Quitting Smoking: A Difficult But Important Decision

Smoking Cessation

Smoking cigarettes is well known as being harmful to your health. Still, many people knowingly continue to smoke due to both the addictive nature of smoking and the difficulty associated with quitting. Nicotine is physically addictive, and smoking habits are psychologically addictive. This makes it difficult to stop smoking because of the large mental and physical urge to smoke. Therefore, it is very important to set up an environment in which smoking cessation is most feasible.

Why is Smoking Addictive?

The addictiveness of smoking comes from a number of factors:

• Nicotine

  Nicotine is the chemical that causes both the desired effects and physical addiction from smoking. Nicotine is excitatory and causes your heartrate and blood pressure to increase while making you feel happy and alert. The fact that nicotine also leads to this effect within 10 seconds of inhaling adds to the addictiveness of the drug.

• Psychology

  Parts of smoking become habit, and you begin to “crave” the physical act of smoking almost as much as you crave the nicotine. Raising your hand to your mouth repeatedly becomes a soothing habit and in itself can be a hard motion to give up.

• Social/everyday behaviours

  This is one of the most difficult aspects of smoking cessation. It becomes such an integral part of your daily life that it feels like something is missing if you don’t smoke in certain situations. The common places for the strongest urge to smoke are driving, when you wake up, breaks at work, and spending time with other smokers. Since you can’t avoid being in the car or waking up in the morning when you quit smoking, these activities can act as triggers and make avoiding smoking more difficult.

• Withdrawal symptoms

  Many people don’t realize how physically and mentally difficult it can be to quit smoking, and this is, at least in part, due to the symptoms experienced during withdrawal.

Smoking Withdrawal

Side effects experienced during smoking withdrawal can be extremely unpleasant and are often the reason why people give up quitting.

• Worsened mood—anxiety, feeling depressed, irritability, difficulty concentrating
• Restlessness
• Increased appetite (weight gain)
• Headaches
• Difficulty sleeping

These symptoms usually peak 2–3 days and resolve almost completely within 2 weeks. The cravings that continue after this time period are usually then less related to the nicotine addiction and more caused by the social behaviours and psychological habits associated with smoking. There are also ways to minimize these symptoms with medication management. If you think medication management may be helpful, speak to your healthcare provider about this possible option.

Benefits of Quitting Smoking

It's never too late to quit smoking. It has immediate benefits as well as long-term health benefits. Even just decreasing the number of cigarettes in your lifetime can greatly reduce your risk of disease. Following the first 2–3 days after your last cigarette, you immediately start seeing benefits:

• Easier breathing
• Stronger sense of taste
• Increased energy
• Sinuses become clearer

The most important health benefits, though, are the long-term improvements in health, including a reduced risk of:

• Cardiovascular disease
• Cancer
• Infections
• Respiratory issues

  While you can’t cure COPD with smoking cessation, the only effective way to prevent it from getting worse is to stop smoking.

• Death

  Quitting smoking before the age of 50 decreases your chance of dying in the next 15 years by 50%
  In general, the younger you quit smoking, the longer your lifespan can be.

How to Help a Loved One Quit Smoking

There are a number of steps involved with smoking cessation, but the most difficult for most people is the actual initial decision to quit. Many smokers don’t want to quit and also don’t want to be told to quit. The best you can do to support someone in this stage is to give information without being too pushy.

Once someone does make the decision that they want to quit, this is when they will need the most support. Providing moral support and also being able to hold someone accountable can be incredibly helpful for making this tough choice. Ask your loved one about how they would best like to be supported.

How To Make Smoking Cessation Successful for Yourself

Once you have decided to quit smoking, you have crossed the most difficult hurdle in the process. The next step is to stick with it. The cravings are the most intense for the first couple days, and then they should begin to subside. It is important to get through those first few weeks, even if they seem difficult, as you know it will only get easier from there. Some tips to make smoking cessation as effective as possible are:

• Set a date to quit smoking and stick with it.
• Tell your friends and family that you are planning to quit smoking, so they can support you and even keep you accountable.
• Remove all cigarettes and ashtrays from your home, car, and workplace.
• Stay away from avoidable situations where you would typically want to smoke.
• Prepare for how you plan to occupy yourself when you experience cravings, such as by chewing gum, going for a run, playing video games, calling a friend, or cooking. Keeping your hands and/or mouth busy is typically most successful.
• Involve a healthcare provider (HCP), such as a family physician, pharmacist, or counsellor. This can help you to stay accountable and provide support from outside your social group. Even just talking about how you are feeling can help you stay on track.

  You can also speak with your HCP about medication options for quitting smoking.

Medications for Quitting Smoking

There are three types of substances approved by the FDA to aid in smoking cessation. The main benefit of these substances is to reduce urges to smoke and/or help with withdrawal symptoms. These three substances are nicotine replacement therapy, bupropion (brand name Zyban), and varenicline.

Nicotine replacement therapy (NRT)

Nicotine replacement therapy is a great option for those trying to quit smoking due to the negative health consequences of smoking cigarettes. Since the physical addiction to cigarettes comes from nicotine, getting the nicotine from another source allows you to stop inhaling the other harmful chemicals in a cigarette. When quitting smoking, adding in NRT increases rates of abstaining smoking by 50-70%. The many different dosage forms for NRT also allows different patients to tailor the route of administration to their own needs.

NRT gum

Pros

• Different flavours (original, cinnamon, fruit, mint)
• Serves as distraction/substitution for your mouth from smoking
• Can be used in combination with other NRTs
• Can be used to manage acute craving
• Dose can be easily titrated up and down
• Less expensive

Cons

• Frequent dosing can cause poor adherence
• Proper chewing is necessary for correct dosage
• Not acceptable or desirable for some people
• Not ideal for people with a lot of dental work (gum can stick to dental work
• Some possible side effects: mouth/throat irritation, jaw soreness, nausea/burping/vomiting, hiccups, light-headedness

NRT lozenges

Pros

• Different flavours (cherry, mint)
• May serve as oral substitute for smoking
• Dose can be easily titrated up and down
• Can be used to manage acute craving
• Can be used in combination with other NRTs
• Less expensive

Cons

• Frequent dosing can cause poor adherence
• Some possible side effects: mouth and throat irritation, hiccups, nausea/vomiting/burping, light-headedness

NRT transdermal patch

Pros

• Once-daily dosing makes adherence easier
• Discrete, which some people prefer
• Can be used to manage acute cravings
• Can be used in combination with other NRT
• Less expensive

Cons

• Doesn’t satisfy the desire to have something in your mouth
• Not for patients with certain skin conditions
• Cannot be used to treat acute cravings
• Some possible side effects: skin irritation at site of administration, Sleep disturbances

NRT nasal spray

Pros

• Can be titrated up and down for dosage adjustment
• Can be used for acute management of cravings

Cons

• Frequent dosing can cause poor adherence
• Nasal administration is not desirable for everyone
• Not for patients with chronic nasal disorders
• Some possible side effects: nasal and throat irritation, eye irritation/watering, sneezing, coughing
• More expensive

NRT oral inhaler

Pros

• May satisfy the urge to have something in your mouth
• Can be used to manage acute craving
• Can be used in combination with other NRTs

Cons

• Frequent dosing can lead to poor adherence
• Some possible side effects: mouth/throat irritation, cough, hiccups, nausea/vomiting
• More expensive

Bupropion

Bupropion is a medication typically used to treat major depressive disorder (MDD) under the brand name Wellbutrin, but it is also approved by the FDA to aid in smoking cessation, under the brand name Zyban. Bupropion decreases the cravings for nicotine and can also decrease the severity of withdrawal symptoms. Bupropion therapy must be started 1-2 weeks before you stop smoking in order for it to be effective.

Pros

• May also be beneficial to patients with mental health issues
• Can be used in combination with NRT
• Oral medication is typically easy to adhere to

Cons

• Increased seizure risk
• Contradicts the use of other medications (such as monoamine oxidase inhibitors, levodopa, etc)
• Contradictory with certain medical conditions (such as bulimia nervosa or anorexia nervosa)
• Some possible side effects: difficulty sleeping, dry mouth, constipation, nausea

Varenicline

Varenicline is a medication that is approved exclusively to aid in smoking cessation. It has also been shown to be effective in aiding people who have had trouble quitting smoking. Varenicline is effective in even just being able to reduce the number of cigarettes smoked. Varenicline therapy must be started 1 week before you stop smoking in order for it to be effective. The tablets also must be taken after eating and with a full glass of water.

Pros

• The most effective smoking cessation therapy when used in isolation
• Oral medication is typically easy to adhere to
• Often beneficial for patients who have tried and failed other medications for smoking cessation

Cons

• Must be taken after eating and with a full glass of water
• Some possible side effects: nausea, sleep difficulties/vivid dreams, headache, flatulence/constipation, taste changes
• More expensive

What If I Relapse and Start Smoking Again?

Relapse occurs for most people who attempt to quit smoking. It is normal, and it is okay. It’s also important to try not to feel bad about yourself or as though you have failed. The best way to handle a relapse is to just set a new start date to quit smoking and to try again. It is never too late to stop smoking, and you can never try too many times. Even if you are not successful the first time, the more times you try to stop smoking the more you are reducing your smoking-related health risks.