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.
