Tobacco smoking is the leading preventable cause of illness and death. It is responsible for 480,000 deaths per year in the United States, and it shortens life expectancy by 10 years.
But the good news is that no matter how long you’ve smoked, no matter how heavily, your health will benefit from quitting. It is never too soon or too late in life to stop smoking.
Most smokers tell us they want to quit. However, most attempts to quit fail. Nicotine is addictive and about two-thirds of people trying to quit smoking don’t get professional support.
Research and experience have shown us that your best chance of stopping permanently is to get support to learn how to live your life without cigarettes and to use medications that can ease the process of withdrawing from nicotine.
Ease off nicotine
When people try to quit smoking, they may feel depressed, anxious or irritable, and crave a cigarette. That happens because nicotine is a highly addictive drug and people’s bodies have to adjust to living without it. However, drugs and devices are readily available that ease the physical discomfort of nicotine withdrawal and the urge to smoke. Smokers who use them when they quit double their chance of success.
One approach is to use a product that supplies nicotine in a different form than cigarettes. Examples are skin patches, gum and lozenges, which are available without a prescription, as well as an inhaler and nasal spray, which require a prescription. These products deliver small amounts of nicotine to help the smoker wean off nicotine slowly. They don’t contain the other products in tobacco smoke that cause most of the harms from smoking.
At the Mass General Tobacco Research and Treatment Center, we have found that a combination approach is safe and more effective than any one of these products alone. My advice is to use the patch continually and when you have an urge to smoke, add another product that is absorbed quickly—gum, lozenges or an inhaler.
Another strategy is to use one of the two pills that the US Food and Drug Administration has approved to treat smoking: bupropion (Zyban) and varenicline (Chantix). Bupropion, a drug also used to treat depression, increases the odds of quitting, separate from its antidepressive effect.
Varenicline seems to be more effective than bupropion. There are some concerns that in some people it may cause changes in behavior or mood. You and your doctor should discuss which of the prescription medications might be best for you.
Support is key
Many programs are available that can help motivate you to quit and provide support as you deal with withdrawal symptoms, cravings and tempting situations.
The most widely used alternative is counseling by telephone. Another option is to meet in person with a tobacco coach.
Don’t be discouraged if you haven’t been able to quit smoking in the past. Get help and keep trying. You will eventually succeed with the right combination of supports.
The article was written by Nancy A. Rigotti, MD, associate chief of the Division of General Internal Medicine at Massachusetts General Hospital and founder and director of the hospital’s Tobacco Research and Treatment Center.
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