Stopping smoking

Stopping smoking
Why did I start smoking?
Why do I continue to smoke?
Do I want to stop smoking?
Why is it worthwhile stopping?
Preparing to stop
Getting as much support as possible
What withdrawal symptoms should I expect?
Coping strategies
Be prepared to fail and try again

Stopping smoking

Stopping smoking is likely to be one of the most important things you do in your life. This page aims to support you through this difficult challenge. Anyone who has tried to stop smoking will understand how severe this addiction is. Although some people may succeed by going "cold turkey," it is much easier to stop (and not start again) when you can have continued support.

This following information will:

• help you decide where you are on the road to stopping
• look at why you started and why you continue to smoke
• ask you to be honest with yourself about how motivated you are to stop
• provide you with many positive health messages to maintain your motivation
• give you guidance about the actual process of stopping.

Finally, remember there are other sources of information and support -there is a list of useful contacts at the bottom of this page.

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Why did I start smoking?

Some of these points may ring true with you and many of your smoking friends.

• Experimenting with smoking often starts with friends at school. It's an act of rebellion. Some people think it's cool
• Thirteen percent of 12 year-olds smoke on a regular basis. Once they are hooked they will want their close friends to join them in smoking
• The pressure to be part of the in-crowd is incredibly powerful. And there is evidence that you become addicted more quickly if you start young
• You may have been unlucky in that one or both of your parents smoked. This has a strong influence on people taking up the habit
• You may just have been curious to see what it was like but, as with any drug addiction, you were hooked very quickly
• Unfortunately, when we are young we think that 'it will never happen to me' - even when we're told about the dangers of smoking. Tobacco companies have even, in the past, targeted young children by promoting smoking as exciting and glamorous. They know that, if children are hooked when they are young, they are more likely to smoke for life

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Why do I continue to smoke?

An important first step on the road to stopping is accepting that you have a serious addiction. The reason you are desperate for the next cigarette is simply because you need your next 'fix' of nicotine.

The cigarette, cigar or pipe is an extremely efficient way of getting the drug into your brain. One deep breath will rapidly pass the nicotine across your lungs through your circulation. It gets directly to your brain in six seconds - twice as fast as injecting heroin! This gives you the 'kick' that you have been waiting for and that you've come to expect on a regular basis.

When the brain doesn't receive this 'kick,' the craving begins. It's relentless and gets worse and worse until the next dose of nicotine. Everyone who is addicted to a drug will tend to persuade themselves that there isn't a problem in spite of all the strong health messages to stop.

You may be convinced that smoking eases stressful situations. But stress in your life may be closely linked to your brain's internal stress about when the next dose of nicotine is due.

Some people feel it helps their concentration. But once again, the brain finds it difficult to concentrate if it has become increasingly obsessed as to when the next fix is coming.

Women in particular will use the excuse that it will help them to lose weight. Smoking does limit your appetite, but it is a myth that it helps to reduce weight. A study of 4000 adolescents over 7 years found that those who smoked or began smoking did not lose weight during this period.

Others who are firmly addicted will have a more care-free approach - until they develop a smoking-related disease. Everyone knows someone who smoked 20 a day all their life and lived to be 90. You may think that you will be that person. The odds are very much against that, however.

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Do I want to stop smoking?

So where are you on the scale of motivation?

• Do you know all the risks but you're still prepared to risk many serious illnesses that may come if you keep on smoking?
• Are you thinking about stopping but don't feel that the time is right yet? Perhaps you're waiting until you are pregnant. Perhaps you're going to give it up for Lent or next New Year or when you're less stressed, or when the price gets too high
• Do you think you will give up, but need help to decide to do it?
• Have you finally decided to go for it? Are you trying to stop now but feel you need support?
• Have you already stopped, but feel very vulnerable that you will smoke again if you get stressed or have a drink?

Think carefully about where you are on this scale and then think about how you could get yourself to the next stage - stopping forever.

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Why is it worthwhile stopping?

Now we come to the really positive bit! There are lots of good reasons to stop.

• Would you like to live longer? For every cigarette you don't smoke you will gain approximately another 11 minutes of life!
• There are 43 separate potential cancer-causing agents and 550 toxic chemicals in tobacco smoke
• If you stop earlier in life you may save around 60,000, which will go towards enjoying that extra life much more
• You will reduce the risks of tobacco smoke to people around you, including your unborn baby, which otherwise may end up small, premature and with lung problems
• If you are suffering with bronchitis (cough and phlegm every day) this will improve and often clears altogether
• You will be at less risk of your lungs dissolving (COPD) as a direct effect of tobacco smoke. Even if you already have COPD, stopping smoking will slow right down the speed at which you are losing lung function
• It will immediately get rid of the toxic levels of carbon monoxide in your blood
• You will reduce the chance of your arteries getting furred up - so a heart attack will be less likely; so will general blockages of your blood vessels, which result in strokes, dementia, impotence and limb amputation
• The risks of cancer of the lung, mouth, gullet and bladder will also be reduced
• Smokers are 22 times more likely to get lung cancer than non-smokers

Some smokers may be lucky enough not to get any of these diseases but why take the risk? And if you want to continue to be attractive, then it's not a bad idea to avoid that early aging of the skin with wrinkling and shrinking. And you'll also lose that strong smell of tobacco on your breath, in your hair and on your clothes (which you won't be aware of as a smoker).

It's very important to understand that it is never too late to stop smoking.

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Preparing to stop

Think of this as a major campaign. When you really are convinced that you are determined enough to go for it, then:

• Set a date that you are going to stick to, no matter what
• Make sure everyone knows, as this will help you to keep that date - and hopefully people won't tempt you by offering you cigarettes
• Get rid of all tobacco reminders in your close environment
• Write out a list of all the really positive benefits of stopping, putting them somewhere that reminds you on a daily basis
• Most importantly, prepare yourself for those withdrawal symptoms and make sure that you have friends and family to support you

Cutting down is much less likely to work than stopping outright.

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Getting as much support as possible

When doctors help someone to get off heroin, they try to reduce the severe withdrawal symptoms by giving them another type of drug to calm the cravings, which they then need to gradually come off.

The same applies to nicotine and there are now lots of ways of reducing withdrawal symptoms by taking nicotine replacement therapy (NRT) during your most vulnerable early stages of stopping.

Specialist smoking cessation clinics with NRT support give you four times the chance of stopping. And being with others 'in the same boat' means you can support each other.

NRT provides a daily dose of nicotine which can be tailored to the amount of tobacco you smoke. This helps to ease the withdrawal symptoms while you get accustomed to being an ex-smoker. You may feel somewhat edgy and irritable as you gradually scale down the dose of NRT but it isn't as severe as 'cold turkey'. There are a number of systems.

Nicotine Patches
These are stuck on the skin like a plaster and release nicotine gradually over 24 hours, keeping the cravings at bay. They may give you vivid dreams so some people prefer to take them off overnight. But that may result in a strong desire for that first cigarette of the morning. There are also patches which only last 16 hours. Don't smoke while you are on the patch or you may receive an overdose of nicotine!

Other NRT systems deliver shorter boosts of nicotine to the brain as needed and include gum, plastic cigarette inhalator, lozenges, nasal spray and sub-lingual (under the tongue) preparations.

You can buy NRT from a chemist or get a free starter supply as part of a smoking cessation clinic support programme.

Bupropion Hydrochloride
This drug, which is only available on prescription (the brand names are Zyban or Wellbutin), acts in the centre of the brain to dampen down the withdrawal cravings. It has the advantage of being a tablet and provides an opportunity to stop without needing to slowly come off NRT. However, it doesn't suit everybody.

All of the above methods need to be taken in conjunction with support and advice from your doctor/nurse/pharmacist and/or smoking cessation counsellor.

Other non-nicotine products and treatments
Herbal preparations, dummy cigarettes, mouthwashes and alternative therapies such as hypnotherapy and acupuncture are not as well researched, but some people claim success with these approaches. If you do go to a practitioner of complementary or alternative therapy, make sure they are a member of the relevant professional body.

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What withdrawal symptoms should I expect?

Any of the following may occur:

• Cravings
• Irritability
• Insomnia
• Fatigue
• Edginess
• Difficulty in concentrating
• Headache
• Dry mouth [TOP]

Coping strategies

• It may be necessary to change your social routine for a while - to avoid situations (particularly excess alcohol), which will make you more vulnerable to first fag failure!
• Keep a list of motivating factors close to hand
• Don't be too proud to consider stress reduction techniques
• Give your hands something else to do and hobbies may help as a distraction
• Chew on a carrot (rather than popping in a chocolate) if you feel the need to put something in your mouth
• Freshen up your immediate environment
• It is quite common to gain some weight after stopping and it is important to be aware of this. Counter the effect by eating more healthily and taking regular exercise
• Clean or replace old clothes that smell and remind you of tobacco, using the money that you have already saved by stopping
• Mark off your progress on a calendar and make sure friends know how well you are doing
• Brave out the urge - it usually passes within 5 minutes
• Use some form of distraction e.g. go for a walk, ring a friend/counsellor for support
• Take some slow deep breaths, ideally out in the fresh air on a nice day
• Talk to your lungs! Tell them you are going to protect them as you would any loved one
• Drink plenty of water
• More sleep will help and if insomnia is a problem take more exercise during the day, have a warm bath and read a book in bed
• Pamper yourself with a treat and pat yourself on the back as each tobacco-free day passes
• Take one day at a time

Recovery timetable

20 mins after stopping	Blood pressure and heart rate drop
8 hours after	Blood carbon monoxide levels back to normal
24 hours after	Reduced risk of sudden heart attack
48 hours after	Sense of taste and smell returning
2 weeks after	Brain is much more adjusted to lack of nicotine
3 weeks – 3 months after	Improving exercise capacity, reduction in phlegm and lung congestion
3-9 months after	Breathing improving and lugs able to defend better against infection. Energy levels up
1 year after	Risk of heart attack drops to 50 per cent of that of a smoker
5 years after	From this point on the risk of strike is reducing to that of a non-smoker
10 years after	Risk of death from lung cancer reduced by half for average smoker
15 years after	Risk of heart attack now approaching that of someone who has never smoked

Be prepared to fail and try again

Please don't despair if you fail on your first attempt! You won't be the first or last smoker that this has happened to. Regroup, work out what went wrong - was it peer pressure, alcohol, stress, etc? Don't be ashamed and it is very important at this stage to maintain your nicotine replacement therapy, family and group support.

TRY AGAIN!

Further sources of help and information:

Your GP or practice nurse: they can tell you about local smoking cessation services.

NHS Stop Smoking Services:
Helpline 0800 169 0 169
http://www.givingupsmoking.co.uk/nhs_sss

QUIT - helpline 0800 00 22 00.
Ground Floor, 211 Old Street, London EC1V 9NR.
http://www.quit.org.uk/

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Page last medically reviewed: September '07