The Straight Dope on Smoking Cessation - How to Quit Smoking

When my sisters and I were young, my father did his very best to educate us about the dangers of smoking. He had all the right qualifications. He was a family doctor, who had worked with Albert Schweitzer for nine months. He had the best educational materials, like home movies of amputated limbs. One of the nastier side effects of smoking, he would tell us, is that nicotine blocks the smaller blood vessels. The resulting lack of oxygen caused hands, feet, legs, etc. to die and then rot right off the body. Not right away, but at the tail end of, say, a thirty-year long pack a day habit. It was great stuff to strike the fear of God into an impressionable ten year-old, but in the end it wasn't enough to stop me from developing my own pack a day habit.

As a teenager growing up in the Seventies, those images of chain smoking rock stars and French intellectuals carried so much more weight than Dad's lectures. And it would be at least another twenty years before C. Everett Koop, George Bush's Surgeon General, dropped the dime on the tobacco industry, proclaiming nicotine to be every bit as addictive as heroin and cocaine. By that time, I had already smoked myself to near-death twice. After all, having the flu and bronchitis makes life twice as miserable without that nicotine fix. Never mind that smoking while being that ill will bring on the worst kind of pneumonia you can imagine.

If you've ever wondered what it would feel like to have your throat spray-glued shut, try smoking while having bronchitis. You'll learn something else, too: that too much nitroglycerin spray will give you the worst headaches ever. It's normally administered to patients who are about to die from a heart attack, but it is also very good at opening swollen shut airways.

That experience was about as successful in helping me quit smoking as Dad's home movies. But it's not as though I never tried to give up smoking. The vast majority of smokers try quitting over and over again. The addiction, however, is much stronger than best intentions. What makes things worse is that, despite all public laws and advertising campaigns we already have in place, the addiction to nicotine is not only minimized in the public opinion; it's considered to be one that's socially acceptable. Bringing up your nicotine habit is the best way to get laughed out of any twelve-step program.

Like so many other smokers, I've tried to quit smoking many times. Mark Twain is supposed to have said it's the easiest thing in the world; after all, he had done it quite often. Like any other addiction, nicotine dependency is a lifelong affliction. And the bad news for nicotine addicts is that there is no magic bullet. There are plenty of books on how to quit smoking, and many of them are very good. There are smoking cessation aids, and many of them are very good, as well. I have tried four different approaches, with varying degrees of success: cold turkey, the patch, nicotine gum, and Chantix.

Who hasn't heard the story of the former smoker who just cold-turkeyed his habit?

"Twenty-five years ago, I put out my last butt, and I never picked up another one again. It's all about willpower."

The cold turkey method, in my experience, is the most painful, most dangerous, and least effective method. Nicotine withdrawals are terrible. For a heavy smoker, like me, the first two weeks are pure Hell. That goes for the quitter as well as for those unfortunate enough to cross his or her path.

My own withdrawal symptoms, while cold-turkeying, included sleeplessness, irritability, and great physical discomfort. There were days when I literally wanted to crawl out of my skin.

I know of one person who became so agitated during his first two weeks of quitting that, in a fit of rage, he broke every dish in the house and kicked a hole into the kitchen door.

Although my own behaviors never escalated to that degree, I became a thoroughly unpleasant person during my first two weeks. My friends, who had been supportive of my quitting at first, repeatedly invited me to pick up the habit again after a few days. I became that hard to live with.

The withdrawal symptoms subsided after two weeks, and as long as I wasn't around tobacco smoke, I didn't have any cravings.

The cold turkey method required a lot of willpower on my part, and a saintlike patience on the part of my friends. It required something else, as well: an awareness that the present absence of nicotine cravings doesn't mean you have beaten your addiction.

In all honesty, I do not recommend the cold turkey method.

My next attempt to quit smoking involved the use of nicotine patches. Adhesive nicotine patches administer a low dose of nicotine through the skin over a twenty-four hour period. That dose is decreased over a period of three to six months.

At first, the cost of a week's supply may seem prohibitive. But when I did the math, I realized that one week's worth of nicotine patches cost about the same as one carton of name brand cigarettes. That was about how much I smoked in a week.

The biggest mistake a person using the patch can make is to not read the instructions that come with the step 1 pack. The instructions are absolutely vital. For instance, before using the patch, you should abstain from smoking for a full twenty four hours. Once you are on the patch, you must not smoke. And if you decide to go back to smoking, be sure to be off the patch for a full twenty four hours. A nicotine overdose will make you as sick as a dog. It can even kill you.

It is also a mistake to think that simply applying the patch is all you need to do. The patch will take the edge of the nicotine withdrawals, but it in no way replaces the full experience of smoking. Smokers love the feeling of the smoke filling up their lungs. It's ironic, but smoking actually makes breathing a pleasurable experience. Many patch manufacturers therefore recommend a program of daily deep breathing exercises while using the patch.

As with all addictions, physical nicotine dependency is only one aspect of a much larger syndrome. The patch takes care of one aspect of the addiction, but it is no replacement for the necessary commitment to being smoke free. If your commitment to being nicotine free is lukewarm, the patch will not help you.

When on the patch, you'll need to constantly remind yourself of why you want to be smoke free. That's and easy enough task, though. Write three good reasons for wanting to quit smoking on a 3x5 index card, and carry it in your wallet. When you get the craving, reach for the card first. Read it every morning when you wake up. Read it after breakfast, lunch, dinner. Read it before you go to bed. Read it every time you would normally reach for you pack of smokes.

The patch is not for everyone, however. Nicotine is an irritant, a poison. It has been wreaking havoc in your lungs and your blood vessels, and your skin isn't likely to be happy about being brutalized by nicotine, either. Some users have reported severe skin irritation from the patch, and if you choose to use the patch, be sure to apply it to a different area of your body every day.

In my experience, the time of year is also a factor to consider. Your mind may love nicotine, but your body hates it. It will do everything it can to get rid of it. And a good hot summer day will ensure you'll sweat that patch right off your body.

Nicotine gum is great. In fact it's so wonderful, I doubt it is a very effective smoking cessation aid. When using nicotine gum, be sure to follow the program doggedly. I mean: doggedly. Otherwise, you're likely to become more addicted to the gum than cigarettes.

Chewing nicotine gum offers many social and other types of payoffs that smoking cigarettes doesn't. Your friends may frown on your smoking habit, but they'll approve of your being on the gum. You can't smoke in a bar or restaurant, but you sure as heck can chew gum. You don't have to leave your work station for a smoke break. You can pop in that piece of gum right there. You can chew it when you're sick with the flu. And best of all, while a cigarette may last you anywhere from five to ten minutes, you can milk a single piece of nicotine gum for nearly two hours of chewing pleasure. Imagine a two hour smoke!

It's not a terribly flawed product, because in the end, you the addict, must take responsibility for your own addiction. You must be willing to work the program. You must be committed to becoming smoke free. You must not cheat!

Some people don't like the taste of nicotine gum. However, the manufacturers deserve credit for having done a lot work work in improving the taste. I have found that overuse of the gum creates an unpleasant tingling sensation in the tongue.

Not too long ago Pfizer placed a drug called Chantix on the market. For a time, it was considered the magic bullet for the problem of nicotine addiction. The concept is both, simple and beautiful. You take one pill every day for six months, and you don't have to make a serious effort to quit. But while you are happily smoking away, Chantix is blocking the nicotine receptors in your brain.

Yes, our brains are programmed to enjoy nicotine. Chantix makes sure they don't. So while you're lighting up one coffin nail after the other, you're not getting any enjoyment out of it.

I smoked my way through the first two weeks of being on that pill, but I gradually smoked less and less, until one day I realized I still had half a pack of cigarettes left, but no desire to light up.

I never experienced any side effects while on Chantix, but according to the manufacturers, these can be quite serious.

"The most common side effects include nausea (30%), sleep disturbance, constipation, gas and/or vomiting," states the cautionary note on chantix.com. "Some patients have reported changes in behavior, agitation, depressed mood, suicidal thinking and behavior."

Law firms, such as Audet & Partners, LLP have even set up their own websites looking for those who want to participate in a class action law suit against Pfizer.

As scientists continue to study the mechanics of addictive behavior, more options will become available to those looking for effective ways to quit smoking. Discipline and determination are likely to remain key factors in the quest for freedom from nicotine. And even though there still is no magic bullet to date, more answers and options on how to quit smoking become available every day.