How You–and Obama–Can Quit Smoking

Barack Obama’s doctor just told him he needs to quit smoking. It’s not the first time he’s heard it, and it probably won’t be the last–smokers have to quit multiple times before they’re finally done smoking. Here’s a quick run-down on what you and Obama can both do to increase the odds that the next time you quit will be the last time.

First, be ready to quit. Quitting is often a tough process, and there’s no point in starting if you know it won’t work. If you’re not ready to quit, figure out why not. Consider what you enjoy about smoking–an escape from the office, companionship, the comfort of a familiar habit. Start weighing those factors against what you don’t enjoy–the cost, the health effects, the holier-than-thou attitude from those yuppies in that Prius speeding by you.

Use these to play mindgames with yourself. Each time you light up, remember how bad it makes you smell. Or think what you could do instead with all the money you’ve spent in the past month on cigarettes. Or if you’re inclined to the macabre, follow the advice of one of my patients who quit a pack-a-day habit. He made a list of twenty diseases linked to smoking (see the end of the article) and mentally labeled each cigarette in the pack with the name of one disease as he smoked it. If you consistently link smoking to something negative, you’ll be more prepared to give up the habit.

Once you’re ready to quit, learn about your options. Get information from a health care provider, online, or call 1-800-QUIT-NOW. Use their support to develop a plan that combines three elements: lifestyle changes, a quit program, and medications.

When it comes to changing your lifestyle, focus on eliminating your triggers and reinforcing a smoke-free life. Ask friends not to smoke around you. Avoid places, people, and frothy beverages that make you smoke. When cravings hit, have sugarfree gum or low calorie snacks in your home, office, and car. Get support from the people closest to you. You changed your relationship status on Facebook after your last breakup, why not publicly announce that you’re finally getting out of an abusive relationship with nicotine? Tweet it to the world.

Next, line up a quit program and start the program before you actually quit smoking. Options range from a simple one-time phone conversation to multiple intensive sessions with a trained expert. Two free, easily accessible resources are 1-800-QUIT-NOW and online chats at LiveHelp. Your community might have a Nicotine Anonymous group or a local health care organization that provides a quit program. In general, the more intensive the program, the more likely it is to help you succeed. People pay to have experts design a workout program, a healthy diet, a polished resume. It makes sense to get an expert on your side when it comes to quitting smoking, especially when it’s free.

In addition to lifestyle changes and quit programs, medications are an effective tool to help you quit. The three most commonly used medications are nicotine, buproprion, and varenicline.

Nicotine replacement therapy with patches, gum, inhalers, or sprays doubles the success rate of quitting. Probably the most effective way to use nicotine substitutes is to wear the patch and then have an additional agent, such as the gum, to combat breakthrough cravings. If you smoke less than 25 cigarettes a day, you should chew the 2mg dose of gum; if you smoke more than that, use the 4mg dose. The gum is more effective the less you chew it and the more you park it between your gum and cheek, like dipping tobacco. People sometimes worry that they’re replacing one bad habit (cigarettes) with another (nicotine), but the negative health effects from smoking come primarily from all the other toxins in the smoke, not nicotine. The patch, gum, and other nicotine products are safe when used as prescribed.

Buproprion, also called Wellbutrin and Zyban, is as effective as nicotine replacement in helping people quit smoking. The drug acts on multiple neurotransmitters in the brain to decrease the cravings for a cigarette. It’s usually taken twice a day for three months, starting one week before the quit date. The most common side effect is insomnia, and the most dangerous side effect is an increase in suicidality, especially in adolescents.

Varenicline, also called Chantix, appears to be more effective than either nicotine or buproprion, tripling the success rate of quitting. It binds to the nicotine receptors in your brain, decreasing the withdrawal symptoms and blunting any buzz from a cigarette you might smoke during a moment of weakness. Like buproprion, it is taken twice daily for three months. While it’s a safe drug, like buproprion, there is a concern for an increased risk of suicidality. People taking this medication need to do so under a doctor’s supervision, and they and their families should pay attention to any symptoms of depression or unusual behavior.

There’s no clear best method for combining these three medications. But one medication strategy recommended by experts is to use varenicline and a nicotine patch daily, with an additional nicotine fix–gum or spray–for when a craving really hits you.

Once you’ve determined your best strategy, and lined up medications, counseling, and the support of your friends and family, pick a quit day. Your odds of quitting smoking are best if you go cold turkey rather than winding down over a period of days to weeks. Remember that if it’s your first try, it might not be your last. Don’t be discouraged if you start smoking again, a relapse just puts you one step closer to the day when you finally quit.

Twenty diseases linked to smoking: asthma, blindness, bladder cancer, breast cancer, chronic bronchitis, congestive heart failure, deep vein thrombosis, diabetes type 2, emphysema (COPD), esophageal cancer, heart attacks, impotence, infertility, lung cancer, pancreatic cancer, pulmonary embolism, oral cancer, osteoporosis, stroke, ulcers.

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