July 14th, 2013

Smoking

It’s for quitters

Karen Miller

Smoking is estimated to increase the risk of stroke by two to four times

As anyone who has tried to quit smoking can attest, it is hard — terribly hard. In fact, it often takes smokers between 7 and 11 times to successfully quit, according to the Massachusetts Tobacco Cessation and Prevention Program. Using a combination of methods — including counseling and medications — can dramatically increase the chance of a successful outcome.

The reason quitting smoking is so incredibly difficult is that nicotine — found in all tobacco products — is highly addictive. In fact, the U.S. Surgeon General stated in a 1988 report that nicotine was as addictive as heroin or cocaine.

Given the high level of cancer fatalities, African Americans have even more reasons to quit smoking. But cancer is not the only consequence of tobacco use. Smoking harms nearly every organ of the body and reduces the health of smokers in general, according to the Centers for Disease Control and Prevention. Smoking causes cardiovascular and respiratory diseases. Compared with nonsmokers, smoking is estimated to increase the risk of stroke by two to four times.

Making a plan to quit

Whether your decision to quit smoking is motivated by health risks, for family, to save money or just to feel better, begin by making a plan to quit. The first step is to consult your doctor to find out which anti-smoking tools will work for you. Before your quit date, work with your doctor to decide if you are going to use medications, join a support group or use a different plan to quit.

Once these questions have been answered, it is time to take action. The American Cancer Society advises people to pick a day to quit and throw away all cigarettes and ash trays. Prepare by having substitutions available — things like gum and hard candies to put in your mouth and activities to distract you from thinking about smoking.

Effective medications are an important tool

Despite nicotine’s addictive qualities, there are many effective treatments to help people quit. For more than 25 years, researchers have found clear evidence that several medications work well, especially in conjunction with certain types of counseling.

According to the American Cancer Society, the following drugs can effectively double the chances of quitting:

Bupropion (Zyban®,Wellbutrin®, Aplenzin®), a prescription drug, works to reduce cravings but contains no nicotine. Initially developed to deal with depression, the drug was inadvertently found to lessen the desire for
nicotine when prisoners taking Zyban for depression smoked noticeably less.
Varenicline (Chantix®) is a prescription drug that reduces the pleasure people get from smoking by attaching to nicotine receptors in the brain and blocking nicotine from reacting with them.
Nicotine replacements such as the patch, gum, nasal spray, inhaler or lozenge contain reduced amounts of nicotine to give a small, slow release supply of nicotine to lower cravings. Most are available over the counter, but some are obtained by prescription.

Your primary care doctor can work with you to decide the best medications to use. In some instances, a doctor may recommend a combination of prescription medication and nicotine replacement, but the various combinations each have their own specific requirements. It is important to check with your doctor if you are using a prescription drug and an over-the-counter nicotine replacement product such as the patch.

Like most medications, anti-smoking medications can have side effects. On July 1, 2009, the Food and Drug Administration required that bupropion and varenicline carry a black box warning — the agency’s strongest safety warning — due to side effects including suicidal thoughts, suicidal actions, hostility and depression.

New smoking cessation tools may be on the horizon

Although there are a few relatively new anti-smoking tools, such as Chantix on the market, the search goes on for even more effective methods. For example, a tobacco vaccine has been in the testing process since 2006. The idea behind the vaccine is to keep nicotine from reaching the brain, making smoking less pleasurable. It is part of a new generation of treatments that are designed to attack the psychological dependency on nicotine.

Counseling Is equally important

Individual and group counseling have proven to be very effective tools to help people quit smoking, especially when used in combination with medication. Support can come from health care providers, including anti-smoking groups at clinics, health centers and hospitals, so one of the first places to look for a support group is at your local hospital or health facility. Family and friends can also be very important sources of support.

There are a number of other no-cost or low-cost ways to find counseling support. Telephone counseling has been proven to double people’s success in quitting smoking for good. The Smokers’ Helpline at 800-QUIT-NOW (800-784-8669) is a free, confidential, quit line sponsored by the Massachusetts Department of Public Health. This resource can answer your tobacco-related questions, refer you to tobacco treatment programs and give counseling over the phone.