Smoking Cessation “Quitting smoking is easy, I've done it a thousand times!" –Mark Twain Smoking cessation may not be easy, but half of adult smokers have been able to quit and new medical therapies can more than double your chance of successfully breaking the habit. Chantix (varenicline) is a medication which works directly on the nicotine receptor, blocking the addictive effects of nicotine on the brain. Wellbutrin (buproprion or Zyban) is an antidepressant which adjusts levels of dopamine, a chemical involved in addictive behavior. The main side effects of Chantix are nausea and insomnia. Although it is safe to take Chantix while smoking, these side effects tend to be greater when using nicotine or nicotine replacement products. Wellbutrin has few side effects but can sometimes cause anxiety, insomnia, headache, stomach discomfort, and tremor. In high doses it can increase the risk of seizures, so it is important no to double-up on your dose if you miss one. Wellbutrin may not be safe in people with bipolar disorder or eating disorders. It is safe to use while smoking or taking nicotine replacement products. Very rarely, Chantix and Wellbutrin have been associated with psychiatric side effects including suicidality, agitation and depression. Although smoking increases your risk of dying from a heart attack, stroke and cancer, there is hope: if you are able to quit for 5-15 years, these risks will go down to normal! 1) Set a Quit Date It’s good to pick a quit date that will be easy for you, such as when you expect stress to be low, or even an important or busy day if that will help distract you from smoking. Also consider the medication you are taking in setting your quit date: Chantix can work the first week, while Wellbutrin takes 2-6 weeks to take effect. It is safe to smoke while taking these medicines, although you may experience greater side effects of Chantix. 2) Prepare for Your Quit Date Before your quit date, smoke as much as you normally would but limit yourself to smoking in only one place. (If you can’t limit to one, try two places). A place that is a constant part of your life (like your room or car) wouldn’t be a good idea… the hope is that you will be able to avoid this smoking place after you quit to decrease the reminders that trigger the habit. People tend to have more success with quitting when they go “cold turkey” (stopping cigarettes all the sudden rather than gradually). That’s what you’ll do on your quit date. Plan ahead for this: • Make a list of all the reasons you want to stop smoking to review in times of cravings. • Tell people about your quit date and write it on all your calendars. • Make a list of “triggers”: events or situations that make you want to smoke. Plan how you will deal with these. • If you’ve tried quitting before and weren’t successful, review what helped and what got in your way that time. Think of what you can do differently this time around. 3) Dealing with Cravings and Withdrawal Symptoms Cravings are urges for cigarettes or nicotine; though they can be intense, keep in mind that they usually only last a few minutes. Withdrawal symptoms include irritability, difficulty concentrating, trouble sleeping, fatigue, headache, increased appetite and digestive problems. These usually last only a few weeks, and some people do not experience them at all. Solutions to ease withdrawal are below:	Online Resources Chantix The company’s web site features information about the medication and advice on smoking cessation. Wellbutrin Information on Wellbutrin (also known as Zyban or buproprion) from Dr. Aiken’s web site. Tobacco Information and Prevention Source (TIPS) A wealth of information from the Center for Disease Control (CDC). Cigars and Smokeless Tobacco In the search box, enter “cigars” or “smokeless tobacco” for specialized information from the National Cancer Institute. Quit Smoking Plan (PDF) Quit Smoking Plan For Pregnant Women (PDF) These personalized planners from the U.S. Department of Health guide you through smoking cessation. Support Programs National Cancer Institute Provides free telephone counseling to aid in smoking cessation. 1-877-44U-QUIT, Monday through Friday from 9 AM until 4:30 PM. More information is available on their website. Freedom From Smoking® Support program through the American Lung Association: 1-800-LUNG-USA (1-800-586-4872); an online version is also available at http://www.lungusa.org/ (scroll down to “Freedom from Smoking”). Fresh Start Program Support program led by former smokers and sponsored by the American Cancer Society: 1-800-227-2345. Benefits of Quitting… 20 minutes after quitting: Your blood pressure drops to a level close to that before the last cigarette. The temperature of your hands and feet increases to normal. 8 hours after quitting: The carbon monoxide level in your blood drops to normal. 24 hours after quitting: Your chance of a heart attack decreases. 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases up to 30%. 1 to 9 months after quitting: Coughing, sinus congestion, fatigue, and shortness of breath decrease; cilia (tiny hair like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce infection. 1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's. 5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5-15 years after quitting. 10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decrease. 15 years after quitting: The risk of coronary heart disease is that of a nonsmoker's. (from the US Surgeon General's Report, 1990)
Withdrawal Problem	Solutions
Nicotine Cravings	Distract yourself by walking, doing chores or socializing with non-smokers. Develop other activities for your hands and mouth to replace the smoking habit, such as toothpicks, sugarless gum, drawing, cleaning, or exercise.
Trouble sleeping	Try this advice on Restoring Sleep.
Constipation	Exercise, eat more fiber (fruits and vegetables or take over-the-counter supplements like metamucil); drink plenty of fluids. Try an over-the-counter stool-softner (such as colace 100mg twice a day) Talk to your doctor if you still aren’t moving your bowels once a day.
Weight Gain	Diet and exercise are the best way to control weight gain, but it may be too difficult to diet while you are concentrating on quitting. Some of the weight gain after smoking comes from snack-food, so try these tips: · Snack on raw vegetables, pretzels, or fruit · Drink water, juice or sparkling water instead of sodas and alcohol · Eat fish or chicken (non-fried) · Try sugarless gum or sugar-free hard candy.
Anxiety and Irritability	Warn the people close to you that you might be moody while you quit. Remember that you may have been using cigarettes to cope with stress and can now begin building new coping skills, such as: Mindfulness relaxation exercises. Deep Breathing: please one hand on your abdomen and one on your chest. Try to breathe from your abdomen, so that your abdomen’s hand moves in and out while your chest’s hand stays mostly still. Sit and take regular abdominal breaths while repeating a soothing or positive phrase, such as “I can stop smoking.”
Loss of motivation	Keep a list of the reasons you decided to stop and review them. Keep track of your progress. Call friends for support.
Fatigue	Try light exercise in the afternoon. Try this advice on Restoring Sleep.
Cravings	Develop other activities for your hands and mouth to replace the smoking habit, such as toothpicks, sugarless gum, drawing, cleaning, or exercise.
If you live with a smoker	Ask them to limit their smoking to one room or to smoke outdoors while you are trying to quit.
	—Updated 7/7/09 by Chris Aiken, MD