CHAPTER 16

Tools for Quitters

Seek support from loved ones, other quitters, counselors, and your doctor, who may recommend medical treatment options.
“In the medical profession, we know that many approaches to quitting will work,” says Steven Schroeder, M.D., Director of the Smoking Cessation Leadership Center at the University of California, San Francisco. “It's similar to treating hypertension—there are many options and choosing a treatment depends on the individual's circumstances. Counseling over free telephone quit lines and internet quit services are nonmedical approaches that work and are underused. Drug therapies can be very effective. I tell people that some drugs aren't my first choice because there are side effects. However, for some smokers who have tried other methods, the benefits will outweigh the risk.”

PART 1 Help for Kicking the Habit

True or False?

If you smoke while using a patch...

Gum, lozenges
Description: Over-the-counter oral nicotine replacement therapies How it Works: Taken when a smoker would normally have a cigarette; alleviates a quitter’s nicotine craving without the damaging effects of smoke
Success Rate: After one year, 15% of quitters who used only one of these therapies was smoke-free. Is it for you? Very convenient and available without a prescription. You can use one of these nicotine replacements any time you feel an urge to smoke.

Nasal sprays, inhalers
Description: Prescription mists give a dose of nicotine into nasal passage How it Works: Taken when a smoker would normally have a cigarette; alleviates a quitter’s nicotine craving without the damaging effects of smoke
Success Rate: Like gum and lozenges, these nicotine replacement therapies alone yield a 15% success rate after a year. A study in France showed that smokers who used an inhaler in combination with the nicotine patch had nearly a 20% success rate. Is it for you? These methods work more rapidly than gum or lozenges, but require a doctor’s prescription. Discuss it with your physician.

Nicotine patch
Description: An adhesive, topical patch, applied to skin once a day
How it Works: Nicotine is absorbed through the skin
Success Rate: About 15% after one year. A study in France showed that smokers who used an inhaler in combination with the nicotine patch had nearly a 20% success rate.
Is it for you? It delivers a steady dose of nicotine all day, rather than single-incident “hits” of the drug. Many quitters find the once-a-day application convenient.

Counseling
Description: One on one therapy, or a smoke cessation group support that takes place online or on-site. How it Works: Talking about the challenges of quitting with someone, or many people, who understands the difficulty can be reassuring and inspiring.
Success Rate: Counseling and support groups seem to improve quitters’ chances of success by varying degrees, in combination with other treatments. According to the ALA, nearly 30% of Freedom from Smoking attendees were smoke-free after a year. Social support can increase the odds of success by up to 50%, according to a 2000 Dept. of HHS report. Is it for you? Some programs to investigate: The American Lung Association’s Freedom from Smoking Online, becomeanex.org, quitnet.com. Also, inquire at your local American CAncer Society, American Lung Association, Nicotine Anonymous chapter or local hospital.

Varenicline
Description: Prescription pill, non-nicotine
How it Works: Blocks nicotine receptors, making smoke less satisfying
Success Rate: 20% of smokers abstained one year after starting treatment
Is it for you? Possible side effects include changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions. There is evidence that varenicline may raise the risk of heart attacks and arrhythmias. Discuss the pros and cons of this option thoroughly with your physician.

Bupropion
Description: Prescription pill, antidepressant
How it Works: Buproprion’s regulation of brain chemicals related to nicotine receptors seems to reduce cravings for quitters. Success Rate: A 15% success rate after one year. Used in combination with nicotine replacement therapy, under a physician’s care, success rates were more than 35% at one year.
Is it for you? Your doctor will best be able to determine the appropriateness of this prescription drug for you.

Hypnosis, acupuncture, herbs, laser treatment
Description: Nonmedication therapies
How it Works: Various methods (and mostly, it doesn’t work)
Success Rate: Alternative therapies such as these have been shown to be far less effective than mainstream methods discussed here. Several controlled studies found they were ineffective. No university studies published in mainstream medical journals provide reliable data on lasers’ success rate 12 months after treatment.
Is it for you? Quitters who have not succeeded with research-based methods sometimes try these alternatives, and sometimes they work. If you try one of these therapies, make sure to discuss their efficacy and possible side effects with your doctor. Also, thoroughly analyze the cost.

Vaccines (in development)
Description: Causes the immune system to create antibodies that bind to nicotine.
How it Works: After binding to the new antibodies, nicotine molecules can’t bind to the receptors in the brain that are associated with nicotine addiction.
Success Rate: Two vaccines are still in development, so final success rates are not yet known.