Making the Decision to Quit

Just how and why do people stop smoking? Ahh, that is the ultimate question. Researchers have been looking into it for years. One theory that has been used is the "Stages of Change Model." The model is based on research that shows that behavior changes related to smoking occur over a continuum. In other words, not all people are at the same point in the "getting ready to quit" scenario.

Here's an overview of the stages:

• Pre-contemplator.
  This is the smoker who is not even thinking about quitting right now.
• Contemplator.
  This is the smoker who is actively thinking about quitting but is not quite ready to make a serious attempt yet. This person may say, "Yes, I'm ready to quit, but the stress of finals is too much, or I don't want to gain weight, or I'm not sure if I can do it."
• Preparation.
  Smokers in the preparation stage seriously intend to quit in the next month and often have tried to quit in the past 12 months. They usually have developed a plan to quit.
• Action.
  In this stage, the smoker has taken action to quit and is in the first 6 months of being smoke-free.
• Maintenance.
  This is the period of 6 months to five years after quitting when the new non-smoker is actively engaged in taking steps to avoid smoking again. This usually includes incorporating other healthy behaviors into one’s life.

Setting a Quit Date and Making a Quit Plan

Once a person has decided to quit, it's time to pick the all-important Quit Date. Make sure it's pretty soon - like maybe in the next month. Choosing one too far in the future will make it easier to rationalize a way out of it. But there also needs to be enough time to get prepared. Then it's time to come up with a solid plan. Here are some steps to help smokers get prepared.

• Pick the date and mark it on a calendar (in plain sight!)
• Tell friends and family about the quit date and ask for their support.
• Stock up on sugarless gum, cinnamon sticks, carrot sticks and hard candy.

Decide on a plan. What options does the health center offer for cessation? Are there community resources or on-line support services that best match your personal needs? You can call the toll-free national QuitLine at 1-800-QUIT-NOW to receive telephone support and advice to prepare to quit and throughout the quit process.

Is nicotine replacement therapy (i.e., the patch or gum) or other medications the way to go? Medications have been proven to increase the success of quitting. Investigate your options and decide what will work best for you. If you decide on medication, you may need to start using it before your quit date.

Attending a smoking cessation class or calling a quit line also can help you to stay smoke-free.

Practice saying, "No, thank you. I don't smoke."

Set up a support system. Tell others of your plan and ask for their support. Ask a friend to quit with you. You can also join Nicotine Anonymous or talk with a friend who has successfully quit and is willing to help.

Get rid of all cigarettes, lighters, ashtrays, etc.

Identify your triggers, the things that tempt you to smoke. Think about the times or rituals during the day when you normally smoke, such as with a cup of coffee in the morning, between classes, while studying or at the bar. Figure out what you will do instead of smoking, such as skipping the coffee, going for a walk, chomping on carrot sticks or lollipops and even avoiding the bar. These temptations will become less and less strong the longer you are smoke-free.

If weight gain is a concern, know that exercise can decrease your chances of gaining weight while you quit and can make quitting easier.
What To Do When the Quit Day Comes

Do not smoke. Stop smoking the night before and when you wake up the next morning, you will have an 8-hour head start to being smoke-free!

Keep active - try walking, exercising or doing other activities or hobbies.

Drink lots of water and juices.

Start nicotine replacement therapy (if chosen).

Continue attending a smoking cessation class, following a self-help plan and using computer resources. Call your support system or the quitline when you're tempted.

Avoid high-risk situations where the urge to smoke is strong. Sit in non-smoking sections when you go out to eat or frequent smoke-free establishments.

Think HALT – Don’t get too Hungry, Angry, Lonely, or Tired.

Reduce or avoid alcohol and caffeine. Why? Alcohol clouds judgment and can make it easier to slip and smoke. Plus, alcohol may be linked to smoking for some people and it's important to break this connection.

Use the four "A's"

• Avoid. Certain people and places can tempt you to smoke. Stay away for now. Later on, you'll be able to cope.
• Alter. Switch to soft drinks or water instead of coffee or alcohol. Take a different route to school or work. Take a walk when you used to take a smoke break!
• Alternatives. Use oral substitutions like sugarless gum, hard candy or sunflower seeds.
• Activities. Exercise or hobbies that keep your hands busy (video games, needlework, woodworking, etc.) can help distract the urge to smoke.

Dealing with Withdrawal

Everybody knows that withdrawal comes with the territory of quitting but that doesn't make it any easier. It can be hard and even frustrating for the person quitting to deal with withdrawal and for those around the person. But understanding what's going on, physically and psychologically, can help and can assist you in helping a friend quit.

When smokers quit, they begin to go through some changes, some physical, some emotional. The physical symptoms, while annoying and difficult, are not life threatening. Nicotine replacement products such as the patch or gum can help reduce many of these physical symptoms. For most smokers, the bigger challenge is the psychological part of quitting.

This psychological part of smoking is really hard to beat because smoking becomes linked to so many things - things like waking up in the morning, eating, reading, watching TV, drinking coffee, etc. It's like a ritual. Your body becomes used to having a cigarette with certain activities and will miss this link when you first become smoke-free.

It will take time to "un-link" smoking from these activities. Unfortunately, the patch or gum can't relieve the psychological need to smoke. That's why it's so important for the smoker to create a plan to deal with situations that trigger their urge to smoke. Smokers can also ask friends and family for support with simple things like walking around the building before class instead of having a cigarette.
Withdrawal Symptoms

If and when a smoker goes through withdrawal, they need to keep this in mind. Even though they may not act like themselves, and they may feel rotten, these feelings will pass. After 30 days or so, and after they've quit smoking, all this will be behind them. In the meantime, here are some of the withdrawal symptoms smokers may experience and what they can do about them.

Craving. This is the body's physical addiction saying, "I need nicotine now!" Each craving will last for only a couple of minutes and will eventually stop happening altogether in about seven days. Smokers should use nicotine replacement products to help reduce cravings. If the smoker still feels the urge, they can admit out loud to themselves or someone else that they are having a craving. Then they should count to one hundred and let the feeling pass - and it will, usually within a couple minutes.

Difficulty Concentrating. "Help, I quit smoking and I can't concentrate!" Some people say nicotine helps focus their attention. When they quit smoking, the increased blood flow and oxygen can lead to a feeling of mental fogginess. If this happens, they should try making lists and daily schedules to keep organized, then set aside some total relaxation time when they don't have to concentrate on anything!

Fatigue/Sleeping Problems. Trouble sleeping and fatigue are common symptoms of withdrawal. Because nicotine increases one's metabolism to an abnormally high rate, when people stop smoking their metabolism drops back to normal, making them feel like their energy level has dropped. So what can they do? They need to get their body used to the new metabolic rate by getting plenty of sleep, whenever possible. Although sleep patterns may be interrupted at first, this is normal and temporary.

Irritability. If you have snapped at someone or had a new non-smoker snap at you, you know what we are talking about. Irritability is caused by the body trying to adjust to the sudden disappearance of all those chemicals it's been used to. The best way to handle this is for smokers to simply be honest with those around them that they are trying to quit and they do not feel like themselves.
Staying Quit (Maintenance)

Staying quit is the final, and most important, stage of the process. Many of the same methods can be used to stay quit as were used to help get through withdrawal. A smoker should think ahead to those times when they may feel the urge to smoke and plan on how they will use alternatives and activities to deal with it.

Here are some things a smoker can do if they feel tempted to start smoking again:

• Wait. Cravings are natural and they will pass. Don't think about not being able to smoke for the rest your life, think about not smoking for the next 10 minutes.
• Remember the reasons for wanting to quit. You only have to go through this once and then you'll be a non-smoker for the rest of your life.
• Seek support. Call someone. Tell them you are thinking about smoking and ask them to help you through it. Talk to friends who have successfully quit or friends quitting with you.
• Replace the craving with something healthy. Drink water, make yourself a snack, take a walk, exercise, see a movie. Do something to pass the time.
• Reduce stress. Is something happening in your life that is causing stress? Try to let it go, talk to a counselor, take a shower, go work out, schedule a massage…do whatever it takes to de-stress!

What Happens When You Quit?

• Many smokers have heard the negative effects of smoking and know that quitting can lower chances of getting related cancers. However, the benefits of quitting begin with the first 20 minutes and can continue as long as one stays quit.

After smoking the last cigarette:

• 20 Minutes
• Blood pressure and pulse drop to normal
  Body temperature of hands and feet increases to normal
  8 Hours
• Carbon monoxide levels in blood drop to normal
  Oxygen levels in blood increase to normal
  24 Hours
• Chance of heart attack decreases
  48 Hours
• Nerve endings start to re-grow
  Smell and taste abilities are enhanced
  2 Weeks to 3 Months
• Circulation improves
  Walking becomes easier
  Lung function increases by up to 30%
  1 to 9 Months
• Coughing, fatigue, shortness of breath and sinus congestion decrease
  Cilia re-grow in lungs, increasing the lungs' ability to clean itself, handle mucus and reduce infection
  1 Year
• Excess risk of coronary heart disease is half that of a smoker
  5 Years
• Lung cancer death rate decreases by almost half, for average (1 pack a day) former smoker
  Stroke risk reduced to that of a non-smoker
  Risk of cancer of the mouth, throat and esophagus is half that of a smoker
  10 Years
• Lung cancer death is similar to that of a non-smoker
  Precancerous cells are replaced
  Risk of cancer of mouth, throat, esophagus, bladder, kidney, cervix and pancreas decreases
  15 Years
• Risk of coronary heart disease is that of a non-smoker
  Source: American Cancer Society

In addition to the health benefits, overall appearance will also improve by eliminating the yellow teeth, stale breath and smell of cigarette smoke on hair and clothes. Confidence will grow because quitting and leading a smoke-free lifestyle can give someone a strong sense of satisfaction and the feeling that they can accomplish anything.

And quitters may have more money! Those who smoked 20 cigarettes a day will save themselves about $1,200 a year. Non-smokers also pay less for life insurance premiums.

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You Can Quit Smoking

Five Common Myths About Quitting Smoking
Five myths still exist about quitting. You can get the facts here.

Five Common Myths

Myth 1: Smoking is just a bad habit.

Fact: Tobacco use is an addiction. According to the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, nicotine is a very addictive drug. For some people, it can be as addictive as heroin or cocaine.

Myth 2: Quitting is just a matter of willpower.

Fact: Because smoking is an addiction, quitting is often very difficult. A number of treatments are available that can help.

Myth 3: If you can’t quit the first time you try, you will never be able to quit.

Fact: Quitting is hard. Usually people make two or three tries, or more, before being able to quit for good.

Myth 4: The best way to quit is “cold turkey.”

Fact: The most effective way to quit smoking is by using a combination of counseling and nicotine replacement therapy (such as the nicotine patch, inhaler, gum, or nasal spray) or non-nicotine medicines (such as bupropion SR). Your health care provider or smoking cessation clinic is the best place to go to for help with quitting.

Myth 5: Quitting is expensive.

Fact: Treatments cost from $3 to $10 a day. A pack-a-day smoker spends almost $1,000 per year. Check with your health insurance plan to find out if smoking cessation medications and/or counseling are covered.

For More Information

To get a free copy of other consumer products on quitting smoking, call any of the following toll-free numbers:

• Agency for Healthcare Research and Quality, 800-358-9295.
• Centers for Disease Control and Prevention, 800-CDC-1311
• National Cancer Institute, 800-4-CANCER