Stopping smoking

Stopping smoking is the greatest single step a person can take to improve their health. When the daily assault of carbon monoxide, tar and other poisons has stopped, the body will begin to repair the damage. Body systems start to return to normal: breathing improves, improved ability to cope with sudden exertion, smoker's cough goes and phlegm reduces, sense of taste and smell improves, and hair, skin and breath no longer smell of tobacco smoke. In the long-term, stopping reduces the risk of dying prematurely from diseases caused by smoking.

Cigarette smoking has profound implications for human health. Over the years the body learns not only to tolerate the chemicals in cigarette smoke but also to depend upon some of them. In some cases this may impact in the way the body processes certain prescribed medications. People currently taking any medications, especially psychopharmacological medications, should consult their doctor before stopping smoking.

Of the 50 million smokers in the USA, each year approximately 20 million try to stop. Intensive smoking cessation programs, administered by a specialist, enable many people to stop smoking, for the following reasons; (1) intensive programs are strongly correlated with cessation success, (2) information obtained in the assessment stage (e.g. comorbidity, stress level) is useful in counseling, (3) many different types of clinicians (e.g., nurses, dentists, psychologists) are effective in increasing quit rates, (4) intensive programs should offer 4-7 sessions, each at least 20-30 minutes in length, lasting at least 2 weeks,(5) counseling should offer problem solving and skills training as well as social support, (6) counseling should reinforce motivation to quit and relapse prevention, (7) individual and group counseling are both effective, (8) every smoker should be offered nicotine replacement therapy (patch or gum), except when medically contraindicated.

Nicotine replacement therapy is effectives for most people wanting to stop smoking. Between the patch and the gum, the patch is associated with fewer compliance problems and requires less effort to train in its use.

Basic stopping plan: (1) Set a quit date, ideally within 2 weeks. (2) Inform friends, family, and co-workers of plans to quit and ask for support. (3) Remove cigarettes from home, car and workplace and avoid smoking in these places. (4) Review previous quit attempts - what helped, what led to relapse. (5) Anticipate challenges, particularly during the critical first few weeks, including nicotine withdrawal. Total abstinence is essential - not even a single cigarette. Drinking alcohol is strongly associated with relapse. Having other smokers in the household hinders successful quitting.

To prevent relapse, offer ex-smokers reinforcement. Congratulate, encourage, and stress importance of remaining abstinent. Review the benefits, including potential health benefits, to be derived from cessation. Review the person's success in quitting. Inquire about problems encountered in maintaining abstinence and offer possible solutions. Anticipate problems or threats to maintaining abstinence. Discuss specific problems, such as: Weight gain. Negative mood/depression. Prolonged nicotine withdrawal. Lack of support for cessation.

Referring to the tobacco industry following revelations that it manipulates nicotine levels to increase the addictiveness of cigarettes, the American Medical Association is reported to have stated: "we should force the removal of this scourge from our nation."