Smoking Cessation Health Article

Definition

Smoking cessation is the medical term for quitting smoking. It is a vital part of cancer prevention because smoking is the single most preventable cause of death from cancer. As early as 1982, the Surgeon General reported that tobacco causes more cancer deaths in the United States than any other factor-30% of all cancer deaths, including 87% of deaths from lung cancer. Although people think of smoking most often in connection with lung cancer, smoking is also associated with cancers of the mouth, throat, voice box (larynx), esophagus, pancreas, kidney, and bladder. Women who smoke increase their risk of cancer of the cervix. Quitting smoking, however, significantly reduces the risk of cancer; 15 years after quitting, a former smoker's risk is almost as low as that of someone who has never smoked.

Description

Smoking cessation covers several different approaches, ranging from medications and psychotherapy to special classes and programs. Smoking is a habit difficult to break because it involves many different aspects of a person's emotions and social life as well as physical addiction to nicotine. Most people who quit smoking successfully use a combination of treatments or techniques for quitting.

Special concerns

People who are trying to quit smoking are often concerned about:

• Withdrawal symptoms. Nicotine, the substance in tobacco that gives smokers a pleasurable feeling, is as addictive as heroin or cocaine. Withdrawal from nicotine may produce depression, anger, fatigue, headaches, problems with sleep or concentration, or increased appetite for food. These symptoms usually start several hours after the last cigarette. They may last for several days or several weeks.
• Weight gain. Many people, particularly women, gain between two and 10 pounds after giving up smoking. This mild weight gain, however, is not nearly as great a danger to health as continuing to smoke. Getting more exercise can help.
• Stress. Many smokers started to smoke as a way to cope with stress and tension. Finding other methods—exercise, meditation, biofeedback, massage, and others, can reduce the temptation to smoke when stress arises.
• Side effects of nicotine replacement products. Smokers who are using these products to help them quit may experience headaches, nausea, sore throat, or long-term dependence. Side effects can often be reduced or eliminated by using a lower dosage of the product or switching to another form of nicotine replacement.

Treatments

Nicotine replacement therapy

Nicotine replacement therapy gives the smoker a measured supply of nicotine without the other harmful chemicals in tobacco. It reduces the physical craving for cigarettes so that the smoker can handle the psychological aspects of quitting more effectively.

As of 2001, the Food and Drug Administration (FDA) had approved four forms of nicotine replacement therapy:

• Transdermal patches. Patches, which are non-prescription items, supply measured doses of nicotine through the skin. The doses are lowered over a period of weeks, thus helping the smoker to reduce the need for nicotine gradually.
• Nicotine gum. Nicotine gum provides a fast-acting nicotine replacement that is absorbed through the mouth tissues. The smoker chews the gum slowly and then keeps it against the inside of the cheek for 20 to 30 minutes. The gum is also available without prescription.
• Nasal spray. Nicotine nasal spray provides nicotine through the tissues that line the nose. It acts much more rapidly than the patches or gum, but requires a doctor's prescription.
• Inhalers. Nicotine inhalers are plastic tubes containing nicotine plugs. The plug gives off nicotine vapor when the smoker puffs on the tube. Some smokers prefer inhalers because they look more like cigarettes than other types of nicotine replacement. They also require a doctor's prescription.

Other medications

Bupropion, which is sold under the trade name Zyban, is an antidepressant medication given to lower the symptoms of withdrawal from nicotine. Bupropion by itself can help people quit smoking, but its success rate is even higher when it is used together with nicotine replacement therapy. Another drug that is sometimes given for nicotine withdrawal is buspirone (BuSpar), which is an antianxiety medication.

Stop-smoking programs and groups

Stop-smoking programs help by reinforcing a smoker's decision to give up tobacco. They teach people to recognize common problems that occur during quitting and they offer emotional support and encouragement. While stop-smoking programs do not have as high a success rate by themselves as medications or nicotine replacement therapy, they are very helpful as part of an overall quitting plan. The most effective programs include either individual or group psychological counseling. Many state Medicaid plans now cover the costs of smoking cessation programs; further information is available from the American Association of Respiratory Care at <http://www.aarc.org/advocacy/state/smoking_treatment.html.>

The Great American Smokeout has been held annually since 1977 on the third Thursday in November to call attention to the high human costs of smoking. Smokers are asked to quit for the day and donate the money saved on cigarettes to high school scholarship funds.

Nicotine Anonymous is an organization that applies the Twelve Steps of Alcoholics Anonymous (AA) to tobacco addiction. Its group meetings are free of charge.

Alternative and complementary therapies

Some people find that hypnosis helps them to quit. Acupuncture has also been used, but there are no large-scale studies comparing it to other stop-smoking treatments. A list of physicians who are also licensed acupuncturists is available from the American Academy of Medical Acupuncture at (800) 521-2262.

Other complementary approaches that have been shown to be useful in quitting smoking include movement therapies like yoga, t'ai chi, and dance. Prayer and meditation have also helped many smokers learn to handle stress without using tobacco.

See Also Cigarettes

Resources

BOOKS

American Cancer Society. Quitting Smoking. New York: American Cancer Society, 2000. 29 June 2001.<http://www.cancer.org/tobacco/quitting.>

"Smoking Cessation.". In The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

United States Public Health Service. You Can Quit Smoking. Consumer Guide, June 2000. 29 June 2001.Government Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. <http:www.surgeongeneral.gov/tobacco/consquits.htm./>

ORGANIZATIONS

American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. <http://www.aarc.org> 29 June 2001.

American Cancer Society (ACS). 1599 Clifton Road, NE, Atlanta, GA 30329. (404) 320-3333 or (800) ACS-2345. Fax: (404) 329-7530. <http://www.cancer.org/> 29 June 2001.

American Lung Association. 1740 Broadway, 14th Floor, New York, NY 10019. (212) 315-8700 or (800) 586-4872 (LUNG USA).

National Cancer Institute, Office of Cancer Communications. 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. (800) 4-CANCER (1-800-422-6237). TTY: (800) 332-8615. <http://www.nci.nih.gov./> 29 June 2001.

National Heart, Lung, and Blood Institute. Information Center, P. O. Box 30105, Bethesda, MD 20824. (301) 251-1222.

Nicotine Anonymous. (415) 750-0328. <http://www.nicotineanonymous.org/> 29 June 2001.

OTHER

United States Public Health Service Fact Sheet. Treating Tobac co Use and Dependence. June, 2000. <http://www.surgeongeneral.gov/tobacco/smokfact.htm.> 29 June 2001.

Rebecca J. Frey, Ph.D.