Quitting Smoking: It Takes a Toolbox

It’s never too late to quit smoking. The sooner you quit, the better your chances of preventing cancer and other tobacco-related illnesses.

Most people who smoke want to quit, but doing so is often easier said than done. Many people who try to quit smoking are initially unsuccessful, which can lead to feelings of failure and anxiety about trying to quit again. The process may be accompanied by a number of unpleasant symptoms, including intense nicotine cravings, restlessness, trouble concentrating, sleeping issues, anxiety, irritability, and increases in appetite and weight gain.

Fortunately, people who want to quit smoking have more help than ever. From various medications, tobacco treatment counseling programs and smartphone support apps, the number of tobacco cessation aids is ever-increasing.

Not every one of these tools will work for all who try them. However, most healthcare providers agree that a combination of medication and behavioral changes gives people the best chance to quit for good.

Medications That Help People Kick the Habit

Although you don’t have to use medications to quit smoking, they can be very effective. In fact, multiple studies have shown that using nicotine replacement therapy (NRT) can nearly double your chances of quitting. Available in both over-the-counter (OTC) and prescription-only forms, this type of medication works by offering users small doses of nicotine to reduce nicotine cravings associated with giving up tobacco.

OTC NRT products include:

• Patches: You put one nicotine patch on in the morning and leave it in place all day, usually on the skin of your upper chest, upper arm, shoulder, back or inner arm. The patch releases a steady dose of nicotine throughout the day to help reduce symptoms of nicotine withdrawal. The nicotine is absorbed into the bloodstream through the skin.
• Chewing gum: Nicotine chewing gum releases small amounts of nicotine in the user’s mouth to curb nicotine cravings. The gum in sold in different flavors and two nicotine doses.
• Lozenges: Nicotine lozenges slowly dissolve in the mouth to release nicotine over the course of approximately 20 to 30 minutes to reduce cravings.

Prescription-only NRT products include:

• Inhalers: When you puff on a nicotine inhaler, nicotine vapor is released from a cartridge inside the device. The nicotine is absorbed into your bloodstream through the lining of your mouth and throat.
• Nasal spray: Nicotine nasal sprays are similar in size and shape to nasal sprays for congestion and allergies. Nicotine nasal sprays deliver a dose of nicotine into your nostrils in the form of an atomized solution. The nicotine is absorbed into the body through the lining of the nasal cavity.

The US Food and Drug Administration has approved two smoking cessation products that do not contain nicotine: varenicline and Zyban (bupropion). Available by prescription only, both varenicline and bupropion help to curb nicotine cravings by breaking the nicotine-dopamine connection in the brain. Dopamine is a hormone involved in the brain’s reward center. Every time a person uses tobacco, the nicotine in the tobacco causes a release of dopamine that makes the person feel good, encouraging them to use tobacco again to obtain more nicotine.

Varenicline and bupropion both work by disrupting the nicotine/dopamine reaction in the brain, but do so differently. Varenicline blocks and binds to nicotine receptors in the brain, stopping the release of dopamine. An antidepressant, bupropion also helps balance dopamine levels as nicotine exits the body, reducing nicotine cravings and related withdrawal symptoms.

Changes in Behavior

Here are a few ways in which changing your daily behavior can optimize your success in resisting nicotine cravings while you are quitting smoking:

• Try to avoid triggers: Urges to smoke are likely to be strongest in the places and situations where you typically smoked. These situations may include stressful moments, talking on the phone, parties and/or bars, or in the morning when sipping on the day’s first cup of coffee. Once you identify your triggers, you can put a plan together to avoid them or cope with them without using tobacco.
• Exercise more: Physical activity can distract you from nicotine cravings, while also helping you to minimize or avoid the weight gain that some people experience when they give up tobacco.
• Oral substitutes: Things that keep your mouth and hands busy can be very helpful while you are quitting tobacco. These include chewing sugarless gum and eating healthy snacks such as carrots, apples, sunflower seeds, pistachios and sugarless candy.
• Relaxation techniques: Smoking is often a way in which people cope with stress. Resisting tobacco cravings can itself be stressful. You can reduce your stress level by practicing relaxation techniques, including deep breathing, yoga, muscle relaxation, visualization, massage and listening to calming music.
• Don't have “just one” cigarette: People quitting smoking may be tempted at some point in the process to have “just one” cigarette to satisfy a nicotine craving. Don’t give in to this temptation. More often than not, having that one cigarette will lead to many more, if not a complete relapse.

Reaching Out for Support

You don’t have to quit smoking alone. People quitting should take advantage of any help that is available to them. For many tobacco users, having a strong support network can make the quitting process much easier. Effective support can be as simple as talking and spending time with family and friends. Other types of support include:

• Individual counseling: Some people benefit from one-on-one counseling with a Certified Tobacco Treatment Specialist (CTTS), which is a professional who has the skills, knowledge and training to provide effective, evidence-based interventions for tobacco dependence. University Hospitals offers a Tobacco Treatment Counseling Program, which provides individual behavioral counseling with a CTTS, medication therapy, education and relapse prevention. To set up an appointment, call 216-896-1810 or email Tobacco.Treatment@UHhospitals.org.
• Support groups: A number of different organizations offer tobacco cessation support groups that typically offer lectures, group meetings for mutual support, and discussions of coping methods and ways to optimize success in quitting.
• Telephone quitlines: Quitlines provide free coaching over the phone to support people who are quitting smoking. Quitlines in the US include 1-800-QUIT-NOW.
• Text messaging programs: A number of programs that send automated text messages to help people stop smoking are available. For example, Smokefree.gov offers free text messaging programs that provide 24/7 encouragement, advice and tips for giving up tobacco.
• Smartphone apps and other online resources: For example, the quitSTART App is a free smartphone app that offers tips, inspiration and challenges for people quitting smoking.