It's a puzzle that has thwarted even the most determined people: how to quit smoking once and for all. As much as you may seriously want to stop, smoking cessation is hard. Really, really hard.
Why is it so difficult for smokers to quit? It has to do with dopamine, the "feel-good" chemical in your brain.
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"Nicotine stimulates the brain to release a large quantity of dopamine. Over time, the brain is conditioned to release more dopamine from nicotine and less from other pleasurable activities," Indra Cidambi, MD, board-certified addiction psychiatrist and medical director of Center for Network Therapy in Middlesex, New Jersey, tells LIVESTRONG.com.
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So what is the most effective way to quit smoking? The answer can be different for everyone. The three major categories of smoking cessation plans are cognitive behavioral therapy, nicotine replacement and prescription medications, which we'll break down below, along with other helpful behavioral changes.
"The individual wanting to quit should decide on the treatment most comfortable and most feasible for them," Lawrence Weinstein, MD, Chief Medical Officer at American Addiction Centers in Brentwood, Tennessee, tells LIVESTRONG.com.
Here are seven tactics to try:
1. Try Cognitive Behavioral Therapy (CBT)
Working with a specially trained therapist to learn how to reshape destructive thought patterns — like, "I've been smoking so long that it must be hopeless" — can be a key component of long-term success.
"Behavioral therapy helps to address anxiety, depression, isolation and shame, and provides intervention strategies," Dr. Cidambi says.
CBT can be done one-on-one, or in a group with one therapist and several other people who are also trying to quit. In either case, the main job of the therapist is to help you recognize self-defeating thoughts and reshape them. Oftentimes, patients are given "homework" in between appointments to reinforce what the therapist has taught them.
"If the patient would like the cessation process to be a more holistic or medication-free experience, some form of behavioral therapy may be the best route," Dr. Weinstein says.
If you're interested in trying CBT to help you quit, ask your doctor where to find a therapist or program near you.
Quitlines offer free, over-the-phone coaching to help you kick the habit. Call 1-800-QUIT-NOW for free support.
2. Reduce Stress
Because stress is a big force behind the urge to smoke, according to Smokefree.gov, CBT reinforces general stress-relief techniques.
Instead of reaching for a cigarette when stress strikes, try going for a short walk or doing some relaxation exercises, such as deep breathing, stretching or visualization.
The 4-7-8 breathing method is especially helpful for lowering stress and anxiety. To do it:
- Sit up straight in a comfortable position.
- With the tip of your tongue just behind your upper front teeth, slowly inhale through your nose for a count of 4, expanding your diaphragm as you do.
- Hold your breath for a count of 7.
- Open your mouth slightly, keeping your tongue in place, and exhale for a count of 8.
- Repeat four times, or until you feel calmer.
3. Identify Your Triggers
Another important part of CBT is recognizing what your personal triggers are — when and where you are most likely to light up — then devising substitutes or workarounds.
For many smokers, triggers include:
- Being around family or friends who smoke
- Eating a big meal
The idea is to replace smoking with substitutes that can diffuse those triggers. For example, that might be ordering nonalcoholic drinks in place of cocktails, asking your friends not to light up around you and chewing minty gum after dinner.
4. Get Moving
Starting an exercise program (with your doctor's sign off) can help with quitting as well.
Working out can reduce cravings, lower stress and make it easier to get through withdrawal symptoms, according to the U.S. Department of Health and Human Services. It's a healthy outlet to ease feelings of anxiety or restlessness that come with quitting.
There's no one "best" exercise to do, but one small May 2017 study in Nicotine and Tobacco Research found that aerobic exercise (think: jogging, swimming) may act as a balm for the anxiety associated with nicotine withdrawal. It also seems to help with cravings.
The Physical Activity Guidelines for Americans suggest adults get at least 150 minutes of moderate-intensity aerobic exercise every week. It should also be spread throughout the week, so a half hour of activity on five or more days a week is a good goal.
Exercise can also help manage COPD and other lung conditions.
Social support can help you quit, according to the Centers for Disease Control and Prevention (CDC). Tell everyone you see regularly that you're going to stop smoking, and explain your plan for quitting. Directly ask for their encouragement. The more supportive folks in your corner, the better.
You may also want to ask a friend who is also a smoker to join you in quitting. Having someone to turn to who knows what you're going through — and keep you accountable — could make all the difference.
Online support can help, too. Consider joining a Facebook group that offers tips for quitting and stories from others going through the process, such as the CDC Tobacco Free group.
6. Consider Nicotine Replacement
This type of therapy is pretty straightforward: You replace cigarettes with small, consistent deliveries of nicotine via a skin patch, lozenges, gum, nasal spray or an inhaler. This approach takes the edge off your nicotine withdrawal symptoms so you're able to better focus on breaking the psychological aspect of your addiction.
While nicotine replacement products are available over the counter, it's wise to chat with your doctor before starting to use any of them.
7. Ask About Prescription Medication
Those who are severely addicted to nicotine — signs include smoking within five minutes of waking up, when sick and in the middle of the night — should talk to their doctor about prescription medication options, according to the American Cancer Society. The two that have been approved by the FDA for this purpose are bupropion (brand name Zyban) and varenicline (brand name Chantix).
Neither one of these medications contains nicotine, and both need to be started in advance of the day you quit. Your physician will guide you in deciding which one is better for you, and when and how to take it.
How to Choose the Right Treatment for You
Don't assume the method your cousin or co-worker found success with will necessarily work for you. It's possible the most effective therapy for you may be a combination of any or all of the above.
"The success rate of quitting cigarettes increases dramatically when pharmacotherapy is combined with behavioral therapy," Dr. Cidambi says. "Pharmacotherapy consists of nicotine replacement therapy and medications. Both address withdrawal symptoms."
How Bad Is Smoking, Really?
The effects of smoking are serious and numerous. Tobacco use is the leading cause of preventable death, often leading to lung cancer, heart disease, stroke and debilitating respiratory conditions, including Chronic Obstructive Pulmonary Disease (COPD), per the Substance Abuse and Mental Health Services Association.
To be more specific, the average lifespan of people who smoke more than 20 cigarettes per day is 13 years shorter than that of nonsmokers, per a September 2017 study by Statistics Netherlands and the Trimbos Institute.
The habit can also cause harm that isn't as obvious, including depriving your body of nutrients, per an October 2004 study in Nutrition Journal, and even perpetuating belly fat, per a September 2012 study in PLOS One. Beyond appearances, belly fat comes with its own health risks, including diabetes, dementia and cancer.
But quitting, even after years of smoking, can improve your health dramatically.
"Imagine this: Within two to three weeks of quitting smoking, the risk of having a heart attack decreases, and within one year the risk falls by half," Dr. Cidambi says.
Quitting With COPD
If you have COPD, continuing to smoke will only drastically worsen the condition. Interestingly, smokers with COPD seem to be different from smokers without it.
According to a September 2015 study in Respiration, smokers with COPD were more aware of and worried about the health risks of smoking. They also reported higher levels of depression and less self-efficacy to keep from lighting up. Taking those differences into account may help those with COPD come up with smoking cessation treatments that stick, particularly if they work with a doctor or other professional.
People with COPD "must without a doubt receive help in order to quit smoking," noted a 2014 report by the University of Geneva (Switzerland) Medical School. The first-line treatment for people with COPD, noted the report authors, is nicotine replacement. They observed it was three times as successful in enabling smokers to quit than a placebo — 22 percent in a group that chewed 2 mg nicotine gum during group support sessions, "a good result."
Subsequently, a large August 2016 study in the Cochrane Database of Systematic Reviews found evidence that smokers with COPD who receive a combination of high‐intensity behavioral support and medication are more than twice as likely to quit as people who receive only behavioral support. (The researchers did not determine whether any specific form of behavioral support is better than another for COPD-afflicted smokers.)
- Centers for Disease Control and Prevention: "Tips from Former Smokers"
- Substance Abuse and Mental Health Services Administration: "Find Help"
- Respiration: "Do We Need Tailored Smoking Cessation Interventions for Smokers with COPD? A Comparative Study of Smokers with and without COPD Regarding Factors Associated with Tobacco Smoking"
- Respiration: "Heavy Smokers Cut Their Lifespan by 13 years on Average"
- University of Geneva (Switzerland): "How Smoking Cessation Affects the Progression of COPD"
- Cochrane Database of Systematic Reviews: "Smoking Cessation for People with Chronic Obstructive Pulmonary Disease"
- American Cancer Society: "Prescription Medicines to Help You Quit Tobacco"
- PLOS One: "Cigarette smoking increases abdominal and visceral obesity but not overall fatness: an observational study"
- Nutrition Journal: "Effect of smoking on vitamin A, vitamin E, and other trace elements in patients with cardiovascular disease in Bangladesh: a cross-sectional study"
- U.S. Department of Health and Human Services: "How Smoking Affects Your Workout"
- Nicotine and Tobacco Research: "Acute Effects of Aerobic Exercise on Affect and Smoking Craving in the Weeks Before and After a Cessation Attempt"
- U.S. Department of Health and Human Services: "Physical Activity Guidelines for Americans: 2nd Edition"
- Smokefree.gov: "Stress & Smoking"
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