feelings of stress and frustration that accompany smoking withdrawal. WHAT TO DO IF YOU RELAPSE Most people try to quit smoking several times before they kick the habit for good, so don t beat yourself up if you start smoking again. Turn the relapse into a rebound by learning from your mistake. Analyze what happened right before you started smoking again, identify the triggers or trouble spots you ran into, and make a new stop-smoking plan that eliminates them. It s also important to emphasize the difference between a slip and a relapse. If you slip up and smoke a cigarette, it doesn t mean that you can t get back on the wagon. You can choose to learn from the slip and let it motivate you to try harder or you can use it as an excuse to go back to your smoking habit. But the choice is yours. A slip doesn t have to turn into a full-blown relapse. WHAT TO DO IF YOU SLIP Understand that you ve had a slip. You ve had a small setback. This doesn t make you a smoker again.

8 Don t be too hard on yourself. One slip up doesn t make you a failure. It doesn t mean you can t quit for good. Don t be too easy on yourself either. If you slip up, don t say, Well, I ve blown it. I might as well smoke the rest of this pack. It s important to get back on the nonsmoking track right away. Remember, your goal is no cigarettes not even one puff. Feel good about all the time you went without smoking. Try to learn how to make your coping skills better. Find the trigger. Exactly what was it that made you smoke? Be aware of that trigger. Decide now how you will cope with it when it comes up again. Learn from your experience. What has helped you the most to keep from smoking? Make sure to do that on your next try. Are you using a medicine to help you quit? Don t stop using your medicine after only one or two cigarettes. Stay with it. It will help you get back on track. See your doctor or another health professional. He or she can help motivate you to quit smoking. Source: SmokeFree.gov According to the National Center for Chronic Disease Prevention and Health Promotion, most slips and relapses occur within the first three months of quitting, so make a special effort to stay out of temptation s way during this time. Here are some tips for avoiding relapse: Avoid alcohol. Many people connect drinking with smoking. If drinking alcohol makes you want a cigarette, stick to non-alcoholic drinks instead. Stay away from other smokers. Being around smoking can make you want to smoke. Find other ways to cope with depression. There are lots of ways to improve your mood without smoking. Find other ways to relax. Rather than smoking when you need to relax, deal productively with stress and anxiety. HELP AND SUPPORT FOR QUITTING SMOKING There are many different resources and organizations you can look to for help when you re trying to stop smoking. Here area few places to start: Find a local or online support group. Getting support from a group of people who understand nicotine addiction is one of the best ways to quit smoking. The largest support group is Nicotine Anonymous. To locate a group in your area, visit the Nicotine Anonymous web site. Call the the Maine Tobacco Helpline at to receive support and counseling as well as other helpful information on smoking cessation or visit Contact your local American Cancer Society (ACS) office or call The American Cancer Society at ACS-2345 to find out what resources might be available to you.

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