Treatment for Nicotine Addiction

With the current knowledge on the health and financial cost of tobacco use, prevalence of antismoking messages, and the general cultural stigma that is now placed on smokers, it’s no wonder that more people are trying to quit—or are being pressured to do so. The stakes for successfully quitting are high for not only the user and her family, but also for the user’s employer, health insurer, and government. The Centers for Disease Control (CDC) reports that more than 68 percent of current smokers would like to quit and more than half of all smokers have tried to do so within the past year. How many have been successful? Slightly more than 6 percent of smokers have succeeded in quitting within the past year.1

Methods of Quitting

There is no one-size-fits-all approach when it comes to quitting tobacco and nicotine. And there’s no wrong way to quit either. Here are the most common approaches:

Whatever method you choose to try, we know that people succeed at quitting most often when they learn how to tolerate symptoms of withdrawal from nicotine, develop strategies to use when dealing with triggers, and receive support and encouragement. Motivation is another key factor in whether or not smokers succeed in their efforts to quit.

Paying for Smoking Cessation

Research shows that when people have insurance coverage for smoking cessation treatment, they are more likely to get treatment and thus more likely to be successful in quitting.

The Affordable Care Act passed in 2010 requires insurance companies and employers to cover smoking cessation treatment.2 Every state Medicare program is now required to cover smoking cessation treatment for pregnant women, and in 2014 will no longer be able to exclude smoking cessation medications, whether prescription or over the counter, from their drug coverage; this applies to all beneficiaries. Currently, six states cover all of the smoking cessation treatments that are recommended by the Public Health Service.3

Quitting on Your Own

Some people are able to wake up one day and simply decide to stop smoking, and so they do, quitting cold turkey. Those who use this method of quitting succeed 5 percent of the time.4 People who quit cold turkey will likely face an array of physical and psychological consequences. On the physical side, they should be prepared for symptoms of withdrawal and cravings to use. These will pass in time, but can be uncomfortable and include anxiety, nausea, irritability, and insomnia. People who quit cold turkey will also have to deal with the psychological implications of quitting tobacco, which may include encountering various triggers to use throughout their day and feelings of loss. Willpower alone is often not sufficient to keep a smoker from going back to tobacco. Having a solid support system may help those who choose to quit without medication or counseling.

Why Quitting Is So Hard

Imagine that you have spouse, partner, or best friend in life who is available to you 24/7. This is someone you can depend on in times of celebration and times of sorrow, times of boredom and times of stress and anxiety. Being with this person always leaves you feeling a bit better—whether you needed a pick-me-up or a nod to relax. What’s more, you meet with this person at the same time each and every day, usually several times a day. The connection forged between you and this person is ultra-deep and you never fear that he or she will leave you, no matter what. Oh, by the way, this “person” is actually a cigarette—your most reliable and trusted “friend” in life. And now you want to walk away from it all?

With such a devoted friend as this cigarette (or cigar, pipe, or form of smokeless tobacco), is it any wonder why quitting smoking is so difficult? And the more a person smokes per day—the more times he stops to light up, or step outside, or meet a coworker for a cigarette break—the harder it is to quit. Smoking has been called a habit for good reason. Most other drug addicts do not turn to their drug of choice as many times a day as a smoker does.

What does it mean to “break the habit” then? Well, for starters most smokers will have to begin and end their day a different way, as well as what they do on their breaks at work, what they hold in their hand with a cup of coffee or a drink, and what they do when they’re stuck in traffic. This might also entail spending less time with one’s work buddies, since joining them over their cigarette breaks will be all but impossible. When you stop to think about how much this “habit” has been incorporated into the fabric of a smoker’s life, you realize the extent of what it means to quit. All of these social aspects—and then there is the physical addiction and withdrawal process! It can be a lot for one person to handle. That’s why having a support system can make all the difference.

Counseling, Groups, and Other Support

For those who want or need help quitting, the number of counseling options has never been more plentiful, from one-on-one sessions to group classes. Though the types of available counseling vary widely, effective counseling usually includes skills and problem-solving training and social support.

Brief Interventions

Today, we recognize that even brief interventions may help some people quit smoking. This may mean that your doctor asks about your tobacco use during a routine physical exam and gives you a pamphlet on the benefits of quitting. For this reason, clinicians are now advised to counsel all patients who use tobacco to quit, whether or not they have the desire to quit. This and education about the dangers of smoking may help motivate some people to quit.

Telephone counseling research has shown that telephone counseling can be very helpful to people who are trying to quit and to those who have already quit. In some cases, it is even as effective as face-to-face counseling and support groups. Telephone counseling sessions are often more convenient to people than traditional counseling programs. They can call from their own homes when it works best for their schedule, including nights and weekends. Trained counselors can offer advice on medications, nicotine replacement therapy, and support programs or classes. Twelve Step support groups such as Nicotine Anonymous offer people an opportunity to attend meetings and to listen to others who are going through the same process of learning to live without tobacco and nicotine. Anyone who wants to gain freedom from nicotine, including people using smoking cessation programs or medications, is welcome to attend the free meetings. Meetings are run by the participants, who offer one another experience, strength, and hope. To find a local meeting, go to www.nicotine-anonymous.org or call 877-879-6422.

Here are some resources and hotlines for support when quitting tobacco:

National Network of Tobacco Cessation Quitlines

Toll-free hotline: 1-800-QUITNOW (1-800-784-8669)

www.naquitline.org

American Cancer Society

Toll-free hotline: 1-800-ACS-2345 (1-800-227-2345)

www.cancer.org

American Lung Association

Toll-free hotline: 1-800-LUNGUSA (1-800-586-4872)

www.lungusa.org

National Cancer Institute

Toll-free hotline: 1-877-44U-QUIT (1-877-448-7848)

www.smokefree.gov

Centers for Disease Control and Prevention

How to Quit web pages provide a variety of cessation tips, tools, and resources.

www.cdc.gov/tobacco/quit_smoking/how_to_quit/quit_tips/

Online Support Groups

Especially helpful for people living in areas without traditional support groups or for those who cannot find the time to attend such meetings, online groups and support networks provide invaluable guidance and advice—and they offer it 24/7.

What’s more, today you can use apps to help you in your journey to nicotine-free living. Some apps help users create a personalized plan for quitting and offer motivational tips, while others tally how much quitting is increasing your lifespan and saving you money. You can even receive support from others through chat rooms connected to the apps. Facebook also features many pages related to smoking cessation efforts.

Smoking Cessation Programs

Smoking cessation programs are available through many groups and locations, including hospitals and clinics, insurance providers and workplaces, and national organizations. Programs motivate users to quit and help them develop strategies to use for dealing with triggers and withdrawal symptoms.

While a handful of inpatient smoking cessation programs are now available, most programs designed to help you quit and stay quit are conducted on an outpatient basis. Programs may be held at a local clinic or community center, or they may be available exclusively online.

Research shows that the intensity of a program—how often it meets and how long the sessions are—corresponds with its rate of success. The American Cancer Society recommends looking for more intense programs, where

Holistic Therapies

Some people report that alternative therapies such as meditation, acupuncture, or hypnosis are helpful in dealing with withdrawal symptoms and cravings for tobacco. Although the science backing up the effectiveness of these therapies in smoking cessation is limited, they seem to be most effective when combined with other methods of tobacco cessation.6

Medications

Let’s look at the medications that are currently available to help people as they quit nicotine. These include five nicotine-based medications and two that do not include nicotine; all help with cravings and withdrawal symptoms.

Nicotine Replacement Medications

Nicotine replacement medications contain low doses of nicotine, usually one-third to one-half the dose of traditional cigarettes. They are also smokeless and so do not expose users to chemicals that come with smoking. Nicotine replacement medications take longer to reach the brain than other tobacco products and are thus not viewed as posing a risk of dependence. The dose of nicotine during the cessation process starts off higher and is decreased as time goes on, and the person’s withdrawal symptoms diminish and she prepares to be abstinent from all nicotine products. The packaging on most nicotine replacement medications suggests that they be used for six to sixteen weeks. Nicotine replacement medications have been approved by the FDA for use by tobacco users age eighteen and over.

Nicotine replacement has been found most effective for people who smoke more, which is defined as fifteen or more cigarettes per day. Tobacco users who want to quit are urged to consult with their health care provider about which, if any, nicotine replacement medication may be best for them.

Note: In April 2013, the FDA announced that the packaging of nicotine replacement therapies (NRT) will change in the near future, removing warnings about using NRTs with other forms of nicotine. This change is intended to reassure users that even if they slip and smoke a cigarette, they can still safety return to using this therapy in their next attempt to quit.7

Below is a summary of the various types of nicotine replacement therapies, their brand names, and whether or not they require a prescription.8

Medications That Do Not Contain Nicotine

The FDA has approved two medications that do not contain nicotine for smoking cessation:

Combo Treatments

Research shows that using evidence-based smoking cessation tools—including counseling, support groups, and nicotine replacement products—doubles or even triples the odds of success.10 When counseling and nicotine replacement therapies are used together, success rates are between 20 and 40 percent.

Programs for Youth

Gaining freedom from nicotine and learning how to live a tobacco-free lifestyle is not so different for adolescents than it is for adults. However, counseling may take on a more important role for youth, as those who are under eighteen cannot legally purchase nicotine replacement medications. (However, doctors can prescribe these medications for minors who are under their care if they are dependent on nicotine.)

Programs that are found to be most successful for youth are fun and engaging. Most include an educational component, focusing on the dangers of continued tobacco use. They also teach young people practical skills for staying off nicotine, including refusal skills.

One smoking cessation program for youth, the ASCENT program, uses some of the principles from the Stages of Change Model that was developed by James Prochaska and Carlo DiClemente in the 1980s. This model recognizes that people move through different stages as they prepare for and make behavior changes towards quitting smoking, drinking, or using other drugs. The idea behind this way of looking at behavior change is that people may be at different places in their readiness to change and may have more or less motivation to change. The ASCENT program, then, is designed to help adolescents wherever they are in the process of change. Here are the five stages:

  1. Precontemplation: A stage of exploration, looking at pros and cons of quitting
  2. Contemplation: Considering making change, a stage of motivation and encouragement
  3. Decision and determination: Making the decision to change, developing strategies for quitting
  4. Action: Utilizing plan and strategies to quit; providing support
  5. Maintenance: Moving forward with a plan, using coping strategies and support as needed; if relapse occurs, getting back on course

Quitting Tobacco—What to Expect

What should you expect when you quit? It’s normal to experience symptoms of withdrawal and triggers to use. Tobacco use is an oral habit, so it’s not uncommon for people to use food as a substitute for smoking during the early stages of quitting and to experience some minor weight gain.

Withdrawal

Uncomfortable withdrawal symptoms may appear within a few hours of your last cigarette. Remember, when you stop feeding your brain the drug it has gotten used to, the corresponding feel-good results screech to an abrupt halt and your body cries out for more. Here’s what that entails:

Short-term Symptoms

Long-term Symptoms

Withdrawal symptoms are generally more intense the longer you smoked and the more you smoked. In time, your body and brain will learn to go on without nicotine and will begin to heal itself. Most people report that the worst withdrawal is over after the first week and the symptoms continue to decline over the first month. Smoking cessation medications may help lessen the intensity of withdrawal symptoms.

Triggers

Beyond physical withdrawal symptoms, breaking the habit of smoking or using another form of tobacco includes dealing with the triggers to use in daily life. Whether someone has been a regular smoker for one, ten, or thirty years, habits form around that use. For example, a person may light up every time he:

These are, of course, just examples. Individual smokers may experience different triggers depending on when they usually smoked. Most experts recommend trying to identify your triggers and then make plans to avoid them, perhaps by changing your routine or by finding ways to lessen their effect. Preparation and awareness seem to be the key here.

Tips on Quitting12

Drink lots of water!

Distract yourself from smoking by chewing a piece of gum, brushing your teeth, or calling a friend.

The next time you have a craving to smoke, try to delay for five minutes.

Remember, the craving goes away whether you smoke the cigarette or not!

Be prepared for the “after a meal” cigarette craving. Instead of smoking, brush your teeth, gargle with mouthwash, and find something else to do.

Change your routine and break habits that usually go with smoking cigarettes. If you like to drink beer, soda, or coffee with a cigarette, try a different drink, such as fruit juice or water.

Practice taking a few deep breaths when feeling the urge to smoke.

Write down a list of your most common triggers with coping strategies for each and carry it with you to reference when you encounter a tough situation.

Try to exercise for at least fifteen minutes every day.

Practice stress management exercises such as deep breathing, muscular relaxation, delay plus behavioral alternatives, imagery, thinking straight, and self-talk to help with urges to smoke.

If you have a slip and smoke a cigarette, do not give up. Relapse is common, and you just have to renew your commitment and get back on track.

Reward yourself for staying smoke free for one week, one month, three months, and so on.

Be patient! Frequently remind yourself why you quit smoking and that quitting smoking gets easier every day.

See yourself as a person who chooses not to smoke anymore.

Calculate how much money you are saving each week that you remain smoke free.

Relapse

Perhaps more than with any other drug, quitting nicotine is hard to get right the first time. Relapse is common and it often takes several attempts before a person succeeds at quitting. For that reason, it’s important to view quitting as a process—do not feel defeated if you slip up and smoke or relapse into your old using behavior. Instead, it’s best to learn from your mistakes and be prepared to start again.

Many experts agree that success occurs when people take these four steps:

  1. Make the decision to quit.
  2. Pick a day to quit and make a plan for quitting.
  3. Stick to your plan and work through withdrawal.
  4. Make a plan to stay tobacco-free.

If you don’t succeed with one quit plan, try another. Also, develop a relapse prevention plan that includes strategies to manage stress and get support. This plan might include a list of your common triggers, a list of alternative behaviors to deal with cravings, a list of people you can call for support, and your motivation for quitting (your health, children, etc.). Keep this plan handy and reference it throughout your first weeks of quitting.