One of the Best ways to quit smoking

Good news is that the United States public health services have reviewed the scientific literature on ways to quit smoking and has incredibly thoroughly, systematically and impartially analyzed those methods. They actually reviewed more than 8,000 scientific articles and they pulled them together to give what are called meta-analytical results, so not just one single story or one anecdotal report, but rather, the whole body of research on the most effective ways to quit smoking.

An action that has been shown to really increase quit rates is systematically identifying smokers when they present to health clinics in America, having a system in place in those clinics to help them to quit, and having it brought up every time they visit. We know that seven out of 10 smokers visit a primary care doctor every year, so those physicians have unequalled access to smokers.

 Scientifically proven therapy is medicine. All three of these are important, they work additively, each of them by themselves boost quit rates.

 The government identified seven medicines that the FDA has tested and endorsed. There are five nicotine medicines: the gum, the patch, the lozenge, the nasal spray and the inhaler. And then there are two prescription pills: Bupropion, some people know it by the brand name Zyban, and the other is called Varenicline, which people may know by the brand name Chantix. Those two have been shown to boost success rates. Of course, any medicine you need to talk to your doctor about. Each of these medicines have some people for whom they’re not appropriate, but for the most part the medicines can be used for most smokers.

The recommended treatment for nicotine medicinesis anywhere from eight weeks of the medicine up to six months. That’s the recommended course of therapy, and that’s pretty much across the board for all of them. People tend to use the gum and the lozenge longer and the nicotine patch shorter.

Cigarettes contain 4,000 chemicals, of which about 40 are carcinogens, which can cause cancer. Nicotine is only one of 4,000. It happens to be the addictive one, but it’s only one of 4,000. What the idea is in designing these medications is that you get rid of your cigarettes with those 4,000 chemicals, you use nicotine as a bridge to then get to a point where you’re using no nicotine and no cigarettes. That is the goal.

The rub of course is the 5% of people who successfully quit with nicotine products, but end up using them long term. Is that a goal? Absolutely not, the goal is to be free of both cigarettes and nicotine, but if the alternative is, Do I use one chemical—nicotine—indefinitely, or do I return to cigarettes with 4,000 chemicals, many of which are deadly like arsenic and carcinogens? Without question I’d say to a patient, our goal is to get you off these medications, but if the only way you can stay free of cigarettes is to use them, then the risk of that nicotine is so minimal that it’s reasonable compared to the enormous risk of the 4,000 chemicals in cigarettes.

Nicotine gum, such as the brand Nicorette, is one of the methods people tend to stay on longer. Can extended use of the nicotine gum be harmful? The jury is still out on that, there are at least some theoretical risks of nicotine in terms of the cardiovascular system. Some of these risks may be associated with the way it’s delivered particularly if it’s delivered to the lungs in cigarettes it appears to be much more harmful than through a gum or a patch. The risks are possible, but probably minimal. But, realistically, it’s a no brainer when you match it up against the risks of smoking.

There is not a lot of science to guide that, but my clinical experience is that there are a few strategies that can be used. One is to take the gum on a more scheduled basis, a particular time throughout the day, and over a couple of weeks lengthen the time between pieces of the gum. The second approach is to cut the gum in half, and mix it with a piece of regular chewing gum. The third approach that we’ve used in our clinic is to buy a really spicy cinnamon gum like Big Red, and use that to substitute in between pieces of the Nicorette, and you get the same taste sensation that you’ve gotten used to, but you don’t get the hit of nicotine. You then increase the amount of spicy gum and decrease the amount of pieces of nicotine gum.

 It isn’t all about a medicine, it really is taking a person who has made a decision to quit and giving them some extra tools. So we talk about setting a specific quit date, some specific time over the next week when, on that date, you’ll start with not even a single puff. The second thing we do is review past experience. Almost every smoker has already tried to quit, but got into trouble and eventually relapsed, so how can they handle that situation differently? And also, what worked, and can we build on that?

The third point is to ask them to anticipate challenges to the upcoming quit attempt. Smokers know what’s going to get them into trouble, and if they practice coping strategies or plans before they quit, when they’re in withdrawal, they’re much more likely to implement those plans and make it through those dangerous situations. Another element to consider is alcohol—the leading factor that is associated with failing once you’ve started a quit attempt is drinking. 50% of people who try to quit and then relapse have some alcohol in their bloodstream when they have the first puff of smoke that leads to that relapse. So we urge them to, maybe for the first month or two, to totally abstain, so you don’t let your guard down in a way that will lead you to relapse. The link between drinking and smoking is a powerful one. And the last of the five points is smokers in the household. Probably the hardest thing is if you’re married to a smoker, you’re trying to quit, but your spouse is continuing to smoke. You really need to set up some ground rules for the house, and let them know that I won’t be at my best for the next couple of weeks and I’ll need a little slack.

So best way is  not start smoking at all, if so try to stop it getting best ways and doing it as soon as you can. It is for you, your family and friends either.