Source: news.ncmonline.com
Author: Erin Marcus, M.D.

Editor’s Note: In the debut of A Doctor’s Word, Dr. Erin Marcus wrote about an African-American man’s effort to quit smoking cigarettes. This week, she offers practical advice for all who would like to kick the habit. Dr. Marcus is associate professor of clinical medicine at the University of Miami Miller School of Medicine.

In my first column, I shared the story of Lawrence Jones, a 55-year-old man who smoked for 35 years until July, when he decided to quit. In his words, he was “sick and tired of being sick and tired.” Giving up the addictive habit of tobacco is extremely difficult, and Jones’ success depended on the help of a counselor, smoking cessation classes, nicotine replacement patches, and the support of a friend. Here are some things that helped Jones, as well as tips I’ve garnered over the years as a primary care physician.

To succeed at quitting, you first have to decide that this is something you really want to do. Medicine and classes won’t work unless you have made a commitment. In Jones’ case, a graphic video that his counselor played at his first stop smoking class made him resolve to quit. It showed pictures of smokers that he could not forget: a man missing an eye and part of his nose from mouth cancer, and people breathing through tracheotomies – holes that doctors surgically cut in their throats when cancer prevented them from breathing. “You have to be willing to give it your all,” Jones said. “But the pros outweigh the cons.”

If you can, join a stop smoking group. This can be difficult to do, as often these are held during working hours. But if you can find one at a time convenient for you, these groups can be very helpful in providing support and strategies and keeping you focused on your goal. Jones attended seven hour-long classes and describes them as crucial to his success. Call your local county health department or hospital and ask if they offer or know of a local smoking cessation program. The American Lung Association is a national organization that can direct you to smoking cessation classes in your region: 1-800- lung USA, or www.ffsonline.org

Set a quit date and prepare in advance for what you will do once you quit. This includes changing your environment by removing ashtrays and other smoking-related items from your home. It also includes telling your friends and loved ones about your plan and asking for their support. The first few weeks you will probably be the most tense and irritable. Plan to alleviate the stress through activities such as exercise, meditation, using a stress ball, or sharing your feelings with a friend.

Get medication in advance of your quit date. Yes, we all know people who quit “cold turkey” and succeeded. But research shows that your odds of succeeding are much higher if you use medication. There are three different medications: varenicline, brand name Chantix, which helps treat nicotine withdrawal as well as smokers’ cravings for tobacco after they quit; bupropion, or Zyban, which reduces cravings; and nicotine replacement, sold in the form of patches, inhalers and gum. Varenicline can be used alone, while bupropion and nicotine replacement are often used together. Jones has been using patches alone with success.

If you’re paying for these medications entirely out of pocket, be aware that they aren’t cheap. At my local pharmacy, bupropion costs $87 a month, nicotine replacement runs between $40 and $50 monthly, and varenicline costs $182 a month. But it’s important to remember how much you will save by not buying cigarettes, which cost up to $10 a pack.

Varenicline and bupropion require prescriptions, and they can have side effects. Some state Medicaid programs and insurance plans cover these medications. For more information, check the American Lung Association website (www.ffsonline.org) link called “state tobacco cessation coverage.” Very rarely, free or discounted medication is available through some state telephone quit lines. Call 1-800-QUIT NOW for more information.

If you can, find a “sponsor,” or a friend, who will be there for you when you are trying to quit. For some smokers, this is someone who listens when they feel frustrated; for others, it’s someone who can be empathetic as they mourn the ending of a lifelong habit, which can feel like losing an old friend. In Jones’ case, his sponsor was a non-smoking friend who rationed his cigarettes when he was tapering down and listened to him when he was withdrawing. “He was a good sponsor – he didn’t cut any corners or do me any favors,” Jones said. “In the beginning I would get aggressive, and he was somebody who was willing to be yelled at and ignored.”

Know your smoking triggers, and take steps to avoid them or to develop a way to cope with them. For Jones, being alone and isolated prompted him to smoke, so when he feels isolated, he talks to his sponsor. He also has been in touch with friends and family and has avoided places that he fears would make him go back to his old habits, such as the apartment in which his late girlfriend lived.

Be aware that most people make many attempts to quit before succeeding. If you have tried before and failed, you aren’t alone, and that doesn’t mean you should give up. It takes five to seven attempts, on average, before succeeding. Some smokers are able to succeed with far fewer attempts; others, many more. In the words of Mark Twain, “Quitting smoking is easy. I’ve done it a thousand times.”

Remember the Five D’s. These are outlined in the pamphlet “Pathways to Freedom,” which is referenced below. Jones’ smoking counselor, Mary Mites, recommends these to the people in her class. They are: Drink water – up to eight glasses daily, to cleanse your body of nicotine; Deep Breathe, to help relax; Do Something Else, to get your mind off smoking; Discuss, or talk about what you’re experiencing; and Delay – when you get the urge, count to 250. When Jones got the urge to buy a pack of cigarettes, he would stash the money in a jar –and after several weeks he had saved enough to buy an $80 pair of Stacy Adams shoes.

Put something in your mouth other than food. Many smokers miss the sense of something in their mouth when they are quitting. Jones uses gum when he gets a craving (go sugar-free if you are going to do that). Some people find the plastic sticks used to stir coffee to be helpful.

Quit lines may help. These are toll-free telephone lines, organized by the National Cancer Institute, that provide telephone counseling free of charge. Some have criticized these lines for not having a diverse staff of counselors, but Jones found the lines very helpful when, in his words, he was “searching for ways to not focus on picking up a cigarette.” The numbers are: 1-877-44U-QUIT and 1-800-QUIT NOW.

Information sources that I find useful are: Pathways to Freedom, a guide for African Americans developed by the U.S. Centers for Disease Control in collaboration with churches and community organizations; it’s available at http://www.cdc.gov/TOBACCO/quit_smoking/how_to_quit/pathways/index.htm

The government website http://www.smokefree.gov/ is also replete with useful information, as is that of the American Lung Association: www.ffsonline.org.