Why Is Quitting So Hard?

In 2003, 21.6% of Americans were smokers, and 70% of them wanted to quit. Quitting?and sticking with it? can be a huge physical, social, and emotional challenge.

An addiction to nicotine is more powerful than an addiction to heroin or cocaine. When you inhale nicotine through tobacco products, the nicotine reaches your brain almost instantly to produce a feeling of reward. Over time, your body craves more nicotine and becomes dependent on it.

When your body does not get nicotine, if you are dependent on it, you may have withdrawal symptoms. You may feel irritable or angry, have a headache, or be unable to concentrate.

Smokers also rely on the routine of smoking?for example, in the car on the way to work, or with friends at break time, or after dinner. Quitting is thus a very tough challenge for smokers.

What Medications Can Help Me Quit?

Some smoking-cessation medications contain nicotine. These medications help to lessen withdrawal symptoms by slowly lowering the nicotine levels in the body. They let the smoker focus on breaking the social habits of nicotine without battling the withdrawal symptoms at the same time.

Medications that do not contain nicotine also are available with a prescription. One medication (bupropion) is contained in the products called Wellbutrin and Zyban, and it works to calm the cravings of smoking. Nicotine medication and these products can be used together. In fact, the combination is both common and successful. Another prescription medication that is now available and that does not contain nicotine is called Chantix.

Choosing the right medication can be difficult, but medications can make it easier to quit and to stay quit (see the Table). Talk to your doctor if you have more questions about medications.

How Can I Develop a Quit Plan?

Although medications can help you quit, they are only part of the overall process. Here are a few steps to prepare you to become and stay smoke-free:

• Choose a quit date?and stick to it
• Find people who will help you quit
• Be prepared. Think ahead about the challenges you may come across?for example, wanting to light up with your morning cup of coffee, or having to turn down a cigarette from a friend who smokes.
• Understand your medications. Know how and when to use them and what to expect from each of them.
• Have self-help materials available. Great resources and links are available at www.cdc.gov/tobacco/how2quit.htm.
• Get information on available programs and services. Check out the National Network of Tobacco Cessation Quitlines at 800-QUIT-NOW.
• Keep busy. Distract yourself by exercising, drinking water, or chewing gum.
• Avoid temptation. Establish a new routine to help you avoid old habits.
• Understand "slips."Smoking 1 or 2 cigarettes is not a relapse?just a slip. Knowing what caused the slip will help you prevent it in the future.

Other Resources for Help

Many pharmacies, health care offices, and Veterans Affairs or Indian Health Service facilities have established smoking-cessation clinics. If you participate in one of these clinics, you will have regular appointments with a pharmacist or another health care provider who is certified in tobacco-cessation counseling. You and the health care provider together will establish and maintain a Quit Plan, discuss and monitor your medications, and work toward helping you become and stay smoke-free. Check on what local community programs are available for you.

Dr. Holmberg would like to thank Megan Wohr, RPh, NCPS. Ms.Wohr is a pharmacist at Phoenix Indian Medical Center in Phoenix, Ariz, where she has a pharmacy-based tobacco-cessation clinic. She was a great help in writing this article.

Dr. Holmberg is a pharmacist with Phoenix Children's Hospital, Phoenix, Ariz.