STORY BYMonths after making your New Year's resolution to quit smoking, you're still struggling to kick the habit. If quitting cold turkey isn't working – it may be time to get some help.
“Cold turkey is one of the least effective ways to quit smoking,” says Dr. Marc Mooney, a postdoctoral fellow in the Center for Substance Abuse at The University of Texas Medical School at Houston. “By adding medication, or nicotine replacement and support, you can double your success rate.”
Highly addictive, nicotine in cigarettes causes the brain to release neurotransmitters involved with pleasure and reward. This stimulates the body and gives smokers an almost immediate “rush.” Smokers come down a few minutes to hours later feeling depressed and tired. To perk up, they smoke another cigarette, beginning the cycle of addiction.
Many quitters slip up when they feel cravings, frustration, irritability and other symptoms caused by nicotine withdrawal. Smoking cessation aids help take the edge off of nicotine cravings and reduce withdrawal symptoms.
“Most relapse happens during the first two to three weeks after quitting,” says Dr. Unto Pallonen, associate professor in Health Promotion and Behavioral Sciences at the UT School of Public Health. “There is a tremendous drop in quit rates, and then they stabilize.”
If smokers can make it through those first critical weeks, they have a good chance at successfully quitting smoking, he says.
With so many ways to quit smoking – including the patch, nicotine gum and prescription drugs – selecting one can be a monumental task. Here's a breakdown of the quit methods available to smokers today.
Nicotine replacement products replace the nicotine smokers get when they puff on a cigarette. Unlike cigarettes which have a fast and powerful nicotine delivery that goes straight to the lungs and brain, nicotine replacement products deliver a smaller amount over a longer timeframe. This mitigates the addictive properties of nicotine.
Most nicotine replacement products are available over the counter. The nicotine inhaler and nasal spray are available only by prescription.
The Patch – The nicotine patch releases a steady “dose” of nicotine to the body through the skin. The patch comes in a variety of sizes, depending on how heavy a smoker you are. It should be worn continuously, but can be removed at night if you find that the stimulating properties of nicotine keep you up. Most patches need to be changed once a day.
Some people may react to the adhesive or the nicotine on the patch, with reddening and itching of the skin that is exposed to the patch. Make sure to place the patch on a different part of the skin each day. Apply on dry skin.
The average retail price for a starter box of over-the-counter nicotine patches is approximately $4 a day*.
Gum – Nicotine gum sends nicotine to the brain in a stronger, quicker dose than the patch. Still, smokers won't get the same rush from nicotine gum as they do from smoking. Smokers chew the gum when they have a craving, then park it in the side of their mouths. One piece of gum (which is available in two strengths) is one dose. You can chew up to 24 pieces a day, depending on the nicotine concentration in the gum. Using too much gum can cause side effects like hiccups and upset stomach.
The average retail price for nicotine gum is approximately $5 a day for average usage during the first six weeks of use.
Spray – The nicotine nasal spray gives smokers a quick nicotine rush. A dose is two sprays, one in each nostril. Smokers squeeze the spray whenever they feel a craving.
The average retail price for nicotine nasal spray is approximately $5 to $15 a day, depending on how frequently you use it.
Inhaler – Smokers puff on the inhaler like a cigarette. However, the inhaler delivers nicotine directly into the mouth, where it is absorbed, rather than the lungs. Nicotine enters the body much more slowly from the inhaler than from a cigarette. You get the most benefit out of the inhaler by puffing on it frequently and continuously for 20 minutes. Gently puff on the inhaler to avoid getting a headache or a sore throat.
The average retail cost of the nicotine inhaler is approximately $45 a package, for 42 cartridges. The maximum suggested dose is 16 cartridges a day. The inhaler is available only by prescription.
Lozenge – The nicotine lozenge is the newest nicotine replacement product to be approved by the FDA. It looks like a cough drop, and slowly releases nicotine as it dissolves. One lozenge is one dose, and lasts about 20 to 30 minutes. You can take up to 20 lozenges a day. As with the gum, side effects can include hiccups, indigestion and stomach upset.
The average retail price for the nicotine lozenge ranges from $6 a day for average usage to $12 a day for heavy usage, during the first six weeks of use.
Bupropion hydrochloride (Zyban), known as Wellbutrin when prescribed for depression, stimulates the release of a feel-good chemical in the brain, called dopamine. Smokers begin taking Zyban while still smoking, one week before they quit. Treatment is continued for 7 to 12 weeks, depending on how much the person smokes. The average wholesale price of Zyban is an estimated $2.50 day.
Mooney is studying whether combining Zyban with a drug called naltrexone, might improve the quit rate among smokers. Naltrexone blocks the area in the brain that responds to nicotine. The drug is used to treat people addicted to opiates, like heroin, and alcohol. Mooney is currently recruiting patients for a clinical trial on the drug combination.
(For information, call 713-500-2802.)
On average, nicotine replacement products have about a 25 percent rate of success meaning that 25 percent of people using the product had remained non-smokers after a year. Zyban alone has a similar success rate to that of traditional nicotine replacement products.
Understanding your smoking pattern can make it easier for you to choose a smoking cessation method. If you are a heavy smoker, smoking up to 30 to 40 cigarettes a day, you may want to use a combination of medications and nicotine replacement. If you will miss having a cigarette in your mouth, the nicotine inhaler, gum or lozenge might be a good choice. If you are always on the go, then the nicotine patch may be for you. Consult your doctor when choosing a method.
If you don't like one method, you can always try another.
“It is important for smokers to realize that they will likely slip, but they should try to quit again and keep going,” Mooney says. “Use it as a lesson and requit immediately.”
While smoking cessation products are helpful, they only address physical addiction to smoking. Smoking is also a psychological and social addiction. Quitting can bring big changes, from how you wake up in the morning to the people you hang out with.
“We are dealing with a behavior change,” Pallonen says. “For most of us changing our habits can be very challenging, it can be done, but it is not easy.”
No matter what method you choose to quit smoking, quitting will be easier if you have some support. Support can be informal and come from your friends and family, or you can seek help from a formal smoking cessation group, or a quitline.
Contact your local chapter of the American Lung Association or American Cancer Society for smoking cessation resources in your area. For more information on joining a smoking cessation study, contact the UT Treatment Research Clinic at (713) 500-2802.
Last Updated: 2-25-2005Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
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Dr. Unto Pallonen is an associate professor in the Department of Health Promotion and Behavioral Sciences at the UT School of Public Health.
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Packing Bag Lunches Safely
If you pack lunches for your child to take to school, be careful that you do not accidentally expose them to foodborne illness.
Bagged lunches, especially those containing perishable foods, need to be packed and handled properly in order to keep the food safe. In general, perishable foods should not be left at room temperature for more than two hours. If left out too long, the temperature of the food can enter the danger zone where bacteria grow most rapidly, which is between 40 and 140 degrees Fahrenheit.
Below are some tips to help families pack bagged lunches safely:
Before eating lunch or snacks at school, make sure your child washes his or her hands with soap and warm water for at least 20 seconds. If your child's school does not have a handwashing program in place, encourage them to adopt a such a program, as handwashing is one of the best ways kids and parents can protect health and stop the spread of germs.
