Frequently my smoking patients ask “HOW can I stop?”
My goal is to “stack the deck” so that you are more successful. Surveys show 70 percent of smokers want to quit. Over 40 percent have tried to quit in the past year by intentionally not smoking for at least 24 hours.
The long-term success rate of any one unaided quit attempt is low, with only 5 to 7 still abstinent one year later. With optimal treatment, one-year abstinence rates after a single quit attempt can exceed 30 percent! Few patients seek a physician’s help and most don’t use the most effective treatment. Most former smokers made several quit attempts before succeeding. I view tobacco use as a chronic relapsing disorder whose management requires an approach like that of diabetes and hypertension.
Nicotine is highly addictive. It’s a potent psychoactive drug that skillfully causes physical dependence and tolerance. In the absence of nicotine, a smoker develops cravings for cigarettes with symptoms like
• Depressed mood
• Irritability, frustration, or anger
• Difficulty concentrating
• Decreased heart rate
• Increased appetite which may lead to weight gain
Pharmacotherapy for smoking cessation aims to relieve the symptoms of nicotine withdrawal and/or make smoking less physically rewarding, thereby making it easier for a smoker to stop. Experts agree that a trifecta of nicotine replacement, buproprion, and counseling may work best.
There are many nicotine replacement products: gum, patch and lozenges. Few trials have directly compared them. Their most common side effects are insomnia and vivid dreams. The patch gives a constant amount of nicotine whereas the gum can be used to respond to cravings.
Buproprion is an antidepressant which helps decrease withdrawal symptoms. This should be started 7 days before desired quit date. It DOUBLES the likelihood of successful cessation.
Behavioral counseling will help. 1-800-QUIT-NOW provides telephone counseling. Computer counseling increases abstinent rates by 45%.
Before quitting, you must decide that you want to quit, pick a date, tell loved ones/coworkers your plan (so they will support and not tempt you) and call your doctor today.