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Smoking Cessation

Smoking Cessation

Alternate Names

  • quitting smoking
  • nicotine withdrawal

Definition

Smoking cessation is the process of quitting smoking. It involves withdrawal from nicotine addiction and a change in habits.

What is going on in the body?

At least 70% of smokers in the United States have made at least one quit attempt. The nicotine in tobacco is as addictive as cocaine. It is because of this addiction that quitting can be so difficult. Nicotine is the primary drug contained in tobacco, one that is responsible for many of its desired effects but which also harms the body in many ways.
Nicotine withdrawal occurs when the person takes in a lesser amount of nicotine. To stop smoking, a person must deal with nicotine addiction. The individual also needs to change learned associations, or habits.

Risks

What are the causes and risks of the condition?

People quickly become dependent on nicotine when using tobacco products. Anyone who uses these substances is at risk of experiencing withdrawal symptoms. A trigger or desire is anything that creates an impulse to use tobacco. Triggers can be feelings, such as stress, anxiety, depression, or boredom. They can be visual, such as a picture of a poised glamorous movie star taking a long, seemingly satisfying drag. Triggers can even be certain times of the day, such as work breaks or meals. Being around others who smoke can also be a trigger.

Prevention

What can be done to prevent the condition?

Once a person starts smoking, he or she quickly becomes addicted to nicotine. The key is never to start smoking. Antismoking campaigns can be effective in getting this message out.

Diagnosed

How is the condition diagnosed?

Someone who is addicted to nicotine will have strong cravings for it. When the person doesn't smoke for a period of time, he or she will have nicotine withdrawal symptoms.

Long Term Effects

What are the long-term effects of the condition?

There are typically no long-term effects from nicotine withdrawal. The most intense symptoms last only a few weeks. Craving for nicotine is the only symptom that persists longer than a month. The health risks from the chemicals found in tobacco are enormous.
Tobacco use can cause the following diseases:
  • chronic bronchitis
  • coronary artery disease and other forms of heart disease
  • emphysema
  • gastroesophageal reflux disease
  • lung cancer
  • many other forms of cancer
Tobacco use can also cause the following conditions:
  • decreased life expectancy
  • erectile dysfunction, or impotence
  • gray hair and baldness
  • high blood pressure and circulation problems
  • infertility in men and women
  • osteoporosis and increased risk for bone fractures
  • premature wrinkles
  • weakened immune system
The good news is that the health damage caused by tobacco is preventable and much of it is reversible. Within 20 minutes of quitting, the healing begins. Fifteen years after quitting, the person's risk of heart disease and early death is almost the same as that of people who have never smoked.
In addition, an individual's risk of dying from lung cancer, chronic bronchitis or emphysema decreases as long as he or she remains smoke free. An individual who quits smoking will have the following advantages:
  • circulation to the hands and feet will improve
  • food will taste better
  • general health will improve
  • risk for serious illness will decrease
  • sense of smell will improve
  • skin will look healthier

Other Risks

What are the risks to others?

Smoking cessation poses no risk to others. In fact, quitting will reduce the amount of secondhand smoke to which friends and family are exposed, and may even influence others to quit as well.

Treatments

What are the treatments for the condition?

The first step in smoking cessation is setting up a Quit Plan. A Quit Plan includes the following:
  • quit date and written commitment to stop smoking
  • preferred quit option(s)
  • preferred quit method(s)
  • support team
  • coping strategies for dealing with triggers, withdrawal symptoms, and other challenges
There are a number of methods for quitting smoking that address the addiction to nicotine. Going cold turkey, which means stopping smoking abruptly, is one method. Two other methods are non-nicotine medication and various forms of nicotine replacement therapy. The person's level of nicotine dependence and the results of any prior quit attempts should be taken into consideration.
The individual can work with the healthcare professional to choose the best method. Regardless of the method chosen, the person must also pay attention to breaking the physical habits of pulling out and lighting the cigarettes. Research shows that smokers who use behavior modification strategies in addition to addressing the physical addiction have a better chance of succeeding.
Nicotine replacement products help reduce the physical withdrawal symptoms that occur with smoking cessation. These medicines help reverse the process in which the person's body learned to crave more and more nicotine. Over time, they help the person's body stop craving nicotine.
However, nicotine replacement therapy does not completely eliminate withdrawal symptoms nor does it give the individual any more willpower. It does let the person focus on breaking the habit of smoking as the body adjusts to lower levels of nicotine.
Types of nicotine replacement therapy include:
  • nicotine gum, which is available over-the-counter or by prescription
  • nicotine inhalers, which are available by prescription
  • nicotine nasal spray, which is given by prescription
  • nicotine patches, which are available over-the-counter in various strengths
Since these products replace the nicotine the person would have gotten from a cigarette, nothing new is being introduced into the body. The direct effect from nicotine is the same except that the drug is administered at a more constant level instead of in a "rush" as one would get from a cigarette. This helps deal with the addiction, especially as the dose of replacement is reduced.
A person using nicotine replacement products should not continue to smoke. Nicotine can cause serious medical problems, including death, if it is abused. Nicotine replacement products are not recommended in certain situations:
  • people who have had a heart attack within the past 2 weeks
  • people who have serious arrhythmias, or irregular heartbeats
  • people who have angina, the chest pain associated with heart disease
  • women who are pregnant, unless their healthcare professional specifically recommends it
Bupropion (i.e., Zyban) is a pharmaceutical alternative to nicotine replacement that has been approved by the FDA for smoking cessation. How Zyban works is largely unknown. It is thought to act on certain pathways in the brain that are involved in nicotine addiction and withdrawal, helping the person feel less of an urge to smoke. Zyban also helps reduce some of the more bothersome nicotine withdrawal symptoms associated with smoking cessation such as anxiety, irritability, frustration, difficulty concentrating, and restlessness.
The newest medication for smoking cessation is varenicline (i.e., Chantix), a drug that blocks nicotine receptors in the brain. The medication is taken in increasing doses for a week and then smoking is stopped.

Side Effects

What are the side effects of the treatments?

The most frequently reported side effect from the nicotine patch is skin irritation. Those who use a 24-hour patch sometimes report having vivid dreams. The patch may also cause headache or joint pain.
Nicotine gum can cause some minor mouth, tongue, and throat irritation. It may also cause an arrhythmia and palpitations. Swallowing the gum can cause nausea or vomiting.
The most common side effects from the nasal spray are irritation of the nose and throat, watering eyes, sneezing, and cough. These side effects may lessen in intensity after the first week of use.
The most common side effect of the nicotine inhaler is irritation of the lining of the mouth and throat. Some people may experience cough, runny nose, or nausea.
The most common side effects of Zyban include dry mouth and insomnia. If side effects occur, they are generally mild and disappear after a few weeks. Other side effects include shakiness, skin rash, dizziness, and anxiety.

After Treatment

What happens after treatment for the condition?

Withdrawal symptoms are temporary, generally lasting only 1 to 2 weeks. The person can derail smoking triggers by using counteractions. Counteraction involves actively responding to the trigger, but not in the usual way. Instead of smoking, the individual comes up with a different and healthier response.
There are three main ways to cope with triggers.
    • Avoid the situation. Someone who smoked while driving a car can choose a different route that requires more concentration.
    • Change the situation. The person may choose to sit in the nonsmoking section of restaurants.
    • Find a substitute for a cigarette. Pens, small toys, or rubber bands are good options. Chew sugarless gum or hard candy, or try carrot sticks.
A relapse occurs when a person who has stopped smoking slips and has a cigarette. Keys to dealing with a relapse include:
  • Learn from the relapse and move on.
  • Figure out the details that led to the slip.
  • Review the Quit Plan and reasons to stop smoking.
  • Revise the Quit Plan and set a new quit date.

Monitor

How is the condition monitored?

To remain nicotine free, smokers should avoid tempting situations and do something else when the urge to smoke arises.

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