Smoking Cessation
How to manage withdrawal
Tips, tricks, medications, cell phone apps to help you quit smoking
Bryan Byers, BSN, RN and Brad Burns, BSN, RN
Smoking addiction is a two-fold problem. Smoking is ritualistic: you open the pack and light up the cigarette. You socialize with your fellow smokers and you keep your hands occupied. The rituals are almost as addictive as the chemicals. When you smoke, it releases dopamine – the feel good chemical. Unfortunately, the sensation is short-lived while the damage is long lasting. This is why a two-fold approach to quitting is best. Addiction experts believe that an approach addressing both the psychological and physical aspects of the addictions offers the best chance of success.
First, let’s address the physical component of addiction. There are several Food and Drug Administration (FDA) approved medicines. The following paragraphs will introduce a few of the different methods and discuss their pros and cons.
Probably the most well-known medication to help a smoker quit is nicotine supplementation. The supplementations come in various forms such as a nicotine patch, gum, lozenge and inhaler. All of the different forms of nicotine supplementation have some similarities. They can cut down on cravings and withdrawal symptoms. However, they do have differences as we will see.
Nicotine patches are nice because they are over the counter (OTC), easy to use, and deliver a reliable, steady dose of nicotine. The cons are that they have a slow onset of action; meaning that you will not feel better for a period of time. They may also irritate the skin. This may not be the best method for those with sensitive skin.
Nicotine gum and lozenges are another OTC nicotine supplement. The advantages to these methods is that you are able to control when you receive a dose of nicotine, and it keeps your mouth busy. The disadvantages are that you are not supposed to eat or drink anything for 15 minutes after having them, and some people have reported that it irritates their mouth and stomach.
Nicotine inhalers require a prescription from your doctor. They deliver an accurate dose of nicotine that your doctor will help you choose. The inhaler also mimics the hand to mouth ritual that smokers have developed. The disadvantages to this method are that it can cause throat or mouth irritation, you need a prescription, and it may irritation the lungs. This method may not be advisable for anyone who has a lung condition such as COPD or asthma.
There are also medicines that have been FDA approved to treat smoking. Zyban is one such medication. Zyban is a dopamine and norepinephrine reuptake inhibitor. This means that it will increase some of the chemicals in your brain that smoking does, and has been proven to decrease cravings and withdrawal. There is evidence to support that your chances of quitting are doubled with Zyban. People who have used Zyban also tend to experience less weight gain and can still smoke without risk. Sometimes this makes weening off of cigarettes easier. Some of the side effects to this medicine are insomnia, dry mouth, headaches and rash. Zyban also requires a prescription and may increase your blood pressure. People who have a seizure disorder are advised against this medication.
Chantix is another prescription medication that has been proven effective for smoking cessation. Chantix is a partial nicotine receptor agonist. This means that it stimulates the same areas that smoking does, but not as strongly. Chantix has been shown to increase your probability of quitting threefold. It has also been shown to have less relapses than Zyban. Chantix may not be for everybody. Some of the people who should avoid it are those who have heart conditions or serious psychiatric illnesses such as schizophrenia, bipolar or major depression. Also, people who are taking Chantix are advised not to smoke while taking it.
The psychological component of smoking is another important factor in being successful at treating smoking addiction. Behavioral modifications are an important part of treatment including: reasons for quitting, identifying triggers, planning to avoid or cope with eat trigger, develop a support system, rewarding yourself, and a written commitment to quitting each day. Like with any addiction problem, half the battle is learning to live one day at a time.
While medication and therapy in combination are great strategies, empowering yourself will help you to quit as well. www.cancer.gov has many useful tools. Along with information about medications, they have a section that covers “how to handle withdrawal symptoms and triggers when you decide to quit smoking.” Some of the topics covered are what symptoms of withdrawal you will be faced with (anger, frustration, irritability, etc.) and how to cope with them. They report that the symptoms are short lived – usually only a week or so.
Behavior and rituals also play a big part of the addiction people have to smoking. Some people smoke when they are stressed, feel anxious, depressed, or get bored. Some may experience smoking as a daily ritual when they are having their morning coffee, take a break at work, or are just hanging out with a group of friends. This social aspect of smoking becomes ingrained as a habit in the daily lives of smokers, and may be just as addicting as the chemical component of smoking.
To successfully address smoking, a good plan that addresses both the physiological and psychological issues involved may help. Some smokers are able to quit cold turkey, while others may need to cut down over time. Either way, the plan should be tailored around your individual needs and smoking habits.
Start by asking yourself some questions about what type of smoker you are, how much you smoke, and the reasons you smoke. Are you more of a social smoker that only has a cigarette when others are doing it? Do you only smoke when you are out at a bar and alcohol is involved? Is it a ritual that you do during specific times of the day, or do you only smoke when you feel stressed or anxious? From this point a good acronym to use is the START method:
S = Set a date to quit.
Choose a specific date that is within the next few weeks so that you have enough time to prepare and that you do not lose your motivation to quit
T = Tell family, friends, co-workers and colleges of your plan to quit.
This will provide you with some social supports in your efforts to quit smoking. Find a friend or trusted person that you can go to when it gets hard and you feel like picking up a cigarette.
A = Anticipate and plan for the challenges that you may encounter.
Some common challenges are obviously cravings and withdrawal. Other challenges may not be as obvious such as an unexpected stressful event, or going to an environment where there are a lot of smokers, like a casino.
R = Remove the cigarettes from your environment. This includes home, work, car, purse or briefcase.
T = Talk to your doctor about available help with quitting.
Do not keep an “emergency pack” around. Either get help from your doctor in the form of prescribed medication for smoking cessation, or over the counter products such as patches, lozenges, and nicotine gum. (Robinson 2015)
For those of you high-tech cell phone users, there are apps such as “quitguide, quitstart, and NCI quitpal.” These apps will help you track your daily smoking, update you on your health milestones, and help you understand your smoking patterns to better prepare a quit plan that is tailored to your lifestyle. You can learn more at www.smokefree.gov/apps.
Some of you might be thinking “well what about e-cigarettes?” The reality is that they are a multibillion dollar industry that is predicted to grow exponentially in the coming years. The real truth is that we don’t have any scientific data to support their use. We don’t know if they help you quit or if they are more or less harmful. Right now, the FDA does not even regulate the e-cigarette business. Our recommendation is to avoid them until we know more about their health benefit/risk profile. Remember, the same companies that told us that cigarettes were safe 75 years ago are the same companies that are telling us that e-cigarettes are safe today.
Reference:
Centers for Disease Control and Prevention (2015, September 4). Smoking and Tobacco Use.
Retrievedfrom: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm
Kameg, Kirstyn. “Smoking Cessation” Power-Point presentation. Robert Morris University,
Pittsburgh, PA. 9 July 2015.
National Cancer Institute (2015, September 4). How to Handle Withdrawal Symptoms and
Triggers When You Decide to Quit Smoking. Retrieved from: http://www.cancer.gov/about
cancer/causes-prevention/risk/tobacco/withdrawal-fact-sheet#q1
Smokefree.gov. (2015, September 4). Which Quit Smoking Medication is Right for You?
Retrieved from: http://smokefree.gov/explore-medications
Smokefree.gov. (2015, September 4). Smoke Free Apps. Retrieved from: http://smokefree.gov/apps