You should always consult your physician when making decisions about your health. There are three broad categories of nicotine replacement therapy: nicotine that is absorbed through the skin, mouth, and airways. Here are some important points to help you decide:. The nicotine patch is convenient because it provides long term relief from nicotine withdrawal, and you only have to think about it once a day. The nicotine patch is the most studied type of nicotine replacement therapy, and significantly increases your chances of success by 50 to 70 percent.
Nicotine lozenges and nicotine gum provide short term relief from nicotine withdrawal symptoms. They also help deal with oral cravings that a nicotine patch cannot. The most effective smoking cessation combination is a nicotine patch for long term relief, and nicotine lozenges for breakthrough carvings. The nicotine in lozenges and gum is absorbed through the inner surface of your mouth rather than through your stomach. Food and drinks can affect how the nicotine is absorbed. Most people find nicotine lozenges easier to use than nicotine gum.
Nicotine gum can stick to dental work. How do you use nicotine lozenges? Suck on a lozenge until it is fully dissolved, about 20 to 30 minutes. Do not bite or chew it like hard candy, and do not swallow it. How do you use nicotine gum? Chew the gum slowly until you get a peppery taste or tingle in your mouth.
Then hold it inside your cheek park it until the taste fades. Then chew it again to get the tingle back, and park it again. Nicotine inhalers and nasal sprays are the most fast acting of all nicotine replacement methods. But because they work so quickly they have a higher risk of becoming addictive. However, if they feel they need to continue using the product for longer in order to quit, it is safe to do so in most cases. In other words, follow the instructions, but it is reasonable to use the patch for up to 5 months, if you have the approval of your health care professional. In my experience, most people relapse when they taper down too quickly from the full strength 21 mg patch to the 14 mg patch.
Yes, if you use nicotine replacement therapy incorrectly. Speak to your health professional about the correct way to use it. If you experience any of these symptoms call your doctor. More serious symptoms of nicotine overdose or nicotine poisoning include:. Call Poison Control and get emergency help if you suspect nicotine overdose or nicotine poisoning. Nicotine replacement therapy is considered safe for smokers with a history of cardiovascular disease. It does not increase the risk of heart attacks and strokes in smokers with a history of cardiovascular disease.
There is not enough evidence to be absolutely sure that nicotine replacement therapy is safe for pregnant women. There are prescription drugs that can help you quit. Some can be used along with nicotine replacement therapy. Most have to be started before your planned quit day, and all need a prescription. Zyban Wellbutrin, bupropion is a prescription antidepressant that was later discovered to reduce nicotine cravings and help people quit smoking.
It does not contain nicotine. It acts on chemicals in the brain that cause nicotine cravings. Large scale studies have shown that Zyban is at least as effective as nicotine replacement therapy in smoking cessation. Zyban works best if you start it 1 to 2 weeks before you quit smoking. The usual dosage is mg tablets once or twice per day. Your doctor may want to continue it for 8 to 12 weeks after you quit smoking to help reduce the chance of relapse. The most common side effects include : dry mouth, trouble sleeping, agitation, irritability, indigestion, and headaches.
Antidepressants may increase the risk of suicide in persons younger than When prescribed for smoking cessation, there have been four suicides per one million prescriptions and one case of suicidal ideation per ten thousand prescriptions. Combining Zyban and nicotine replacement therapy, is usually more effective than either treatment alone. Zyban reduces cravings by working on brain chemistry, and nicotine replacement therapy works by gradually weaning your body off nicotine.
Zyban combined with nicotine replacement therapy can slightly increase your blood pressure. Therefore monitoring of blood pressure is recommended in these cases. Varenicline is a prescription medication that can reduce cravings and increase your chances of success. Chantix is a partial nicotine agonist. It partially stimulates the nicotine receptors in the brain so you get a mild effect as if you were smoking, but at the same time it blocks the receptors from giving the full effect of smoking.
This lessens the pleasure you get from smoking, and reduces nicotine withdrawal. Chantix Champix, varenicline should be started a week before your quit day. Chantix Champix, varenicline significantly increases the risk of depressed mood, thoughts of suicide, and attempted suicide.
The findings for varenicline, render it unsuitable for first-line use in smoking cessation. One of the main concerns with electronic cigarettes is that they mimic the use of regular cigarettes. Studies have also shown that the vapor from electronic cigarettes has potentially harmful toxins. Here are just a few smoking facts. Not a long list, but some key facts about the dangers of smoking.
How to Quit Smoking Forever: An Easy Step-By-Step Plan
Smoking causes more deaths each year than all of the following causes combined : Both the founders of Alcoholics Anonymous, Dr. Bob and Bill W. Smoking statistics tend to feel impersonal. Smoking kills 6 million people each year worldwide. More smokers die of heart disease and stroke rather than lung cancer. This is why people often underestimate how deadly smoking is.
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Perhaps your grandfather smoked his whole life and never died of lung cancer. Most smokers die of heart disease or stroke. Smoking causes type 2 diabetes. Smokers are 30 — 40 percent more likely to develop diabetes. Those are just a few of the diseases caused by smoking. There is not an organ or system in your body that is not affected by the dangers of smoking. The full list of smoking diseases is too long and depressing. Second hand smoke causes the same kinds of deaths as smoking. Here are just two of the consequences of living with a smoker or working in a smoking environment.
Nonsmokers exposed to second hand smoke at home or at work are at higher risk of the following: Learn how to overcome anxiety, depression, and addiction. Who will quit with and without the nicotine patch. JAMA , Addict Behav , Arch Gen Psychiatry , Cochrane Database Syst Rev , BMC Public Health , Using novel analytic methods to detect differential treatment effects over 8 weeks of pharmacotherapy. Nicotine Tob Res , N Engl J Med , PLoS One , Unassisted quitting was seen as most suitable for those who were not heavily addicted to cigarettes.
The participant below equates heavy smoking with dependence. I have friends who quit like that, cold turkey, and it worked out pretty well. Nicotine replacement therapy is the most commonly used pharmacotherapy for smoking cessation. In Australia, the cost of NRT is heavily subsidised if participants attend their doctor and receive a prescription.
Despite this, only four of 29 participants intended to use NRT on their next quit attempt. Cost was mentioned as a barrier to the use of NRT by some participants, which could indicate a lack of awareness about government subsidization. NRT might be extremely effective on people who are very physically addicted.
NRT was seen by some of these smokers as failing to deal with the psychological or routine aspects of smoking that they considered central to their dependence. A small number of participants who had experience using NRT acknowledged the role of physiological dependence in their smoking and thought that NRT had been effective for them because it dealt with the physiological aspect of smoking. Yeah, I think that does help because it does take away that initial physical withdrawal feeling so that you can concentrate on trying to manage the habit part of it.
That, for me as I said, it only took a couple of weeks for me to get that clearing out of my system and then it was just a matter of trying to manage the ritual habit part of it. So that definitely made it a lot easier. Participants rarely reported using NRT as directed. Rather, participants were more likely to use NRT short-term during long-haul flights or short-term stays in hospital. Personal experience was particularly salient in relation to side effects. Those who had used NRT and experienced unpleasant side effects reported that they would not use it again.
Because I had a friend who used the patches and he used to have nightmares and-yeah, stuff like that. A small number of participants were concerned about developing dependence on NRT. They saw dependence on nicotine as a negative state, with there being no essential difference between whether they consumed nicotine via smoking cigarettes or via NRT. At some point you do need to just stop. The prescription medications bupropion and varenicline are publicly subsidised forms of pharmacotherapy for smoking cessation in Australia.
Approximately one third of participants were unaware of the existence of these prescription medications for smoking cessation. Because direct to consumer advertising of prescription medications is not permitted in Australia, this is perhaps not surprising. Amongst our participants, those who were older and heavier smokers were more likely to be aware of these medications. Those who did know of these medications frequently expressed concern about their safety.
Cost was mentioned less often, perhaps because the fear of side effects dominated considerations of costs. While only a few had tried prescription medications for smoking cessation, many had heard reports about adverse side effects from their friends, family or acquaintances. The most commonly mentioned were mental health issues and nightmares.
These side effects were cited as the main reason why most would not consider using prescription medication. Made him really sick. As with NRT, perceptions of efficacy were also closely tied to the experiences of family and friends who had used these medications. As the quote demonstrates, having sufficient willpower was still perceived as important, even when medication was taken. However, medication was not generally seen as replacing willpower and mindset, which were seen as essential ingredients of a successful quit attempt:.
Interestingly, the few participants who had used prescription medication found it effective and reported positive attitudes towards it, despite a subsequent relapse. Yeah, I reckon that Champix, like that helped me. But I think if I had have continued with it I probably I want to give it another go, so. As already described, guidelines for treating tobacco dependence recommend that counselling is combined with pharmacotherapy. Few participants in this study reported any personal experiences with counselling for smoking cessation.
The number for the Quitline is displayed prominently on all Australian cigarette packs, and health professionals are encouraged to refer smoking patients to the Quitline. In addition, referral to a counselling service, which is typically the Quitline , is a necessary condition for doctors to prescribe subsidised NRT or prescription medications for patients.
Again I think that is completely dependent on the person. I think it would just make it worse if someone was preaching to me, which is the way I would see it, whether it was actually like that or not. A less commonly discussed theme was a lack of interest in counselling. Even those who expressed positive views of counselling were reluctant to use it for smoking cessation. Only one person intended to use the Quitline on their next quit attempt, and two said that they would use generic counselling. Participants were also questioned about their views on self-help material such as books, pamphlets, and online information.
While participants had moderately positive views about self-help materials, they did not hold strong views about them.
A handful of participants described specific materials that they had found useful. Self-help materials were perceived by a few as insufficient for quitting smoking. Others were not interested in them because they did not enjoy reading. Could be good, yeah. Depends on individual-if someone is having reading as a hobby, could be helpful. People like me who is not really into reading, yeah, could be waste of time for me.
Dispositional or character-based factors were often cited when evaluating the potential of a quitting method. Unassisted quitting was seen as suitable for those with willpower, strong motivation or internal strength. Negative experiences of friends and family were frequently reported, perhaps because such experiences are more salient than positive ones.
Practical factors such as cost or side effects were regarded as significant for some quitting methods. Cost was mainly mentioned as a barrier to using NRT, less often for prescription medication. Side effects were discussed frequently in relation to NRT and prescription medication. The number of side effects mentioned by study participants, particularly in relation to prescription medication, was higher than what would be expected from epidemiological evidence [ 35 , 36 ].
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This may be because smokers misinterpret nicotine withdrawal symptoms as side effects of smoking cessation medications; or because people are more likely to discuss experiences of medication use where they have experienced side effects than those in which they have not. Our finding that some participants did not use NRT in accordance with clinical recommendations is consistent with evidence from quantitative surveys. The latter have found that most smokers do not use NRT as directed and few use a full course of NRT as recommended [ 37 ].
This lack of adherence increases the likelihood that withdrawal symptoms will be experienced and perhaps mistaken for side effects. The fact that not all participants were aware of the existence of prescription medications is not surprising given the lack of direct to consumer advertising of prescription medications in Australia. Additionally, since one of the indications for the prescription of smoking cessation medications in Australia is smoking more than ten cigarettes per day, it should be expected that lighter smokers will have less awareness of prescription medications for smoking cessation [ 5 ].
Research in the UK has shown that young and healthy smokers who attend their doctors are less likely to be prescribed pharmacotherapy for smoking cessation than older smokers with existing health problems [ 38 ]. While our research was not able to assess this possibility, it may be that different types of smokers are being provided with different information about their quitting options by health practitioners.
Even if smokers perceived prescription medication to be helpful, this was weighed against the risk of side effects that many decided made the potential benefits not worth the risk. The literature on risk perception in smoking shows that the distal nature of the health risks are a deterrent to quitting, particularly for young people, as they often hold optimistic beliefs about their ability to quit smoking prior to developing any smoking related health problems [ 39 ].
Any side effects from using pharmacological cessation aids for smoking cessation are more immediate, and may therefore take precedence over the longer-term health risks of smoking. This is consistent with evidence on the use of medications more generally, where the difference between the perceived necessity of a medication and concerns about its use predict poor medication adherence [ 16 ]. Beliefs about addiction were influential in our smokers discourse on smoking cessation.
These participants were more likely to hold positive views about cold turkey quitting. This is a complex topic for health practitioners to negotiate. One potential implication of this finding might be that smokers need to be educated about nicotine addiction in order to convince them that they have a physiological dependence that can be treated using medications. However, as Chapman and McKenzie [ 10 ] argue, such an approach may unintentionally devalue unassisted quitting, and produce a counterproductive effect in which smokers who are told how difficult it will be for them to quit smoking, are less inclined to try to quit.
We suggest that a more sensitive, tailored approach is employed by health care practitioners. Where patients are very averse to medications, it would be counterproductive to emphasize the difficulty of quitting unassisted. Probing patients about their views on nicotine addiction and their attitudes towards medications may aid doctors in designing individualised treatment plans for patients who have tried and failed to quit cold turkey on a number of occasions. Our study shows that smokers evaluate a given method for quitting in light of a range of alternatives and contingencies. For example, when thinking about varenicline, smokers might think that it will be effective, but believe that the side effects are not worth it.
Unassisted quitting is seen as a particularly salient alternative to pharmacological cessation aids because it is free, safe and perceived by many smokers to be the most effective way to quit. Males in particular preferred cold turkey quitting because they anticipated a strong sense of achievement from quitting without help.
The value placed on this sense of achievement from quitting unassisted has been observed in another study [ 26 ]. It may be helpful to take this into account when designing interventions aimed specifically at men. This idea that smokers need to be ready to quit has also been prominent in smoking cessation literature and programs, thanks to the influence of the transtheoretical model of behaviour change. The transtheoretical model posits that individuals pass through a set of ordered stages in their journey to behaviour change, and that different interventions are suitable for different stages of change.
Interventions aimed at people in this stage are primarily informational and aim to increase desire and motivation to move smokers into the next stage—contemplating a quit attempt- rather than promoting an immediate attempt to quit. The transtheoretical model has been strongly criticized on the grounds that behaviour change is more dynamic and complex than the model assumes [ 41 ] and that unplanned, spontaneous quit attempts may be more successful than planned ones [ 17 , 42 , 43 ]. Moreover, the belief that an unqualified desire to quit is required prior to a successful quit attempt has been identified as a barrier to making quit attempt [ 6 , 44 ].
The results of this study are also consistent with previous qualitative research in showing that smokers consider willpower, strength, and motivation as central to successful quitting [ 26 , 27 , 45 ]. Rather, smokers emphasised that willpower and personal choice were necessary, even when cessation aids were used. It aligns with Western cultural values of free choice and individual strength. It is a view that has been heavily promoted by the tobacco industry to argue for fewer government interventions to prevent or discourage smoking [ 46 ]. Even with the increasing biomedicalisation of smoking cessation, it seems highly unlikely that the discourse of willpower will disappear from public discourse on smoking.
Therefore, incorporating beliefs about willpower into smoking cessation campaigns and clinical interactions may be of value. For example, messages that tell people who are using pharmacological cessation that willpower is still required may allow successful quitters to attain the sense of achievement that was valued by some in our study. It also provides more realistic expectations about the efficacy of current pharmacological options. Relatedly, only a small minority of participants believed that cessation aids would be necessary and sufficient to quit smoking.
The negative views of the Quitline expressed by participants are consistent with evidence of low uptake of counselling in general [ 47 , 48 ]. This may be of concern, given that counselling is required in conjunction with the prescription of pharmacological cessation aids in clinical practice guidelines. Despite many acknowledging the psychological and behavioural aspects of smoking, few participants expressed an interest in counselling and only one participant intended to use the recommended combination of pharmacotherapy and counselling for their next quit attempt.
Cutting down is a method of quitting that is commonly used by smokers but we did not directly ask about it. Lastly, although nicotine replacement products are widely advertised in Australia, there is no direct to consumer advertising of prescription medications. It would be useful to examine attitudes in countries where direct to consumer advertising for prescription stop-smoking medications is permitted e. It should be noted that this was qualitative research and no inferences about the prevalence of these beliefs in the larger population of smokers can be drawn.
However, these findings provide an insight into the range of factors that smokers consider when evaluating quitting methods. This information is useful to inform future work in this area. Their views about different methods are often not independent. For example, views about NRT are shaped by very positive attitudes towards quitting cold turkey. Looking at attitudes towards assisted or unassisted quitting in isolation may provide incomplete information on quitting preferences.
It is therefore important that the above-mentioned factors are considered when conducting research into treatment preferences for smoking cessation. We would like to acknowledge the participants who provided their time and thoughts for this research. Thank you to Charmaine Jenson for double coding.
How to Quit Smoking: Groundwork & Preparation
We thank the two anonymous reviewers who provided helpful feedback on a previous version of this paper. All authors contributed to overall study design. Kylie Morphett drafted the interview schedule, interviewed participants and analysed data. BP contributed to data analysis. Kylie Morphett drafted the first version of the manuscript. All authors gave final approval for the version to be published. National Center for Biotechnology Information , U. Published online Jun William Toscano, Academic Editor.
Author information Article notes Copyright and License information Disclaimer. Received Apr 15; Accepted Jun 5. This article has been cited by other articles in PMC. Abstract The development of prescription medication for smoking cessation and the introduction of evidence-based guidelines for health professionals has increasingly medicalised smoking cessation. Keywords: smoking, smoking cessation, medicalization, attitude, qualitative research. Introduction Smoking cessation has become increasingly medicalised since the introduction of nicotine replacement therapy NRT in the s.
Methods Semi-structured interviews were conducted with 29 daily smokers aged 18 years or over from a large metropolitan Australian city. Results 3. Participants Participant demographics are presented in Table 1. Open in a separate window. Table 2 Strategies used on previous quit attempts. Assisted Cessation Nicotine replacement therapy is the most commonly used pharmacotherapy for smoking cessation. Female, 41—54, 11—20 CPD.
Conclusions It should be noted that this was qualitative research and no inferences about the prevalence of these beliefs in the larger population of smokers can be drawn. Acknowledgments We would like to acknowledge the participants who provided their time and thoughts for this research. Supplementary Files Supplementary File 1 Click here for additional data file. Author Contributions All authors contributed to overall study design. Conflicts of Interest The authors declare no conflict of interest. References 1. Cahill K. Pharmacological interventions for smoking cessation: An overview and network meta-analysis.
Cochrane Database Syst. Hartmann-Boyce J.
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Quitlines and nicotine replacement for smoking cessation: Do we need to change policy? Public Health. Smith A. What do we know about unassisted smoking cessation in Australia? A systematic review, — Chapman S. The global research neglect of unassisted smoking cessation: Causes and consequences. PLoS Med. Zhu S.
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Interventions to increase smoking cessation at the population level: How much progress has been made in the last two decades? Wolff F. New terminology for the treatment of tobacco dependence: A proposal for debate. Lawlor D.