The Truth About Smoking Cessation

Despite a steady decline in the number of smokers, tobacco continues to cause twice as many deaths per year as AIDS, alcohol abuse, motor vehicle collisions, illicit drug use, and suicides combined.

Understandably, knowledge of the dangers of smoking or the benefits of quitting is typically not enough to motivate people to quit. Nicotine is highly addictive, and the habitual act of smoking adds a further psychological obstacle to becoming cigarette free. The truth: Quitting smoking is hard, but not impossible.

Help Options

The large majority of would-be quitters don't succeed on their first attempt. Research suggests that people who get help with quitting tend to be more successful. The American Heart Association recommends:

— Nicotine replacement therapy (NRT): The nicotine patch, inhaler, gum, or lozenges are available over-the-counter (OTC).

— Zyban (bupropion): A prescription antidepressant that replaces the "high" of nicotine by increasing the brain's supply of dopamine.

— Chantix (varenicline): A prescription drug that blocks nicotine receptors in the brain.

— Smoking cessation counseling: Individual therapy and support groups.

One study published in Chest randomly assigned 209 smokers who were hospitalized for a heart attack to receive either 3 months of weekly hour-long smoking cessation counseling or "standard care," which included a self-help brochure and a brief counseling session on quitting. Participants who received the intense smoking-cession intervention were also encouraged to use NRT and bupropion.

Two years later, 33% of those in the intense smoking-cessation group had successfully quit, compared with 9% who got standard care. Those in the intense cessation group were also 44% less likely to be hospitalized and 77% less likely to die during the study. (Quitting was confirmed by measuring the carbon monoxide content of participants' breath at regular intervals.)

NRT v. Cold Turkey

Although many studies show that NRT products can help you quit, you shouldn't rule out going cold turkey — quitting all at once, rather than tapering your nicotine use. In many cases, investigators have tested the effectiveness of NRT or smoking-cessation medications by comparing them with a placebo. But placebo users are not committed cold turkey quitters, since they entered the study thinking they may receive the active therapy. Thus, existing research on NRT or medications is not a reflection of how well cold turkey works.

Cold turkey may be a cheaper, quicker, and more effective option, particularly for lighter smokers. A survey of over 6,000 California smokers, published in the Journal of the American Medical Association, found that moderate to heavy smokers (those who smoked 15 or more cigarettes per day) benefited the most from NRT. But NRT didn't increase the chances of quitting for those who smoked less than 15 cigarettes per day.

Overall, NRT tended to be a short-term solution, since most smokers began smoking again after 3 months of nicotine replacement.

Interestingly, similar surveys of California smokers, completed before NRT became available OTC revealed that heavy smokers were most likely to quit with the help of nicotine replacements before they became available without a prescription. This finding suggests that obtaining prescriptions for NRT medication from a doctor requires a high level of commitment and results in support from a physician. Easy access to OTC nicotine replacement may attract less-committed quitters. The lesson may be that no quitting method will work unless you are genuinely committed to it and have some support.

Pointers and Preparation

Quitters gain 10 lbs. on average. But studies show that former smokers tend to develop healthier lifestyles. Moreover, people who smoke but exercise and eat healthfully are more likely to quit; and following healthy habits while still smoking may ward off some of the dangers of cigarettes.

The bottom line: no matter how you approach quitting, you will need a genuine desire to quit and a lot of willpower. The good news is that 20 minutes after quitting your heart rate will improve. After a few weeks, blood circulation improves, cilia — the tiny hairlike fibers in the lungs that remove mucus — grow back, and your risk of pancreatic and esophageal cancer drops. A year later, your risk of heart disease is cut in half, and if you stay smoke free for 10 years, the same can be said for your risk of lung cancer.