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Smoking is one of those things that, by now, everyone knows is terrible for you. It's also one of those things that you may have gotten addicted to, before you knew any better. And if you're like a lot of smokers, you might feel like it's nearly impossible to quit, despite knowing all the reasons why you shouldn't do it. I know from experience, because I witnessed the struggle my parents had, firsthand.
My mom and dad smoked cigarettes for over 30 years, throughout most of my life. They tried again and again to quit, but for one reason or another, they failed, time and again. But then, when they each hit the age of 49, something stuck and they finally kicked their addictions. That was in 2011 for my mom and 2010 for my dad.
If you're struggling with addiction to smoking tobacco products, we're here to tell you that you can quit, too. Certified nurse practitioner and tobacco treatment specialist Gretchen Whitby shared with us a ton of facts, tips, and tricks to help you make 2018 the year that you finally kick that unhealthy habit for good.
People who want to quit smoking need to make it a lifestyle change, Whitby says. She's been with The Ohio State University Wexner Medical Center's Lung Center for five years.
"It's kind of similar to someone who is trying to lose weight," she says. "If they take a diet pill and they lose weight but they go back to eating the same way they did, they gain that weight back. So with smoking, they want to make it a lifestyle change, so it lasts."
Before we dive in to how best to approach the problem, let's take a look at how the journey will affect your body, from the start of the battle all the way through to once you've won the war.
Here's What Happens to Your Body When you Quit Smoking
First things first. Depending on how long and to what extent you've been using tobacco products, you're going to experience some symptoms of withdrawal. Whitby says the most common of these might include dry mouth, cough, nasal drip, headache, dizziness, sleepiness, and inability to concentrate. These are no doubt uncomfortable things to have to deal with, but they pale in comparison to the known risks of smoking, like increased risk for developing cancer and Emphysema.
But instead of thinking about why you shouldn't smoke, it might be more motivational to think about all of the good things that happen to your body when you stop.
Almost immediately, like within 20 minutes of your last puff of a cigarette, your heart rate and blood pressure drop, Whitby says. Within 12 hours, the carbon monoxide level in your blood returns to normal. And within three months of quitting, your blood circulation and lung function begin to improve.
At nine months smoke-free, you'll notice you cough less and breathe easier. And once you hit the one-year mark, your risk of heart disease from all that smoking is cut in half.
Thinking more long-term, Whitby says that five years after quitting smoking, your risk of cancer of the mouth, throat, esophagus, and bladder are cut in half, and your risk of cervical cancer and stroke return to normal. After 10 years from your quit date, you are half as likely to die from lung cancer, and your risk of larynx and pancreatic cancer decreases. And finally, at 15 years, your risk of coronary heart disease will be the same as a nonsmoker.
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All of the above information is based on someone who is considered high risk for lung cancer. Whitby explains that means these numbers apply to a person who has a history of smoking an average of a pack of cigarettes a day, for the past 30 years. This is referred to as a 30-pack-year history of smoking. That doesn't necessarily mean you have to have smoked for 30 years to qualify. Someone who smoked two packs a day for 15 years, or three packs a day for 10 years, would also be in the same boat.
But even if you've been smoking much fewer cigarettes, for a lot less time, Whitby says you'll still experience all of the immediate improvements in health mentioned above, once you quit.
"And people who smoke usually get sick more often and it takes them longer to get over an illness," she says. So a stronger immune system and shorter recovery times when you do get sick, are another perk of dropping the habit, whether you've been smoking for 12 months or 10 years.
But to get these benefits, you have to get through day one, which Whitby says is a three-part challenge.
"In addition to physical or chemical addition, people may also smoke because they have emotional addiction or behavioral addiction," she says.
"For the physical, with the help of medication, we start off with more and then we wean them down. For the emotional, we help them try to focus on finding new coping mechanisms to control their stress. And then for the behavioral or habit, we try to help people come up with a plan to develop new habits [that don't include smoking]."
Whitby explains each for us, in more detail, here.
It's well-settled that nicotine, found in tobacco, is a highly addictive substance. That's why people experience withdrawal symptoms when they stop smoking.
"One of the key things to helping somebody quit is to help them get the nicotine out of their system without major withdrawal symptoms, and that's what the medications do," Whitby says. This approach is called Nicotine Replacement Therapy (NRT), if the option chosen actually includes a dose of nicotine.
There are over-the-counter (OTC) methods, as well as prescription methods, to help smokers wean themselves off of the chemicals they've been putting into their bodies, based on their respective tolerances for the discomfort associated with symptoms of withdrawal.
OTC methods like nicotine gum and lozenges, and prescription methods like inhalers and nasal sprays, can be used as-needed, when a craving for nicotine is particularly strong.
There are also maintenance-based options, which are taken daily to manage on-going cravings. Nicotine patches are available OTC, which are worn all day, every day, and are part of NRT.
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Daily pills are also an option, with a prescription from a doctor. These include Bupropion, which does not contain nicotine and is intended to block cravings and minimize withdrawal symptoms. This drug is also known by brands names Wellbutrin or Zyban. Varenicline, also known as Chantix, is another available pill option. This drug interferes with nicotine receptors in the brain, to both lessen the effects nicotine has on you, and reduce the symptoms of withdrawal.
These pills can be taken in combination with NRT, according to the American Cancer Society.
"OTC and prescription methods kind of cool your brain off while you're making a lifestyle change," Whitby says.
All of these medications may also have side effects of their own, so make sure you talk with a doctor before deciding whether one may be right for you. But if you feel you could benefit from their use, they are intended to help get you through the initial stages of nicotine withdrawal while you figure out new coping mechanisms and new habits that don't include smoking.
The emotional addiction aspect of smoking tobacco products is often linked to stress control, Whitby says. This type of addiction comes with its own set of potential symptoms, like depression, sadness or grief, a sense of loss, frustration, impatience, anger, anxiety, irritability, trouble concentrating, restlessness, or boredom.
That's why it's crucial to have alternate coping mechanisms in mind, when a trigger like one of these emotions presents itself to someone who is trying to quit smoking.
Whitby recommends mindfulness and relaxation techniques to get over this hump, if emotional addiction is something that has fueled your nicotine use.
"It's kind of life a wave," Whitby says. "Some waves are taller and stronger. Some waves are smaller and not strong. So certain triggers are stronger and you need something to take your mind off it."
Mindfulness is a form of meditation focused on living the moment, according to the Mayo Clinic. This goal is to become intensely aware of what you're sensing and feeling in one particular instant, without interpretation or judgment.
Psychology Today outlines several mindfulness activities that take less than one minute to carry out. These include practices like paying attention to the feeling of air on your exposed skin for 10-60 seconds, or noticing in great detail what one breath feels like, from the sensations in your nostrils, your shoulders, and your rib cage, to how your belly expands, and so on.
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Guided imagery has been an integral part of Whitby's practice, she says.
"I recommend this to my patients, to help them think about things that are pleasurable and relax them," she says.
Ohio State has a resource she recommends for this specific coping mechanism, available on its website.
There are also groups like Nicotine Anonymous (NicA), which hold regular in-person meetings and apply the 12-step method used by Alcoholics Anonymous to quitting smoking.
If you'd rather get your emotional support over the phone, the American Cancer Society says that all 50 states and the District of Columbia offer some type of free, phone-based program that links people who want to quit smoking with trained counselors.
"People who use telephone counseling have twice the success rate in quitting smoking as those who don't get this type of help," the site says.
And research has also shown that telephone counseling is helpful for people who are trying to quit smokeless tobacco.
The third aspect of addiction to smoking is behavioral, Whitby says. This means that people who are addicted to smoking, in part, because they're used to doing it while they take certain actions that naturally occur throughout their day. They're used to stepping outside to have a cigarette on their break at work, smoking while they drive, or lifting their hand to their face and actually putting something inside their mouth.
"If you've been smoking for 30 years, you develop huge habits that you have to work on," Whitby says.
For my mom, she had to replace the habit of having something in her mouth all the time.
She opted to keep hard candies and mints on hand, like Lifesavers and Atomic Fireballs, so she could replicate that motion, and "keep her mouth busy."
Whitby says for this particular element of the issue, she likes to provide her patients with a three-column handout.
In the first column, you write down every time you have a cigarette. In the second, you write down what you're doing while you smoke that cigarette, which may be triggers for you nicotine use. In the third, you write down ways you think you might be able to change that routine or do something different.
Identifying these triggers and having a plan in place to overcome cravings associated with them will help you in the future the next time that situation arises, Whitby says.
Another option my mom tried to beat her behavioral addiction was vaping with nicotine-free solutions.
"It helped at first because I could see what looked like smoke," she says. But she moved past that quickly once she no longer felt she needed that visual cue.
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A Few Words About Vaping
There seems to be a trend for people who want to quit smoking to try vaping, Whitby says. But she cautions against this approach, whether you're using it as a physical or behavioral addiction aid.
Vaping, generally, is what it's called when a person uses an Electronic Nicotine Delivery System (ENDS) device to put nicotine into his or her body. These devices may or may not look like a cigarette and consist of a battery on one end, a vaporizer in the middle, and a cartridge on the other end. Using an ENDS device is called "vaping" because of the aerosol cloud that's given off when it's used.
Vaping devices are heat-activated, so when a person sucks air through the cartridge, the device heats up and turns the liquid in that cartridge into a fine spray that can then inhaled by the user.
"Vaping is not FDA approved," Whitby says. According to a fact sheet distributed by the American Thoracic Society, the liquids found in vaping devices have been labeled as safe to eat, but concern remains over what happens when they are inhaled into your lungs.
"It really hasn't been shown yet, to be a reliable source to help somebody quit," Whitby says.
And even though there are customizable liquids that can be used with vapes, so it's possible to vape with nicotine-free solutions, Whitby also points out that the ENDS devices still create a lot of smoke, with potential to seriously irritate your airways.
"We just don't have enough information to know what the long-term effects are," she says.
General Tips For Success
When it comes down to it, my dad says you have to find what motivates you to quit, and you have to be stubborn about it. For him, he says it was the constantly rising cost of cigarettes that finally got him.
"I always said, 'Oh, when they're $1 a pack I'm gonna quit. . . . Oh, when there $2 a pack, I'm gonna quit,'" he says. Then in 2010, they got up to over $5 a pack and he'd finally had enough. (By the way, the national average for the cost of a pack of cigarettes in April was all the way up to $6.16, according to TIME.)
For my mom, it came down to getting my younger brother to quit.
"I needed that buddy system, and I didn't want to be responsible for my son smoking," she says.
So once my dad stopped buying cigarettes out of principal, over the next year she said she wouldn't buy a pack if my brother didn't. And he didn't, so neither did she.
Whitby says if you can delay having that cigarette for 10, 15, or 20 minutes when you get a craving, that will help immensely in your journey. During that waiting period, she recommends revisiting her three-column handout, which can help form new habits.
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"I also encourage people to set a quit date," she says. That's what my dad did.
Then, she says you should start decreasing the numbers of cigarettes you smoke until you reach that date on the calendar.
"If you're going to quit in four weeks, and you smoke 20 cigarettes each day, then you need to cut out five cigarettes per day each week," she says.
My dad says he set the date a little longer out, a couple of months in advance. For him, he focused less on cutting back and more on the finality of his 49th birthday.
"I never cut back or anything like that," he says. "I just smoked like I always did and it just so worked out that I smoked my last cigarette before I went to bed. Then when I got up in the morning, I just didn't smoke."
Whitby also cautions her patients to subscribe to a "no puff, not ever" rule.
"There are nicotine and dopamine receptors in your brain," she explains. "When you smoke, you get what's called up regulation, which means more nicotine receptors are present. When you quit, you get down regulation, which means less nicotine receptors are present, but we don't know how much down regulation actually occurs."
This is why someone who may have quit smoking years ago can be triggered, think they can have "just one puff," and then return to full-blown tobacco use before they know it, because they may have just as many nicotine receptors in their brain as they did when they were smoking regularly.
Free Resources to Help You Quit For Good
With all of this information, it's clear that quitting smoking is a complicated, multilayered process. Thankfully, there are also lots of public resources available to help people navigate through it.
Whitby says one of her patients had success with an app called My QuitBuddy, which was created by the Australian National Preventative Health Agency. She also notes there are many available that are likely just as effective, like US-created QuitGuide and quitSTART.
And the most important thing to remember of all, she says, is not to get discouraged.
"Don't give up, that's the key," Whitby says. "Most people try to quit multiple times before they're successful, and it's never too late to quit."