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Smoking Cessation

We've all read how cigarette smoking can be hazardous to your health, from the numerous public service announcements to the stark warnings on each and every cigarette pack sold. Smoking related illnesses lead to almost half a million premature deaths annually. While cigarette smoking has been decreasing, surprisingly almost one in five U.S. adults still smokes, and the percentages are substantially higher in Europe and parts of Asia.

When it's time to finally quit, it helps to have someone in your corner. While stopping "cold turkey" can be an effective strategy for some people, nicotine is an addictive substance and there are definite withdrawal symptoms in the immediate aftermath. When available, it helps to have a primary care physician involved in the process. Not only can the doctor be motivational, but the many methods and pharmacologic aids to help with smoking cessation can be discussed and the proper alternative prescribed. Attempts to quit smoking are more successful when physicians take a central role in counseling and support.

A social support system is vital to the process, whether through physician, psychological counseling, or even support from friends and family. Sometimes depression and weight gain can accompany attempts to quit and at those times the help of a physician can be integral to treatment. Once a "quit date" is set, contacting those involved in the process is quite important to provide not only encouragement, but to assess progress along the way. 

Medications are often quite helpful with smoking cessation. Nicotine replacement therapies help to relieve cravings, making the withdrawal process go more smoothly. Nicotine replacement is now readily available in the form of nicotine patches, lozenges, inhalers, gum, and even a nasal spray. Patches, which are available over-the-counter, appear to be most helpful for heavy smokers, where the dosage of nicotine can be slowly decreased over time. When using medications, smoking cessation treatment can be as short as eight weeks or longer for those who have more withdrawal symptoms.

Other medications have also been shown to help with nicotine withdrawal during the cessation process.  Varenicline (trade name Chantix) is a partial receptor agonist that reduces cravings and withdrawal symptoms while blocking the binding of smoked nicotine if the "cutting down" method is used.  Buproprion (Wellbutrin or Zyban) are medications originally developed as antidepressants but have been found to be effective in smoking cessation. They must be used only with a doctor's supervision. Acupuncture, increased aerobic exercise, and hypnotherapy all have proponents as alternative therapies in the process.

One last point to mention is the increasing popularity of e-cigarettes. E-cigarettes are electronic nicotine delivery systems that generally deliver nicotine in inhaler solutions, although a few are merely flavored vapors. While they are safer than smoking in that they generally deliver lower dosages of nicotine and avoid the lung carcinogens present in actual cigarettes, e-cigarettes still deliver doses of nicotine that affect the cardiologic and circulatory system. In adolescents, they are often precursors to actual smoking and they remain controversial in their use.

Authored by Dr. Bob Goldstone, M.D.

The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.