Trying to quit smoking with willpower alone almost never works.
Smokers Jessica Hammond and her husband went cold turkey for Lent in 2006. He hung in for about six months; she stayed smoke free through the birth of the Damascus, Md., couple's first child in February. But last July, when her father suddenly became ill and died, the 26-year-old, who started her daily half-pack habit as a college freshman, lost her resolve. Breaks from the hospital bedside vigil meant going outside with family members who would promptly light up. "My breath of fresh air was their cigarette smoke," says Hammond, who joined them. Motivated by her baby daughter, she intends to try again this year: "It's such a nasty habit," she says. "I want to quit now before Amaya even recognizes what a cigarette is."
At any age, quitting can avert or blunt myriad health hazards and might avoid heartache for would-be parents—smoking can hamper conception in women and reduce sperm count in men. The earlier a smoker grinds out that last cigarette, the greater the gain. Male doctors who ditched the habit before age 35 had nearly the same life expectancy as did a matched group of physicians who never picked it up, according to a 2004 study in the British Medical Journal
But most smokers know perfectly well they should quit, and 7 out of 10 say they want to. The challenge is how to break free of nicotine's suffocating grip for good. Just 2 to 4 percent of those who try are smoke free—with no slip-ups—a year later.
Pure willpower is the usual strategy, says Douglas Jorenby, director of clinical services at the University of Wisconsin's Center for Tobacco Research and Intervention, and it rarely works. "Tobacco dependence is a chronic disease," he says, so over the long term, "the odds are very great that you'll relapse."
Most experts agree that smoking is a drug habit with a tenacious clutch. "It's about the same as heroin," says Ivan Montoya, an addiction expert at the National Institute on Drug Abuse. And nicotine, unlike heroin, is legal, available everywhere, promoted by billion-dollar marketing campaigns and associated with enjoyable—and still widely accepted—social behavior.
That's why smokers need help, says Jorenby. The 2008 federal guidelines for treating tobacco use and dependence strongly recommend tools known to help smokers change their puffing ways, including medications that decrease the craving for nicotine, dampen the reward felt from smoking, or both. But only 22 percent of those attempting to quit try medication.
A vaccine that discourages backsliding could be one answer. Montoya has been a medical officer for NIDA-funded clinical trials of such an inoculation. The idea is to spur the body to make antibodies that latch on to nicotine molecules, which are then too big to cross the blood-brain barrier—thus never reaching the brain's pleasure centers. Montoya says the vaccine won't be available for at least two or three years.
But even effective drugs can overcome only part of the problem. Rituals are hard to break, and smoking is entangled with many of them. Andrea Hommen enjoyed them all—the flick of the lighter, bonding with a coworker over drags. "I loved smoking," says the nurse's assistant from Madison, Wis. "I still miss it." A pack-a-day smoker for 15 years, Hommen, 36, made many unsuccessful efforts to undo her habit—with the nicotine patch, lozenges and nasal spray, all of which deliver nicotine at a lower dose and slower rate than cigarettes.
Then, in May 2007, Hommen tried Chantix, which she got free through her employer's smoking-cessation program. The drug does not contain nicotine. It works by diminishing cravings and withdrawal symptoms and by dulling the pleasure if a cigarette is smoked. Its success at keeping smokers off cigarettes for six months is about 70 percent—around 20 percentage points better than a placebo.
But breaking with nicotine can be hellish. The initial period without her smokes was "probably the worst five days of my life," says Hommen. She called in sick with flu-like symptoms. Nausea, a common side effect of the drug, lasted the entire five weeks she took it. Nor is Chantix completely safe. Earlier this year, the Food and Drug Administration issued a warning that Chantix can worsen existing psychiatric illness or cause anxiety, depression or suicidal thoughts. The FDA advised careful monitoring by a physician. But Hommen had none of those problems, and the drug helped her begin a transformation from smoker to triathlete.
Research suggests that pairing medication with group, individual or telephone counseling can boost abstinence rates by 40 to 70 percent over using either one alone. The 2008 guidelines recommend four or more counseling sessions of at least 10 minutes each; the longer and more intense the counseling, the better the result. Emphysema patient Wesley Derey, 59, smoked two packs a day for more than 40 years, losing precious lung function. But 30 days of Chantix and many calls from several smoking cessation telephone services have kept him smoke free for more than six months. Every state now has a free telephone quit-line, accessible by calling 1-800-QUIT-NOW.
There are other weapons in the quitter's arsenal. "I think the most important thing people can do is change the social environment," says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California San Francisco. Two of Hommen's smoking buddies—her husband and a sister—quit with Chantix several months after she did, buttressing her with solidarity and support.
Hommen also set physical and athletic goals, such as tackling the Chicago marathon later this year. Running and cycling got her away from a social environment steeped in the cigarette smoke of family, friends and coworkers. In vulnerable moments, reminding herself of these goals dulls the pangs, she says. In a 2008 review of various studies by the Cochrane Collaboration, exercise was shown to reduce the desire to light up and ease psychological withdrawal, and it may improve quitters' perception of their coping abilities and their self-esteem.
Patients need to recognize the thoughts or behaviors that trigger that conditioned reach for a cigarette, says Jorenby—sipping the morning coffee, walking the dog, feeling sad or stressed. Individualized distractions to overcome specific urges can help break the cycle. One of Jorenby's patients smoked only in his car. The distraction that worked for him was to yell at what he called an "all idiots, all the time" talk radio station.
Even a faceless online peer network can be effective. Logging onto the American Lung Association's Freedom From Smoking message board is what finally worked for Heidi Norie, a 46-year-old mother of three from Vista, Calif. Having smoked for 30 years—at times more than two packs a day—she has been an ex-smoker since March of 2008. "When you're jonesing like crazy, there's almost always somebody there," she says. She recalls once typing "I don't think I can do this" with tears streaming down her face. The 15 posts she received in response got her through the moment. Norie also used Chantix for six weeks to help her quit, but she says, "I attribute my success more to the program than the medicine."
Now, Norie fights complacency, aware that smoking alters the brain—by developing more nicotine receptor sites, for example—which makes relapse a lifelong possibility. Recently, she says, two longtime ex-smokers returned to the message board because they had started up again. "They had moved on and stepped away from the board," Norie says. "It's scary." So, she visits her peers daily—often late at night if she can't sleep—to encourage newbies who are struggling. And to remind herself how far she's come.
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