With the right tools and support, you can quit smoking now

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By now, even the tobacco companies agree: Smoking is bad for your health — very bad, in fact.

Tobacco is responsible for one of every five deaths in the United States. That adds up to more than 435,000 lives lost each year, and more than 8.5 million Americans suffer from chronic illnesses caused by smoking. We’re almost at New Year’s resolution time, and many smokers will resolve to quit. It can be done — more than 45 million Americans have quit. But more than 20 percent of adults still smoke, and the habit remains more prevalent in men than women.

Fortunately, there are more ways to kick the habit than ever before.

DIY

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. Steer clear of stressful periods, and avoid holidays if you’re likely to be invited to smoke-filled parties.

Try to get other smokers in your household or circle of friends to join you in quitting. A 2008 study found that smoking behavior spreads through both close and distant social ties. Your resolve and success can help your friends and, ultimately, your community.

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 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.

If you feel tense, try meditation, deep breathing or yoga.

Begin an exercise program. It will relieve tension, promote good sleep and help control weight gain. Walking for 30 minutes a day can really help.

Eat a healthy diet.

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.

Think positively: You can quit. Take it one day at a time. And if you slip, try, try again, either on your own or with one or more of the other quitting strategies.

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 local chapter of the American Lung Association or American Cancer Society can refer you to a program.

Telephone support can also help. You can try it for yourself by calling the National Smoking Cessation Hotline 1-800-QUIT-NOW. Hypnosis has helped some smokers break free.

Nicotine-replacement therapy

Nicotine patches are available over the counter. One popular 24-hour patch (NicoDerm CQ) comes in three strengths: 21 milligrams, 14 milligrams, and 7 milligrams. Place a new patch on clean, unbroken, hairless skin each day; you can leave it in place all day. Most smokers should start with the 21-milligram dose, but if you weigh less than 100 pounds or smoke fewer than 10 cigarettes a day, you should start with the 14-milligram strength. You can reduce the dose every one to two months. If you have bad dreams while wearing a patch at night, you can use a 16-hour patch that you remove at bedtime. Mild skin irritation is the most common side effect. Store and discard your patches with care to keep them way from young children.

Nicotine gum (Nicorette) is available over the counter. If you smoke more than 25 cigarettes a day, you should use gum that provides 4 milligrams of nicotine per piece; if you smoke less, use the 2-milligram dose. 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. Chewing replaces the oral stimulation of smoking, but some people find the taste unpleasant, and some develop hiccups or indigestion. Coffee, tea, beer and soft drinks may interfere with nicotine absorption.

Nicotine lozenges (Commit) are available without a prescription. If you usually light up within 30 minutes of waking, you should use the 4-milligram strength, while others can use the 2-milligram lozenges. 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. Don’t eat or drink while using a lozenge, and as with nicotine gum, you should avoid acidic beverages for at least 15 minutes before use. Nicotine lozenges are safe for use with dentures. 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 milligrams of nicotine. The cartridge is placed in a device that resembles a plastic cigarette holder, which may help satisfy a smoker’s oral urge. 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. Most of the nicotine is absorbed from the mouth, not the lungs. Side effects may include mouth or throat irritation and cough.

Nicotine nasal sprays (Nicotrol NS) are available by prescription. Each spray delivers 0.5 milligrams 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.

Prescription drugs

Bupropion (Wellbutrin, Zyban) was approved to treat depression and 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. The usual dose is 150 milligrams once a day for the first three days, then 150 milligrams twice a day for 8 to 12 weeks or longer if needed.

Varenicline (Chantix) is the newest drug approved for smoking cessation; although experience is limited, it promises to be the most effective. It blocks nicotine receptors in the brain while partially stimulating these receptors to reduce nicotine-withdrawal symptoms. The usual dose is 0.5 milligrams once a day for the first three days, then 0.5 milligrams twice a day for four days, followed by the full dose of 1 milligram twice a day for 12 weeks or longer.

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