Options for Smoking Cessation

Your risk of developing cancer is reduced by quitting smoking. After five years off cigarettes, your risk of developing cancer is greatly decreased. Even in those who have smoked for many years, life expectancy is increased after quitting smoking. After ten years the ex-smoker has nearly the same risk as a nonsmoker.

Many smokers want to quit. Finding the method that is best to meet your individual needs and styles can be difficult. The following information describes several options for quitting smoking.

COLD TURKEY
With this method, individuals abruptly stop smoking cigarettes. Many quitters have used this method, although it may require several attempts before the individual is successful. It is simple, self-managed and low cost. The individual must be highly committed to his/her goal of quitting. Withdrawal symptoms may be severe for some people, especially if they have been smoking a brand of cigarette with a high nicotine level.

Factors to Consider:

• This process can be managed alone
• Quitting cold turkey is a one-step process
• The cost is minimal
• The smoker must be highly committed to the goal of quitting
• The nicotine withdrawal symptoms (such as irritability, headache, or difficulty sleeping) may be severe for some - especially if the cigarettes smoked contain high levels of nicotine

NICOTINE FADING
When using this method, individuals reduce the nicotine level of cigarettes smoked by 30/60/90 percent over a three week period and stop altogether during the fourth week. This method may help reduce the effects of nicotine withdrawal symptoms. The American Lung Association can provide a list of the nicotine levels of the cigarette brands. This method is simple, self-managed and inexpensive, but requires a high level of motivation and adherence.

Factors to Consider:

• Easy to follow
• Inexpensive
• The smoker must have a high level of motivation

NICOTINE GUM
Nicotine gum provides an alternate source of nicotine and helps reduce withdrawal symptoms. It requires smokers to discontinue the use of cigarettes when using the gum. Individuals who are highly addicted to cigarettes have a greater chance of becoming dependent on the gum. This method is self-managed but requires a high level of motivation and adherence. Smokers often need to chew 10 to 12 pieces of gum daily over a 3 to 6 month period. This can cost up to several hundred dollars, but is less expensive than smoking. Few insurance policies cover this expense. Nicotine gum is not recommended for use in pregnancy, for a person who has recently suffered a heart attack, persons with life-threatening heart rhythms, severe or worsening chest pain, or with active TMJ or joint disease of the jaw. Minor side effects from the gum include lightheadedness, nausea, mouth and throat irritation, hiccups, and an excess amount of saliva.

Factors to Consider:

• This process can be managed alone
• The smoker must have a high level of motivation
• The smoker must stop smoking completely when using the nicotine gum
• Minor side effects may include lightheadedness, nausea, sore mouth, hiccups and excess amount of saliva
• The gum is not recommended during pregnancy, following a heart attack or other heart problems, or if there is joint disease of the jaw
• Denture-wearers may not be able to use the gum
• Long-term smokers are more likely to become dependent on the gum
• Insurance may not cover the cost of the gum
• Nicotine gum is available over-the-counter

NICOTINE TRANSDERMAL (SKIN) PATCH
Transdermal patches are thin medicated patches, which are attached to the skin with adhesive. They provide an alternate source of nicotine, and so help reduce withdrawal symptoms. It requires smokers to discontinue the use of cigarettes when using the patch. This method is a good choice for a highly addictive smoker, particularly if they have been smoking a cigarette with a high level of nicotine. Each patch lasts 24 hours. In order to be successful, individuals must have a high level of motivation and adherence.

Factors to Consider:

• One patch is applied every 24 hours
• The smoker must have a high level of motivation
• The smoker must NOT smoke when using the patch
• Common side effects are skin redness at the patch site when the patch is removed and restless sleep
• The patch is not recommended during pregnancy, or if there is a history of high blood pressure or other heart diseases
• Insurance may not cover the cost of the patch
• The patch is available over-the-counter

ZYBAN
Zyban is a prescription medicine to help people stop smoking. It does not contain any nicotine so it is very different from the nicotine replacement therapies such as the patches or gum. Although it is not known exactly how Zyban works, it has been shown to help individuals stop smoking, as well as reduce nicotine withdrawal symptoms and cravings. The most common side effects include dry mouth, insomnia, agitation and difficulty sleeping. Individuals should not increase the dosage of Zyban without their doctor’s knowledge because it can cause seizures at higher than recommended dosages.

Zyban is not a new medicine. It has been manufactured and distributed as an anti-depressant medicine called Wellbutrin. Zyban was approved by the U.S. Food and Drug Administration (FDA) in 1997 as an aid to smoking cessation treatment.

Factors to Consider:

• Zyban is not for everyone. There is a risk of seizure associated with Zyban.
• You should not take Zyban if you have a seizure disorder, are currently taking MAO inhibitors, Wellbutrin, Wellbutrin SR, or have an eating disorder
• The most common side effects with Zyban are dry mouth and trouble sleeping
• Zyban is available by prescription only
• Insurance may pay for Zyban
• Zyban may be used in combination with the nicotine patch; however, blood pressure should be monitored during treatment

Counseling Services
All of these options are most successful when combined with modification of behaviors that were previously associated with smoking. Additional counseling may include stress management, weight control, and tips for preventing relapse.

Combined Therapies
Studies show that smokers who use a combination of cessation aids greatly increase their chances of remaining smoke-free. Smokers who used a combination of a nicotine patch and nasal spray doubled their chances of remaining smoke free for six years. In another study, researchers compared the effects of treating smokers with Zyban alone, the patch alone, both Zyban and the patch, or a placebo (sugar pill). The group with the highest rate of success were those who used Zyban and the patch. Other studies have shown evidence that nicotine replacement therapy, in combination with behavioral or psychological support is more successful than drug therapy alone.

Your family physician can help advise you on which method of quitting might be best for you. All of these methods are most successful when combined with a support group or smoking cessation program that discusses stress management, weight control, resistance to social pressure, and suggestions for resisting the temptation to light up.

Last Reviewed 2005

Source: Department of Rehabilitation Therapies, Pulmonary Rehabilitation Division

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.