Smoking Cessation

Smoking is a major cause of fatal (heart, lung, cancer) and non-fatal diseases (osteoporosis, skin aging, peptic ulcers, impotence, pregnancy complications), many of which are preventable. Exposure to secondhand smoke is also responsible for deaths from heart disease and contributes to other diseases as well. Of the thousands of chemicals in tobacco products (nicotine, tar, benzene, formaldehyde), studies show that nicotine is the component responsible for establishing and maintaining tobacco dependence.

The benefits of smoking cessation

Smoking cessation has major and immediate health benefits for men and women of all ages. The earlier you quit, the greater the benefits. Quitting smoking before age 50 reduces the risk of dying over the next 15 years by half, when compared with those who continue to smoke. One year after quitting smoking, the risk of dying from coronary heart disease is reduced by half and continues to decline over time. It is also important to remember that quitting smoking will also benefit those around you since exposure to secondhand smoke is harmful. Beyond the health-related reasons for stopping smoking, there are added advantages such as saving money, not smelling of cigarette smoke and breaking free from nicotine dependence.

The risks of quitting smoking

Generally speaking, the health benefits of quitting smoking far outweigh the risks. Smoking leads to two types of dependence: psychological or behavioural dependence, and physical dependence.

Psychological or behavioural dependence
Smokers associate the act of smoking with a pleasant moment during the day where they experience less anxiety, stress, and even boredom. The psychological pleasure associated with smoking makes it a habit that is all the more difficult to break.

Physical dependence
Withdrawal symptoms are common while attempting to stop smoking and are caused by the elimination of nicotine from the body. They are usually at their worst in the first three days and decrease over the next three to four weeks. The most common symptoms are:

  • difficulty sleeping
  • difficulty concentrating
  • irritability
  • gastrointestinal problems
  • headaches
  • tremors

Stopping smoking for good: preparing to quit

While smokers differ in the way in which they smoke and their degree of dependence, all smokers must be well prepared if they want to quit for good. The following steps may help:

Set a date
Ideally, the date should be in the next two weeks.

Tell those closest to you
Tell your family, friends and coworkers about your plan to quit and ask for their support.

Know your triggers
Proper preparation involves identifying your smoking triggers - places, people, state of mind, activities. For example, you may want to think about quitting while off from work, especially if you tend to smoke at work. Keeping a smoker's journal may help. It can help you track your current behaviours in the hopes of better identifying what triggers your urge to smoke (stress, drinking alcohol).

Prepare strategies to help you deal with withdrawal symptoms
There are various tips and tricks available to help you. Take the time to identify what may help you (physical activity, relaxation, deep breathing, having a low-calorie snack, drinking lots of water). Try to stay focused on why you want to quit smoking.

Think about past quit attempts
Most smokers do not quit on their first attempt. If you have tried and have been unsuccessful in the past, try to understand why. What worked for you? What did not work for you? What caused you to relapse and start smoking again? Explore these questions as the answers may help you plan your approach and avoid certain pitfalls this time around.

Avoid certain behaviours
As you prepare to quit smoking, avoid places where you tend to smoke most (car, home) to minimize the psychological aspects associated with smoking.

Get information
Use the various resources at your disposal (pharmacists, CLSC, websites) to get as much information as you can. You can also join a support group, use a pharmacological smoking cessation aid or a combination of several aids.

Reward yourself
It is important to reward yourself. While smoking delivers instant satisfaction, the benefits of quitting are more long-term. Look after yourself and treat yourself to something you enjoy on a regular basis.

Quitting for good: pharmacotherapy

Stopping smoking on your own is possible. Some however, may want to consider pharmacotherapy to improve their chances of success. The goal of treatment is to reduce the physical effects associated with withdrawal, as these peak within the first 72 hours and can persist for several weeks. Furthermore, treatment may be needed to alleviate the psychological effects of withdrawal, which can persist for several years. If you are thinking about a pharmacological aid, speak to your doctor or pharmacist. Here is a brief overview of the various treatments available:

Nicotine replacement
These treatments are designed to replace nicotine from cigarettes. Nicotine substitutes do not contain the thousands of chemical products found in cigarettes, and are therefore less harmful than cigarettes. They deliver nicotine in the form of transdermal patches, gum, lozenges, inhalers and sprays. A pharmacist can help you select the form that is best for you, as well as the appropriate starting and treatment dosages for the duration of your treatment. It is important that you refrain from smoking while using nicotine replacement products.

Bupropion (Zyban®)
Bupropion is a prescription medication that is usually taken for a period of 7 to 12 weeks. It can be combined with nicotine replacement to improve treatment efficacy. This medication reduces smoking cessation symptoms and is usually well tolerated. It is associated however, with some adverse effects. Your doctor will determine if it is a suitable treatment option for you.

Varenicline (Champix®)
Varenicline is a prescription medication that works in the brain to reduce cravings and withdrawal symptoms. Treatment usually lasts 12 weeks. Your doctor will determine if it is a suitable treatment option for you.

Electronic cigarettes (e-cigarettes)
As it stands, the use of electronic cigarettes, also known as e-cigarettes, is not recommended as a smoking cessation device. While they do appear to be less harmful than traditional cigarettes, e-cigarettes are not devoid of chemicals. Right now, the bottom line is that e-cigarettes are unproven as smoking cessation aids, especially in the long-term. Although they are safer than traditional cigarettes, e-cigarettes are not harmless.

Perseverance

Remember that the road to becoming a non-smoker is a long one. Most smokers do not quit from one day to the next and are often unsuccessful after their first attempt. If you manage to quit but succumb to the temptation by smoking one or two cigarettes, do not worry. In fact, you will be closer to your goal if you use this experience to learn how to prevent the temptation next time. Think about becoming a non-smoker and take things one day at a time.

Adopt a positive attitude when it comes to any progress you have made and be proud of being a non-smoker - this will help you get through the tougher times. If you have started smoking again, think ahead of when you would like to stop smoking again. Do not give up altogether. Chose another quitting date. You have the power to become a non-smoker.

For more information or for support:

The Lung Association

www.lung.ca

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