Smoking Cessation
A smoking cessation program is one that helps you stop smoking. There has been a tremendous amount of material published on kicking the smoking habit. It is now clear that never starting smoking when young plays a key role in the overall (lifetime) avoidance of cigarette smoking. Social and peer pressures, in addition to modeling adult behavior, are some of the main factors in influencing young people to start smoking.

Underlying Cause
One study shows that people who had bad experiences during childhood are far more likely to smoke, start smoking at an early age, and continue to smoke heavily into adulthood than people who report no adverse experiences while growing up. Even more amazing is the fact that although there is a large body of evidence that demonstrates smoking is harmful, many people simply continue to smoke. Studies show that 7 out of 10 people who currently smoke would like to quit. More than 7 out of every 10 people, who try to give up smoking, fail.

The maintenance of smoking behavior in the adult is conditioned by many factors. Smoking is used for nonverbal communication such as to emphasize positive feelings and reduce negative feelings. It plays a role in the management of personal stress. It also suppresses the appetite and even provides relaxation in some people. The end result is a pattern of use that assists the smoker in coping with their world. In short, giving up smoking can mean giving up a major personal coping mechanism.

Smoking is Addictive
Some people may require only a few cigarettes to become addicted. Smokers seem to come in three basic types: those who become addicted very quickly, those who become addicted gradually after more regular smoking, and those who can smoke lightly and stop without becoming addicted.

Smoking meets all the criteria for an addiction, including a withdrawal syndrome. Nicotine is addictive, but abstinence from nicotine alone does not reverse the addictive process. According to most experts, it normally takes two or three tries for smokers to finally quit. And most of them must go through several steps to permanently kick the habit.

Other reasons for failure to stop smoking:

• Nicotine withdrawal is unpleasant
• Smoking is an important personal coping mechanism
• The advertising effect
• They aren't sufficiently motivated to quit
• They fail to take advantage of nicotine replacement therapy
• They lack a definite smoking cessation plan
• Weight gain

Symptoms of Nicotine Withdrawal
Withdrawal symptoms are said to begin as soon as several hours after the last cigarette. They reach their peak intensity in 3 to 5 days and generally taper off in a couple of weeks. The symptoms of nicotine withdrawal include both physical and mental or emotional symptoms. Often the later, are the most difficult to deal with.

Some symptoms of nicotine withdrawal include:

• Anxiety
• Depressed mood
• Difficulty concentrating and mild confusion
• Difficulty sleeping
• Food cravings
• Gastrointestinal upset such as indigestion and heartburn
• Headaches
• Increased appetite
• Insomnia
• Irritability, frustration, anger
• Restlessness
• Sore throat, increased cough, and other cold symptoms
• Excessive sweating
• Tingling in the hands and feet

Depression after Smoking Cessation
Many of the symptoms of nicotine withdrawal are similar to those of depression. In a sense people who smoke go through a period of "mourning" over the loss of their cigarettes. What's important is that people who are prone to depression face a 25% chance of triggering depression when they quit smoking. Furthermore depressed smokers have a lower rate of success when trying to quit smoking. Only about 6 out of every 100 depressed smokers who quit smoking are smoke-free after one year. Some medical experts are concerned that smoking may mask symptoms of major depression. These symptoms are likely to become even more apparent even after the nicotine withdrawal has passed.

Tips on how to Prepare Yourself to Quit Smoking

• Carry things to put in your mouth (e.g. sugarless gum, candy, etc.).
• Change your routine.
• Change your smoking routine by setting a schedule. Studies show that people who follow a fixed smoking schedule to progressively reduce their smoking are twice as likely to quit as those who go at it cold turkey.
• Cut down the number of cigarettes you smoke.
• Don't smoke automatically -- smoke only those cigarettes you really want.
• Identify when and why you smoke -- make a record of it
• Make smoking inconvenient -- stop buying cigarettes by the carton.
• Make smoking unpleasant. Collect all your cigarette butts in one large glass container as a visual reminder of the filth made by smoke.
• Notify friends and relatives that you're going to quit. Social pressure is an important stop smoking mechanism and these people are often an excellent source of motivation.
• Reward yourself at the end of each day for not smoking.
• Set a quit date on your calendar.
• Switch to a brand you find distasteful.
• Throw away all of those cigarettes!

Scheduled Reduction
This is a way to progressively reduce the number of cigarettes you smoke in a day. To do this you should try the following program:

• Divide the number of minutes you are awake during the day by the number of cigarettes you smoke in one day. This will give you your minute-long wait period between smokes.
• Set up a smoking schedule based on the number above. Use a timer if necessary. If you miss a cigarette interval by more than 5 minutes you should skip it altogether.
• The next week you should re-calculate your wait period between smokes using one-third fewer total daily cigarettes. This will make the time periods between smokes slightly longer than before.
• At the third week repeat the one-third reduction. By the time the fourth week rolls around (thanks to the final one-third reduction) you should have quit completely

General Measures
No matter which method you choose, it is extremely beneficial to participate in a patient support program. These programs can help you identify personal triggers or situations (or things) that make a smoker want a cigarette--and ways of overcoming them. A variety of self-help programs, support groups, and organizations are in place to assist patients with behavior modification. A combination of nicotine replacement therapy via patches or gum combined with close physician follow-up and/or a self-help support group can markedly increase the likelihood of success in stopping smoking.

The Department of Health and Human Services Agency for Health Care Policy and Research, (AHCPR) has come up with its recommendations after reviewing over 3,000 medical journal articles on smoking cessation published between 1975 and 1994. Copies of the guidelines are available by calling (800) 358-9295.

Other helpful tips:

• Avoid heavy use of alcohol, caffeine, or other stimulants.
• Chew sugarless gum when you want sweets
• Don't set a target date for a holiday when you are tempted with high-calorie foods and drinks
• Drink 6 to 8 glasses of water a day
• Get family members and close friends involved; they can be a source of motivation
• Make sure you have a well balanced diet. It may be helpful to eat at different times or on a different schedule.
• Plan menus carefully
• Put time in your daily schedule for exercise this can be a tremendous benefit
• Set personal goals and reward yourself in some way (other than smoking)
• With any diet and exercise regimen you plan to begin, you should first consult with your physician

Dealing with Weight Gain
Many people feel the moment you quit smoking you will gain weight. Quitting doesn't mean you'll automatically gain weight. When people gain, it's because they often eat more once they quit. Try to combine your smoking cessation program with a low calorie diet. This actually can help you quit smoking easier. If you do experience weight gain, much of it can be attributed to fluid retention and should be temporary. The benefits of giving up cigarettes far outweigh the drawbacks of adding a few pounds. You'd have to gain a very large amount of weight to offset the many substantial health benefits that a normal smoker gains by quitting.

Nicotine Substitutes
An effective way to curb your addiction to nicotine is to provide a new and safer source for it. There are a number of ways this can be accomplished. Other sources for nicotine include time-release patches (e.g. Habitrol, NicoDerm, and ProStep) and nicotine gum. These products release nicotine into the bloodstream in an attempt to curb the symptoms associated with nicotine withdrawal. This method gradually diminishes the body's urge for nicotine.

Many of these products are now available without a doctor's prescription. About 250,000 more smokers have quit each year since the approval of over-the-counter nicotine replacement products. If you choose this form of treatment, you must stop smoking immediately. Not cheating on the very first day of nicotine-replacement use increases the chance of quitting permanently by tenfold. Studies show that these methods alone are not as successful as when they are combined with some sort of behavior modification, peer pressure, and social support groups.

Nicotine Patches
The nicotine patch adheres to your skin and releases nicotine into your bloodstream. There are different strengths of patches and many are now available without a prescription. Some come in different levels of nicotine and are usually worn on the skin for 16 to 24 hours a day.

For example, NicoDerm CQ includes patches that come in three strengths 21, 14, and 7 mg, which are used in a step-down program over a period of 8 to 10 weeks. Many users have experienced redness, itching, or burning of the skin with patches, causing some to discontinue use. The quit rate for patch users is around 20% after six months. This is roughly twice the rate of those who try to quit smoking cold turkey.

Precautions:

• Do not smoke when using a nicotine patch. This can result in toxic blood levels of nicotine. This is potentially dangerous in people with heart disease, stroke, or high blood pressure.
• Minor skin irritation is commonly reported. Moving the patch to different locations can reduce this. Those on very high dose patches may experience headache, nausea, and indigestion.
• Nicotine patches are not considered completely safe in pregnancy. Discuss this with your doctor.
• Store patches in a safe area. There are some reports of small children getting a hold of these products and becoming nicotine toxic after chewing on them.

Nicotine Gum
This works on the same principal as the nicotine patch and also available without a prescription. Nicotine gum is chewed briefly to release nicotine and then rests in your mouth. The additional benefit is the dose of nicotine can be more controlled by the individual. Chewing gum may also help to curb some of the oral urge. The released nicotine is absorbed into the blood through your mouth and gums. The idea here is to start using the gum not more than once per hour in the beginning and be totally off the gum at the end of six months. A recent medical study has shown that female smokers concerned about weight gain are more likely to kick the habit if their smoking cessation program combines nicotine gum with a special, low-calorie diet.

Precautions:

• Caffeine interferes with the absorption of nicotine. Wait at least 15 minutes after having a cup of coffee before chewing the gum.
• Nicotine gum can cause headache, nausea, upset stomach, and dizziness.
• People with dentures should avoid the gum and use another method.
• Some find the gum tastes bad and may upset the stomach.

Nicotine Sprays and Inhalers
A nicotine spray allows you to spray small doses of nicotine into your nasal passages, reducing your urge for nicotine. Due to enhanced nicotine absorption, this method may provide increased effectiveness in the highly dependent smoker. A similar product is the Nicotrol Inhaler. In this case the majority of the nicotine is absorbed through the mouth. Both of these forms of therapy are only available through your doctor.

Precautions:

• Many patients using the nicotine nasal spray reported moderate to severe nasal irritation at the onset of usage.
• Other common side effects that have been reported are runny nose, throat irritation, watering eyes, sneezing, and cough.

Varenicline (Chantix)
One of the newer medications for stop smoking is varenicline, marketed by Pfizer under the trade name Chantix. Chantix is used in combination with behavior modification and counseling. Chantix works in the brain to block the pleasurable effects of smoking. Experts recommend that Chantix be taken for a week prior to your quit date.

The most commonly reported side effects of Chantix include:

• Nausea
• Drowsiness
• Headache
• Insomnia
• Vomiting
• Changes in dreams
• Change in taste
• Excessive gas

Bupropion hydrochloride (Wellbutrin)
Bupropion hydrochloride (Wellbutrin) was found in clinical trials to be an effective agent in smoking cessation therapy. The FDA has approved a sustained release preparation of bupropion, marketed under the trade name Zyban. It is the first non-nicotine stop smoking drug to become available. Some studies have shown the addition of the medication buspirone, an anti-anxiety drug, can significantly increase the smoking cessation rate. These options should be discussed with your doctor.

Stop Smoking Vaccine
NicVAX is intended to help prevent smokers who quit "cold turkey" from starting to smoke again. The vaccine works by stimulating the production of antibodies that capture nicotine before it reaches the brain. This negates the usual kick that smokers receive from cigarettes thereby reducing the incentive to smoke. This vaccine is still in clinical trials pending approval by the FDA.