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Thinking of getting some help next time you try to quit smoking?
This guide presents the pros and the cons of different treat-
ments. In it we provide information that will help you decidewhich treatment best fits your situation. Before we discuss thetreatments, we want to correct some myths many smokers haveabout quitting.
Common Myths About Quitting Smoking
̈ Treatment is not necessary. I just have to tough it out.
It is true that many smokers quit without treatment, but for most, ittakes many attempts over many years before they finally quit. By usingthe treatments in this guide, you double your chances of quitting. Don’tfool around—give yourself the best chance of quitting. It’s important toquit now, before you get a disease caused by smoking.
̈ Medications containing nicotine, like a patch or gum, are harmful
Actually, the tar, carbon monoxide, and other toxins in cigarettes, notthe nicotine, produce most of the harm from smoking. Long-term useof nicotine itself does not appear to be harmful. In addition, currentresearch indicates that nicotine medications that provide a slower,lower dose of nicotine are not addicting.
̈ If I go to counseling for smoking cessation, I’ll have to bare my soul.
Smoking cessation groups are not psychotherapy. They are no-nonsensegroups of smokers and ex-smokers that focus on mutual support andtips to help you stop smoking.
Smokers have a 50% chance of dying from a smoking-related diseasesuch as lung cancer, a heart attack, or emphysema. The cost of most
treatments to stop smoking is low. Most treatments last only 6 to 12weeks. During this time, medications cost $3 per day or less, and groupcounseling costs $5 to $25 per week. (Compare this to how much youspend on smoking.)
Smokers weigh 5 to 7 pounds less than nonsmokers. When they quitsmoking, they gain back those 5 to 7 pounds. When smokers diet whilequitting smoking, they often relapse and start smoking again. The bestsolution is not to diet but to increase your activity while quitting. Youshould wait until you are sure of your abstinence (1 to 3 months) beforetrying to lose weight.
Where Can You Get Help?
Spend a few minutes during your next visit to the doctor and talk toyour doctor, the office nurse, or a health educator. Brief, personaladvice from this team increases your chances of success by 50%. Ahint—write down your questions ahead of time.
Some people like the support and encouragement of others; plus, mak-ing your commitment public can help motivate you. Even if these rea-sons are not important to you, you must talk to your family or bestfriend and let them know whether you want them to be involved and,if so, how—for example, not smoking in front of you or not offeringyou a cigarette.
Maybe it’s time to try stopping with a group of people. Voluntary organ-izations (see box on page 4) often run groups to support and to give
tips to smokers. Groups usually last 45 to 60 minutes once a week for1 to 3 weeks before the quit date and then 1 to 3 weeks after the quitdate. One common problem is that groups are offered only once everyfew months; thus, you will have to decide whether it’s important todelay your quit attempt until a group starts.
Many, but not all, addiction counselors, health educators, nurses, psy-chologists, and physicians have experience helping smokers stop smok-ing. Some new treatments require a physician’s prescription. Be sureany specialist is using a proven method for smoking cessation (we’lldescribe the proven methods later), and ask if they have treated smok-ers before.
Sometimes this is just recorded tips, but now, many health plans, well-ness programs, state health departments, and drug companies that sellsmoking-cessation medications offer free advice over the phone from areal person. Often this advice consists of personalized quitting plansand ongoing supportive counseling.
All of the organizations in the box on page 4 offer pamphlets and bookswith many tips to help smokers stop smoking. It’s best to pick out afew tips especially important to you in your attempt to quit.
Groups can be free or can cost up to $150. Written materials can be freeor can cost up to $10. Specialists can charge from $60 to $150 per hour.
Some health plans cover smoking-cessation treatment, but others donot. Be sure to check.
Organizations With Stop-Smoking Programs
and “Stop Smoking” Experts
American Academy of
Society for Behavioral
American Cancer Society
American Society of
Society for Research on
Nicotine and Tobacco
American Lung Association
Your local clinic, HMO, hospital,
work wellness program, or
health education department
Your state Department of
National Cancer Institute
9000 Rockville Pike
Your state Alcohol and Drug
Bethesda, MD 20892Tel: 800-4-CANCERwww.nci.nih.gov
The boxes on pages 6 and 7 list the treatments that are scientificallyproven to work and those that do not appear to work.
Medications That Contain Nicotine
Four different types of nicotine medications are available: two you canbuy without a prescription—nicotine gum and nicotine patch—and twofor which you need a prescription—nicotine nasal spray and nicotineinhaler. They all are effective—that is, they all double your chances ofquitting. However, they have different pros and cons that will appeal todifferent smokers. All are used for 6 to 12 weeks.
Nicotine gum (Nicorette).
This gum contains a small amount of nico-
tine that is released by chewing and is absorbed in the mouth. There
are two doses: 2 milligrams for light smokers and 4 milligrams for heavy
smokers. The gum produces nicotine levels lower than those from
smoking. As soon as you quit, the gum is used as needed but at least
once every hour for up to 12 weeks. The biggest plus of the gum is that
you use it when you need it—for example, when a craving occurs. You
chew the gum for about 30 minutes at a time. Unfortunately, caffeinat-
ed coffee and soda and juices limit the absorption of nicotine from the
gum, so you cannot drink these right before, during, or right after using
the gum. The most common side effects are disliking the taste, sore jaw,
and burning mouth. Although some people use the gum for long peri-
ods, very few of these have trouble stopping the gum. You should talk
to your doctor before choosing to use nicotine gum if you have heart
problems, high blood pressure, dental problems, ulcers, or diabetes; if
you use medication for asthma or a mental illness; or if you are younger
than 18 years old, pregnant, or breast-feeding.
Nicotine patches (Habitrol, Nicoderm, Nicotrol, Prostep).
Nicotine can be absorbed through the skin, which has led to the devel-
opment of several different skin patches for delivery of nicotine. The
key advantage of the patches is that they are easy to use. The Nicotrol
Scientifically Proven Treatments
Nicotine gum (Nicorette)
Behavioral/supportive therapy via
Treatments That Do Not
Appear to Be Helpful
AcupunctureCigarette filtersHerbal treatmentsHomeopathic treatmentsInjectionsLobeline (BanTron, Nicoban)
Treatments Not Proven
But That Appear Promising
ClonidineCombined nicotine gum + patchCombined Zyban + patchHigher-strength nicotine patchesNicotine-blocking medication
Increased exerciseHypnosisNicotine Anonymous
patch is used for 16 hours (while awake), and the Nicoderm patch isused for 24 hours. After 6 weeks of treatment with Nicoderm, youswitch to lower- and then even lower-strength patches to slowly weanyourself. After 6 weeks of treatment with Nicotrol, you simply stopusing the patch. Although the two patches have different features, useof either doubles quit rates and they appear equally helpful. If you haveone of the conditions mentioned in the previous paragraph on nicotinegum, then you will need to consult with your doctor before using thepatch. The most common side effects of the patches are skin irritation
and (with 24-hour wear) insomnia. Addiction to patches does not occur.
When patches were first introduced, some physicians thought thatsmoking and wearing a patch simultaneously caused heart attacks.
Several scientific studies since then have concluded that smoking andwearing a patch simultaneously do not increase the risk of heart attacks.
However, most physicians believe it is best not to smoke while usingthe patch.
Nicotine nasal spray (Nicotrol NS).
Nicotine nasal spray delivers
nicotine in a manner similar to the nasal sprays used for colds. The
major advantage of the nasal spray is that it gives you more nicotine
faster. However, even with the nasal spray, you receive less nicotine
than with a cigarette. As with the gum, at first it’s best to use the spray
at least once per hour. Some, but not all, studies suggest that smokers
with stronger addictions are especially helped by the nasal spray.
Initially, many users experience nose and throat burning, sneezing,
runny nose, and watery eyes. However, for most users these go away
or are greatly reduced within a week. Although early reports suggested
that some people might become addicted to nicotine nasal spray, later
reports have not supported this finding.
Nicotine inhaler (Nicotrol IN).
The inhaler is a nicotine plug in a
plastic rod that a user puffs on. Although labeled an “inhaler,” in reali-
ty, almost none of the nicotine goes into the lungs; rather, it is absorbed
in the mouth. Thus, the inhaler results in relatively low levels of nico-
tine in the blood. As with the gum and nasal spray, the inhaler can be
used as needed, but it should be used at least hourly. The main advan-
tage of using the inhaler is that it mimics the habit or hand-to-mouth
motions of smoking. The most common side effects of the inhaler are
mild coughing and throat irritation. Addiction to inhalers doesn’t occur,
but one drawback is that the inhaler produces less nicotine in cold
weather (below 50 degrees).
Medications That Do Not Contain Nicotine
Bupropion (Zyban, Wellbutrin).
Bupropion was originally used as
an antidepressant, but it has now been found to be as effective as nico-
tine medications in helping smokers stop smoking. Its main benefit is
that, although receiving nicotine from medications is safe, many smok-
ers prefer a medication that does not contain nicotine. Although wedon’t know exactly how bupropion works, it doesn’t work by its anti-depressant effects; thus, you don’t have to be depressed for bupropionto help you. With bupropion you take medication for one week beforeyou stop smoking and then for 6 to 12 weeks thereafter. The most com-mon side effects are dry mouth and insomnia. Although higher dosesof a version of the medication in bupropion may cause seizures, thisdoes not appear to be a risk when bupropion is used as directed fortreatment of smoking cessation.
Clonidine, a prescription medication usually used to treat
high blood pressure, has been found to help some smokers stop smok-
ing. It does not contain nicotine. Most specialists believe that for most
smokers, clonidine taken as a pill or a patch is less effective and has
more side effects than the other medications available. However, your
doctor may recommend this medication based on his or her experience
or knowledge of your situation.
Wearing a patch and then using nicotine gum for the hard times orwearing a patch and taking bupropion appear to increase your chancesof quitting over using either method alone, although this has not beendefinitely proved. Because these are new treatments, you should askyour doctor about combining medications before doing so.
Behavioral/supportive therapy is the most widely used talking therapyfor smoking cessation because it is scientifically proven to double yourchances of quitting. Behavioral/supportive therapy can be done in sev-eral formats: groups, individual counseling, telephone contacts, or writ-ten materials. The behavioral portion often begins with writing downwhen you smoke to determine your specific triggers for smoking. Next,you develop a plan to avoid your smoking triggers and then use behav-
ioral and thinking strategies when you encounter a trigger (for exam-ple, take a short walk or tell yourself why you want to quit). Sometimesthis therapy involves rewarding yourself for not smoking or makingpersonal contracts with people close to you in which you pledge thatyou will not smoke.
Combining Counseling and Medication
If you want the best chance of quitting, you should use both a coun-
seling treatment and a medication treatment. When you do both, your
chance of quitting increases to near triple that of quitting without treat-
If You Start Smoking Again
First of all, try not to be discouraged. Think of it as falling off a bicy-cle. It hurts, but you are one step closer to success. In addition to re-motivating yourself to try again, ask yourself three questions:
1. What did I learn from this attempt?
Write down a list of things
you will do differently the next time and store it away for your nextattempt.
2. Did I really give the medicine or counseling my best try, and
did it still not help?
If so, then maybe you need to investigate a
different treatment for your next attempt. Maybe you found out that
you really do need some counseling help, or maybe you do need
medication to help control your cravings.
3. Do I have a problem that’s keeping me from quitting?
you have a psychological problem such as depression, or perhapsyou have alcohol problems. Or perhaps your spouse smokes and isnot at all supportive. Whatever the problem, you should considertrying a group or specialist to get help with that particular problem.
If You Succeed in Quitting Smoking
Remember, successful ex-smokers are those who have plans for relapsesituations such as stress and partying. They also know that for them,there is no such thing as smoking just one cigarette.
Make a commitment to help others around you when they try to
quit. You know how hard it is to quit. When you talk to your friendswho are still smokers, tell them how you did it and offer to supporttheir attempt to quit.
Psychiatry Naturalistic Impact of Second-Generation Antipsychotics on Weight Gain Diana I Brixner, Qayyim Said, Patricia K Corey-Lisle, A Vickie Tuomari, Gilbert J L’Italien, William Stockdale, BACKGROUND: While second-generation antipsychotics (SGAs) have had benefits over earlier antipsychotic treatments, their use has been associated with reports of weight gain. Body mass index (B
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