Smoking Cessation

Harry L. Mills, Ph.D. and Joyce R. Mills, M.S., M.Ed.

The World Health Organization expects that by 2020 the worldwide death toll from smoking will reach 10 million, causing nearly 18% of all deaths in the developed world. According to the National Institute on Drug Abuse Research Report on Nicotine Addiction, more people die from tobacco than from alcohol, cocaine, heroin, murder, suicide, car accidents, fire and AIDS combined. Medically tobacco use accounts for one-third of all cancers. Smokers die from cancer at a rate that is twice as high as nonsmokers, four times higher for heavy smokers. Lung cancer is the number one cancer killer for both men and women, with smoking being associated with 90% of lung cancer cases. Smoking is also associated with cancers of the:

·        mouth

·        tongue

·        throat

·        larynx

·        esophagus

·        stomach

·        pancreas

·        cervix,

·        kidney

·        ureter

·        bladder.

In addition to causing cancer, smoking also causes chronic bronchitis and emphysema, and worsens asthma. Cigarette smoking substantially increases the risk of coronary heart disease, including stroke, heart attack, aneurysm and vascular disease. It also contributes to peptic ulcers, varicose veins, osteoporosis, periodontal disease, Alzheimer’s disease, atherosclerosis, high blood pressure, allergies and impotence.

Smoking during pregnancy increases the risk of infant mortality, premature delivery and low birth weight babies.  High levels of nicotine and carbon monoxide, a lethal gas which is another ingredient of tobacco smoke, interfere with the oxygen supply to the fetus which accounts for the developmental delays often seen in the fetuses and infants of mothers who smoke. Following birth, smoking by parents has been linked to sudden death syndrome and an increase in respiratory illnesses in the child.

Secondhand smoke contributes to 3,000 lung cancer deaths in nonsmokers and as many as 40,000 deaths from cardiovascular disease. Secondary smoke in the home accounts for an increased risk of childhood asthma as well as an increase in the symptoms of asthma in children who already have the disease.

Cigarettes are the most commonly used tobacco product and probably the most dangerous. However, cigars, pipes and smokeless tobacco products (chewing tobacco and snuff) involve there own risks.

Cigars

Even if a cigar smoker does not inhale they are still at greater risk for serious health problems than a nonsmoker. Cigars have as much nicotine as several cigarettes and when inhaled this nicotine is absorbed as rapidly as through cigarettes. If not inhaled the nicotine found in cigars is absorbed through the mucus membranes of the mouth. Regardless of the mode of exposure, nicotine is a highly addictive substance. Cigar smokers are also at increased risk for numerous health problems:

• Cigar smoking increases the risk of death from lung, oral cavity, esophagus and larynx (voice box) cancer.
• Cigar smokers are 4 to10 times more likely to die from laryngeal, oral or esophageal cancers as nonsmokers.
• Cigar smokers who inhale are at increased risk for pancreas and bladder cancer.
• If smoke is inhaled there is increased risk for heart disease and lung diseases such as emphysema and chronic bronchitis.
• Cigar smoking has been linked to erectile dysfunction in men.

Pipes

Recent research by the American Cancer Society has found that pipe smokers face similar risks for cancer and other diseases as cigar smokers. Pipe smokers were found to have an increased risk for these cancers:

• lung
• throat
• esophageal
• colon
• larynx.

Pipe smokers were found to have an increased risk for heart disease, stroke and chronic obstructive pulmonary disease (emphysema and chronic bronchitis). Risks were generally less than those due to cigarette smoking but equal to or larger to the risks of smoking cigars.

While pipe smoking has decreased in the US over time, tobacco manufacturers have been quick to note the successful marketing of premium cigars. Similar strategies are seen in the marketing of flavored tobacco and novel pipes to attract new smokers. Of particular concern is the marketing of “hookahs” as a trendy, less hazardous alternative to smoking. Hookahs are a variation of water pipes developed in Turkey over 500 years ago. Hookahs have become popular in the U.S. in recent years, and hookah bars have sprung up in big cities and some college towns in the U.S. Although lounging on velvet pillows, taking turns puffing on a hookah filled with fruit and honey flavored tobacco sounds exciting, it is also hazardous to your health, exotic environment or not.

Smokeless (chew) tobacco

Smokeless tobacco includes chewing tobacco (“chew”) and snuff (“dip” or “rub”). Smokeless tobacco products are not harmless indulgences. The following problems are common:

• Smokeless tobacco delivers a high dose of nicotine resulting in similar daily doses of nicotine in smokeless tobacco users and smokers.
• After using smokeless tobacco for 3 to 5 years white, leathery patches or lesions (leucoplakia) form on the cheek or gum of users. These lesions are capable of developing into cancers of the lip, tongue and cheek.
• Smokeless tobacco may play a role in high blood pressure and cardiovascular disease.
• Individuals who use chewing tobacco and snuff are 2 to 3 times more likely to develop severe dental problems, including tooth loss, abrasion of the teeth, and bone loss around the teeth than non-smokers.
• Gum disease may not only result in tooth loss but is also thought to increase the risk for diseases such as diabetes and heart disease.

Physiological effects

Nicotine activates the pleasure center of the brain. Within 10 seconds of inhaling a puff on a cigarette nicotine levels peak in the brain. The average smoker takes about 10 puffs on every cigarette smoked. Since the pleasurable effects of nicotine are short-lived the smoker soon craves another cigarette. If one cigarette supplies ten surges of nicotine to the brain, smoking 1½ packs of cigarettes a day provides a smoker 300 nicotine hits.  Since cigars and pipe smokers usually do not inhale, their nicotine must be absorbed through the mucosal membranes in the mouth. The mucosal membranes are also the entrance way for nicotine delivered from smokeless tobacco. These other forms of tobacco use may not delivery their nicotine fix as efficiently as a cigarette, but it is delivered.

Some smokers say that smoking relaxes them while others say that it gives them a boost. According to the National Institute of Drug Abuse, nicotine does both—acting as both a stimulant and a sedative. A hit of nicotine stimulates the adrenal glands which cause a release of adrenaline. This release of adrenaline stimulates the body and causes a release of glucose, as well as an increase in respiration, blood pressure and heart rate. Meanwhile insulin output is suppressed which leaves smokers with slightly elevated levels of glucose in their bloodstream. Nicotine also causes the release of dopamine in the part of the brain that controls pleasure and motivation. A similar effect is caused by cocaine and heroin and is believed to be behind the pleasurable sensations reported by many smokers. Nicotine is also able to cause a sedative (calming) effect depending on a smoker’s nervous system arousal and how much nicotine is taken. These effects occur with the use of all tobacco products; cigarette smoking merely provides the most rapid dosing.

Frequent use of tobacco products results in addiction to nicotine. Repeated exposure to nicotine results in the development of tolerance for the drug. As tolerance is build it takes a higher dose of the drug to produce the same level of stimulation. Nicotine is metabolized rapidly which means it disappears from the body in a few hours. Thus morning doses of nicotine have a greater physiological effect on the body than those occurring later in the day because of a period of abstinence during the night.

The addictive properties of nicotine contribute significantly to the difficulty tobacco users have in giving up the habit. The withdrawal symptoms from discontinuing nicotine use can be challenging and often drive people back to tobacco use.

Psychological effects

Psychological factors also influence the difficulty experienced by a user trying to break an addiction to tobacco. The pleasurable consequences of smoking are considerable and they affect not only the body but also the mind. While we rarely think of tobacco use as an addiction of the same caliber as a craving for cocaine or heroin, tobacco’s legal status does not prevent it from being highly addictive. Nicotine is a drug. The initial high from obtaining a hit of the substance relieves the immediate craving for the drug, which may be followed by the user feeling calm and relaxed. Unfortunately this satisfaction is very short-lived and a new craving quick to develop. A person attempting to quit smoking will miss the boost a cigarette gives them and/or the calming effect they perceive. Tobacco has become a dependable friend.

Psychologically, when you quit using tobacco you may go through a period of mourning for your longtime friend. Dr. Kübler-Ross analyzed the stages that human beings go through when in grief. The stages are: denial, bargaining, anger, sadness (depression), guilt and acceptance. It is definitely not an indictment of you if you miss smoking as a kind of friend and companion. It has been a big part of your life for a long time. Be kind to yourself if you have these feelings; they are part of being human. Work through the stages and they will set you free to go on as a non-smoker. Think positively. You can do this.

Behavioral components

It is very easy to associate the feel, smell and sight of a cigarette and the rituals associated with smoking (obtaining the cigarette, handling the cigarette, looking for a lighter and actually lighting the cigarette) as well as the times and places cigarettes are smoked with the pleasurable effects of smoking. These connections are formed by a process called classical conditioning. Just as Pavlov’s dog learned to salivate to the sound of a bell after having it paired several times with meat powder, we humans learn to associate the pleasures of smoking with all those daily activities in which smoking occurs. For example, if a person smokes while drinking a cup of coffee, the sight and smell of a cup of coffee may trigger the craving for a cigarette or make the craving worse. Since many cigarettes are smoked over the course of a day, many such connections are made. If we smoke while driving to work, getting into the car can result in a craving for a cigarette. If we smoke while having a drink after work, then having a drink can elicit the desire for a cigarette. If we smoke to calm down when under stress or upset we will learn to crave a cigarette when we are stressed or upset.

All the places and behaviors associated with smoking must be addressed if a person is going to be able to entirely quit using tobacco. If other behaviors can be substituted for smoking and its rituals, the connection between smoking and these other places and activities can be eliminated. Thus discontinuing the use of tobacco must deal with physical cravings, a sense of emotional loss and a redefinition of associations in a myriad of daily activities. It is a difficult task, but it can be accomplished.

Health and vitality benefits

Life is precious; it is in your power to improve not only the quality of your life but also to enhance the odds of enjoying a longer life. It is estimated that the average male smoker loses about 13 years of life while the average female smoker loses about 14 years of life. Former smokers live longer than people who continue to smoke.

Smoking cessation has immediate and long term consequences for a smoker’s health. The American Cancer Society reports the following benefits of smoking cessation, based on Surgeon Generals’ Reports in 1988 and 1990:

• 20 minutes after quitting smoking: Blood pressure drops to a level close to that before the last cigarette. Temperature of hands and feet return to normal.
• 8 hours after quitting smoking: Carbon monoxide level in the blood drops to normal.
• 24 hours after quitting smoking: Risk of a heart attack decreases.
• 2 weeks to 3 months after quitting smoking: Circulation improves and lung function increases up to 30%.
• 1 to 9 months after quitting smoking: Symptoms such as coughing, sinus congestion, fatigue, and shortness of breath decrease. Cilia (tiny hair like structures in the lungs that remove mucus from the lungs) regain normal function in the lungs which increases the ability for them to handle mucus, clean the lungs and reduce infection.
• 1 year after quitting smoking: The extra risk of coronary heart disease is reduced to half that of a smoker.
• 5 years after quitting smoking: Stroke risk is reduced to the level of a nonsmoker 5-15 years after quitting.
• 10 years after quitting smoking: Lung cancer death rate is about half that of someone who continues to smoke. Risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases.
• 15 years after quitting smoking: Risk of coronary heart disease is the same as a nonsmoker.

Quitting smoking also reduces the effects of tobacco on your physical appearance and improves social interaction with nonsmokers by:

• reducing premature wrinkling of the skin
• eliminating bad breath associated with smoking
• eliminating a major cause for stained teeth
• reducing the risk of gum disease
• eliminating a smoky smell to clothing and hair
• eliminating the cause of yellow fingernails.

Once you quit smoking you will notice that:

• food tastes better
• your sense of smell will return to normal
• activities of daily life will not cause you to be out of breath
• you will feel more energetic and your stamina for physical activity will increase
• exercise will become more enjoyable
• you no longer have to worry whether you have smoking supplies on hand
• breaks at work will no longer have to revolve around smoking
• you will no longer have to go outside in inclement weather to smoke to protect your children’s health because you are setting a good example for them by not smoking
• your clothes and person will not reek of smoke
• falling ashes will no longer damage your clothes
• frantic searches for places to smoke are not necessary
• falling asleep while smoking and setting the house on fire is no longer possible
• social encounters with friends no longer involve issues about whether you may or may not smoke in their home
• as a single nonsmoker you will have a larger group of people to date and possibly establish a long term relationship with than when your habit forced you to associate primarily with other smokers
• you will be part of the mainstream and no longer burdened by social stigmas associated with being a smoker
• no longer will you be a liability to your employer and associates because your habit raises the insurance rates for the entire group or for fear that your excessive sick days will hurt productivity and increase costs
• no longer will you have to worry about landlords refusing to rent to you because you are a smoker.  

The nicotine monkey will be off your back and you will soon begin to look and feel much better. You will experience a resurgence in self-confidence as you abandon smoking and your life will offer new promise. Then, there are the financial considerations…

Planning what to do with found money

If health improvements and more social freedom are not sufficient incentives there are financial rewards to quitting smoking. You can find your hidden money by a simple formula. Take the cost per day for your smoking materials and multiply it by 365 days. Surprised? Now multiply that amount by 10 so you can see what you would save in the next 10 years. And, this does not count all the money you have to spend extra for life and health insurance and for tobacco related health problems.

Just what could you do with all this money? As you begin your abstinence campaign start setting aside the money you would ordinarily spend on smoking materials and supplies such as lighters. Each day your treasure will grow. You are making a courageous fight to increase the length and quality of your life, please consider with care what you will do with this newly found money. Make it worthy of your sacrifice.

Dealing with the issue of weight gain

“I don’t want to gain weight,” is a fear that keeps many people from quitting smoking. While many smokers gain some weight when they quit smoking, it is usually in the five to seven pounds range which is the amount many smokers tend to be under the expected weight for their height. Women tend to gain slightly more weight than men. The weight gain is usually less than 10 pounds when no attempts are made to modify diet or exercise patterns during the period of quitting smoking. If more than ten pounds are gained other factors are probably responsible than smoking cessation. In any case, the danger from this amount of weight gain is not nearly as dangerous as continuing to smoke.

There are two approaches to the weight gain issue. The first involves not worrying about the slight weight gain and focusing on getting to the three to six month point as a nonsmoker, then dealing with the weight gain issue. It is easier to quit smoking if one does not have to also focus on eating issues. In any case, as your body begins to resume more normal functioning once relieved of the daily barrage of carcinogenic toxins and nicotine you will find that you will be able to perform the activities of daily life more easily. Food will taste better and this is a perfect time to reacquaint your body with healthy food choices and begin a program of regular exercise. Exercise can help relieve stress, serve as a substitute activity for smoking and burn excess calories. Nicotine acts as an appetite depressant between meals, once abstinent smoking may be replaced by between meal eating. Eating smaller meals with in between snacks helps many smokers reduce gain weight if there is not an overall increase in calories.

If the idea of gaining a few pounds of weight is really distressing to you then it is ok to be more aware of food issues as you go through smoking cessation. This is not the time to be overly critical of yourself for your food cravings. Do not try focusing on both food and smoking cessation unless you are willing to acknowledge that the tobacco cessation is the more important issue. Be patient with yourself and plan for frequent, small, non-food, non-tobacco rewards to help keep you motivated and to reduce the feeling of deprivation.

Try fresh, raw vegetables when you get the urge to snack. Be sure to drink plenty of water to help flush the nicotine from your system. Substitute diet soda for sugar sweetened soda. If you drink lattes or similar caffeinated beverages on a regular basis, switch to low-fat or fat-free ones and choose a smaller size than usual or switch to a flavored coffee sweetened with a sugar free sweetener.

Plan three nutritious meals and two or three nutritious snacks a day at the same level of calorie intake as while smoking.  These changes are merely to help prevent or reduce weight gain. THIS IS NOT THE TIME TO TRY AND LOSE WEIGHT.  Keep food bowls off the table and have your plate served in the kitchen. This way there will be no leftovers to tempt you after you finish your meal. Eat slowly and savor your food. Leave the table as soon as you finish you meal or snack and brush your teeth.

Regardless of how you plan to deal with the issue of possible weight gain, plan to include a minimum of 20-30 minutes of exercise into your daily schedule. Walking is a great activity to substitute for smoking while you are getting over your dependence on nicotine. Instead of an after dinner smoke, take a walk. Take a yoga class and take note of positions you find most relaxing. When stressed, take a few minutes and assume one of your favorite positions instead of smoking or eating.

As you are able to increase the intensity of your workout you will discover that exercise has important psychological benefits.  Many of the psychological benefits you now may feel you get from tobacco can be obtained from exercise. Exercise can not only make you feel more energetic in general, but can also improve your quality of sleep and help you relax when under stress. Select activities you think you might enjoy and give them a try. Not only will you feel better but increased physical activity is one of the secrets of maintaining a healthy weight.

Medication

If you have had problems quitting before or feel that you might be hooked on nicotine you may want to consider nicotine replacement options. Nicotine replacement works by replacing the nicotine you receive via using tobacco with a safer form while you deal with the psychological and behavioral issues also associated with tobacco use. The nicotine replacement reduces the impact of withdrawal symptoms from nicotine. Many smokers who try to quit without nicotine replacement require several attempts to stop smoking before they are successful because they are so bothered by nicotine withdrawal symptoms. By reducing the symptoms of withdrawal with nicotine replacement smokers have an improved chance of being successful in stopping smoking.

Nicotine replacement only helps with the physiological aspects of smoking; it is not intended to be the only strategy a smoker uses to stop smoking. The US Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guidelines on Smoking Cessation recommends nicotine replacement for all smokers trying to quit except people with heart or circulation diseases and pregnant women. Smokers with these health issues should consult with their doctor as to whether nicotine replacement is appropriate in their particular case as they try to quit smoking.

Nicotine replacement comes in many forms. Nicotine patches, nicotine gum and nicotine lozenges are available over the counter. Nicotine nasal spray and nicotine inhalers are available by prescription. Nicotine inhalers are the most like smoking but the most expensive of the nicotine replacement alternatives. They may or may not be a good idea since ideally a person will want to eliminate cues associated with smoking as they go through the cessation process.

Nicotine gums, lozenges and inhalers use an oral route to control your cravings. The nicotine spray works very fast, while the nicotine inhaler is more like smoking. The patch only has to be applied once a day. Allergies may be seen in some people with the use of patches, inhalers or the nasal spray.

If you decide to try nicotine replacement attempt to determine which method would work best for you based on your current smoking pattern and lifestyle.

Another type of medication that can help some people quit smoking is Zyban (bupropion), also sold as Wellbutrin. This is a prescription medication, an antidepressant, that reduces the symptoms of nicotine addiction by affecting the chemicals in the brain that are related to nicotine craving. When used alone Zyban has been shown to be somewhat better than the nicotine patch in helping people quit smoking for a month. When combined with nicotine replacement significantly more smokers were able to stop smoking for over a month. This medication is not to be taken if some one has a history of a head injury, brain tumor, heart, liver or kidney disease, an eating disorder, mental conditions, diabetes or allergies. Alcohol consumption should be avoided or limited to avoid the risk of having seizures. Excess caffeine can also increase the chance of seizures while on this medication.

Zyban is not recommended for breast feeding women as it can be excreted in the breast milk. Women who are planning a pregnancy or are pregnant are to talk with their doctor before taking this medication. Older adults may be more sensitive to the effects of this drug than younger adults.  There are also a number of possible adverse interactions between Zyban and a number of prescription drugs.Be sure and ask your doctor or pharmacist about possible interactions between this medication and your prescription AND non-prescription medications.

While Zyban may offer additional help to some individuals, it is NOT a nicotine replacement product but a prescription antidepressant. Investigate carefully with your doctor whether its benefits to you outweigh potential risks of side effects.

Behavioral

In addition to nicotine replacement, which will reduce the severity of physical withdrawal symptoms, behavioral aspects of smoking must be addressed. The links between smoking and many of your activities, such as finishing a meal, driving the car, having a cup of coffee or a drink, or dealing with stress must be broken and alternative behaviors learned. It takes awhile for these associations to be broken and healthier substitute behaviors to become a habit. Take it hour by hour and day by day. Be patient with yourself. Try to plan ahead and learn from experience which strategies work best for you. Be sure and plan small, frequent rewards for successes in order to help maintain motivation.

There are also some behavioral treatments that attempt to make smoking aversive (extremely unpleasant) to the smoker. Various strategies are used which overwhelm the smoker with all the negative aspects of smoking. Smoking is thereby associated with the more repulsive consequences of tobacco use to counter the more pleasurable feelings smokers usually consider when contemplating quitting. This method is best undertaken under professional guidance. On the other hand, some people find it helpful to wear a rubber band (or a coated ponytail holder) around the wrist and to snap the band to sting the skin when tempted to smoke. This is a safe, simple, mild punishment for considering a lapse.

While fear of a painful, early death may push a smoker to want to quit, discovering that an after dinner stroll around the block on a beautiful early fall evening is more invigorating than a cigarette, or ten to fifteen minutes of sitting quietly with the eyes closed while breathing deeply can relieve stress better than a cigarette is more motivating in the long run than fear.

Hypnosis

Hypnosis and self-hypnosis combine a deeply relaxed state and the power of suggestion in an effort to improve physical health, and encourage changes of attitude. Hypnosis is used as a tool to help break conditioned behaviors and replace them with new behaviors. A 1996 U.S. National Institute of Health panel found hypnosis to be an effective pain relieving intervention for cancer and other chronic conditions. Hypnosis has also been used as a tool by smokers in their attempt to quit smoking.  Success rates among different studies are variable. Nevertheless, hypnosis may be helpful for some people. It is recommended that a smoker interested in hypnotherapy seek a licensed mental health professional who offers hypnotherapy as one of their services.

Positive thinking

It is important to be firmly commitment to your decision to stop smoking. That is why the stop smoking date and the preparation period are so important. Many other people have made this decision and have succeeded. You can too. Even if you lapse you should treat the lapse as a learning opportunity and think of options to use in the future to prevent a similar lapse. Make modifications to your program based on what you have learned and begin again. Think positively, “I can stop smoking. I will stop smoking and I will do it now.” Don’t think of never smoking again. Think of quitting in terms of one day at a time. Take it one hour at a time. It will get easier.

It is also helpful to cultivate your imagination during cessation. Close you eyes and imagine yourself feeling and looking wonderful, free from tobacco cravings, no longer troubled by coughing spells, smoker’s yellow fingers and teeth, smoker’s sour breath, no longer out of breath from climbing a flight of stairs, able to walk or run or ride a bike with ease. Imagine how proud you will feel of yourself, how more doors seem to be open on all fronts. Imagine yourself becoming healthier as you improve your quality of life. There may not be a fountain of youth but giving up tobacco is definitely an enormous step in making life more fulfilling.  Imagine living to see your children grow up. Imagine what your future grandchildren might be like and how much you would enjoy them. Imagine spending the money formerly spent on tobacco products and accessories to benefit you and your family. Breathe deeply and inhale the joys of a non-smoking life.

Arranging your environment

It is recommended that you clean and organize your environment to reduce the temptation to use tobacco. Just before your first day of smoking cessation you will want to be sure that you home and car are thoroughly cleaned to help remove the smell of smoke. Use air fresheners or sprays like Febreze to maximize the change. You should also plan to wear clean, fresh smelling clothing, and keep yourself well groomed—as this will enhance how you feel about yourself. All tobacco products should be removed from the home, workplace, automobile—anywhere you currently smoke. Ashtrays should be stored in the garage or basement or thrown out.

For the first few weeks, avoid situations you strongly associate with the pleasurable aspects of smoking. This may mean having a glass of ice tea, water or fruit juice before dinner instead of a drink, if the drink is strongly associated with smoking You might also find it easier to have a cup of hot tea in the morning instead of coffee if you regularly smoke while drinking your coffee. Pick a black or green variety and get health benefits in addition to reducing temptation.

You may also find that it is easier to rearrange the furniture in the room you watch TV so that your favorite chair is in a new place. If you regularly smoke while on the phone, use a cordless phone and go to another room to talk or if the weather is nice make your calls from outside the house. Limit your socializing to outdoor activities or situations where smoking is not allowed. If you find it impossible to avoid situations where you’ll be tempted to smoke, such as a family gathering or dinner party, try to associate with the nonsmokers there.

Inoculation

When a person quits smoking there are many challenges. The obvious ones are withdrawal symptoms from nicotine and the loss of the physical and emotional elements that are associated with smoking. Nicotine replacement therapy can help with physical symptoms and removing all smoking supplies from the environment can reduce the temptation to light up. However, there are hundreds of associations with smoking that must be interrupted before a smoker can really become comfortable as an ex-smoker. As part of your preparation you should keep a smoking diary. In it you will record where and when you smoked each cigarette and how you felt as a result of smoking the cigarette. This information will assist you in planning alternatives, ways to avoid triggers and, the places you should avoid during the initial phase of not smoking.

Social Support

Tell friends and family about your decision to quit smoking and the date that you plan to formally quit. Ask for their support. You also need successful former smokers as part of your support system. These supporters can be friends, co-workers or people you meet while participating in a group or online program for smoking cessation. Nicotine Anonymous may be able to help. Their web site is http://www.nicotine-anonymous.org. Be sure to share your planned quit date, your program details, and work out what kind of support you might receive from your special helpers Find out when and how you can contact them. You need people who you can call or instant message when you have moments of temptation that are difficult to handle. Be sure and share your successes as well as your trials with your supporters. It is thoughtful to plan little surprises for your support people to show your appreciation for their help.

Some people discover that quitting smoking is one of the toughest things they will ever do. Everyday problems are seen as insurmountable and you may want to reach for a cigarette. For many people part of the challenge of quitting smoking is caused by a sense of loss. In many cases you can help lessen the severity of these feelings by expressing them to your supporters.

For personal help in quitting smoking contact us.