Tobacco smoke is a mixture of over 7,000 chemicals, hundreds of which are
known toxins, 70 of which cause cancer. Tobacco smoking significantly
increases the risk of many diseases and premature death. The good news,
however, is that smoking cessation can greatly reduce these risks, even
within years of quitting. People who quit smoking are at decreased risk
for lung cancer, many other cancers, heart disease, lung disease, and
infertility (in women of reproductive age). In addition, pregnant women
reduce their risk of having a baby with low birth weight.
Most smokers become dependent on nicotine, which is the addictive substance
in tobacco products that leads to physical dependence and tolerance. This
makes quitting very challenging due to withdrawal symptoms, which include
irritability, anxiety, difficulty concentrating, cigarette cravings, and
Fortunately there are plenty of resources available to assist in the process
of smoking cessation. Quitting without aid has a low success rate long-term,
but behavioral strategies such as counseling and prescription medications
can significantly help improve the odds.
Oftentimes, tobacco is associated with daily routines such as morning coffee,
an alcoholic drink, or the end of a meal. It is important to anticipate
these triggers and find strategies to combat them. This can include finding
a substitute for tobacco, developing alternative routines to avoid triggers,
and utilizing a support system. Examples include finding non-tobacco oral
substitutes for tobacco such as gum, sugarless candy, straws, toothpicks,
lip balm, toothbrush, and bottled water; implementing routine changes
such as switching from morning coffee to tea, taking a brisk walk after
meals, or calling a supportive friend; while driving, remove all tobacco
from the car, have the car interior detailed, or listen to book on tape
or talk radio. During stressful times or intense cravings, try practicing
deep breathing, taking a break from the situation, calling a friend or
family member, self-massage, or nicotine replacement therapy. Avoid consuming
alcohol in the early stages of quitting as it can lead to relapse, and
limit contact with others who are smoking as this can make quitting more
The use of nicotine replacement therapy in various forms decreases the
frequency and intensity of withdrawal cravings. The urge to smoke may
persist, but it will be easier to manage. The options include nicotine
patches, gums, and lozenges. The patch is applied daily upon waking up
and releases a small, but continuous, amount of nicotine through the skin.
The most common side effect is irritation of the skin. The gum and lozenges
are placed inside the mouth and are used in place of cigarettes when the
craving to smoke arises.
Two prescription medications have also been shown to assist with cessation.
Bupropion (Wellbutrin) and varenicline (Chantix) should be started at
least one week prior to quitting and can take up to 4 weeks to reach peak
effectiveness. Chantix has received publicity for its psychiatric side
effects and should be used with caution in those with uncontrolled psychiatric
illness. It can also cause sleep disturbances and should be taken with
food and not at bedtime to help alleviate this.
If you are a smoker, talk to your doctor about creating a personalized
plan to help you quit.