Effective Smoking Cessation Strategies
Effective Smoking Cessation Strategies
There are many means to help in tobacco cessation. There is no “magic cure” for everyone.
The American Lung Association Call Center/Tobacco Quitline provides smoking cessation
counseling, free of charge, over the telephone. The smoking cessation counselors take a look
at your smoking pattern and develop a plan that's right for you. The counselors encourage you
to call in weekly to review your progress, discuss any problems you may be having and revise
your plan as needed - so that your plan works for you. In addition, a Smoking Cessation Packet
is sent to your home to provide you with written information to refer to and help you stay on
track. The Smoking Cessation Packet includes information on:
The American Lung Association Call Center/Tobacco Quitline has been helping clients to quit
smoking, through the use of telephone counseling, for many years. The Call Center/Tobacco
Quitline staff of Registered Nurses, Respiratory Therapists and trained Smoking Cessation
Counselors have found that a combination of methods to assist you in the smoking cessation
process has been most helpful. The methods our staff has found to be most effective in helping
our clients be successful are listed below. A table describing the types of medications, how they
are used, pros and cons, dosage, side effects and approximate costs can be found on the last
page of this packet.
There is a cost to you for prescription medication (check with your insurance carrier) and your
physician must prescribe the medication for you.
Zyban and Wellbutrin are brand names for bupropion hydrochloride, a medication that is used to
treat depression. In treating this condition, researchers found that the chemical in bupropion
hydrochloride had an additional benefit of curbing the urge to smoke - it has been proven to
assist smokers to quit smoking.
This is the only prescription medication to help quit smoking available in tablet form. There is a
small risk of seizure associated with the use of this medication. You cannot take this medication
if you have a seizure disorder, eating disorder or head trauma. It must be used with caution for
those with renal or liver disease, heart disease or history of a heart attack. Your physician can
tell you if this medication is right for you.
Method 2 TAPERING:
There is no cost to you, other than the number of cigarettes you purchase while you are
tapering. Tapering slowly reduces the amount of nicotine your body is used to and has the
added benefit of giving you experience in changing your smoking behaviors so you are prepared
to get through the urges to smoke.
To begin the tapering process you must know the exact number of cigarettes you smoke every
day. Reduce the total number of cigarettes by one every 2 days. For example, if you smoke 30
cigarettes per day, start with 29 cigarettes a day for 2 days, then 28 cigarettes a day for 2 days
and so on. Continue this process until you are at 15 to 20 cigarettes per day - then STOP
SMOKING and begin to use nicotine replacement therapy (patch, gum, lozenge, etc.). At 15 to
20 cigarettes per day the amount of nicotine per day is more equal to the amount of nicotine in
the nicotine patches (approximately 1 milligram per cigarette compared to 21 milligrams in the
initial patch).
It is beneficial to write the number of cigarettes you are allowed each day on a calendar so you
can keep track. This is the maximum number of cigarettes you are allowed to smoke each day.
You can smoke up to that amount, less than the amount, but NOT MORE THAN THE AMOUNT
ALLOWED FOR THE DAY. Follow the instructions -- tapering too quickly will cause withdrawal
symptoms. See the “Tapering Calendar” examples next page.
While you are tapering, you get a chance to try out new techniques to
break your smoking habit.
To break your smoking habit you have to develop new life strategies
Week Sun Mon Tues Wed Thurs Fri Sat 1111111111111 Week Sun Mon Tues Wed Thurs Fri Sat
1 39 39 38 38 37 37 36 1 25 25 24 24 23 23 22
2 36 35 35 34 34 33 33 2 22 21 21 20 20 19 19
3 32 32 31 31 30 30 29 3 18 18 17 17 16 16 15
4 29 28 28 27 27 26 26 4 15 ∅
∅ Start nicotine replacement therapy (i.e., patch, gum, etc.) and DO NOT SMOKE
Week Sun Mon Tues Wed Thurs Fri Sat 1111111111111 Week Sun Mon Tues Wed Thurs Fri Sat
1 29 29 28 28 27 27 26 1 15 15 ∅
2 26 25 25 24 24 23 23 2
3 22 22 21 21 20 20 19 3
4 19 18 18 17 17 16 16 4
∅ Start nicotine replacement therapy (i.e., patch, gum, etc.) and DO NOT SMOKE
1 19 19 18 18 17 17 16
2 16 15 15 ∅
∅ Start nicotine replacement therapy (i.e., patch, gum, etc.) and DO NOT SMOKE
Do you use cigarettes to reduce the stress in your life?
Develop new methods to deal with the day to day stressors in life - smoking does NOT reduce
stress. In fact, it makes the heart beat faster, increases the breathing rate and causes the body
to use more oxygen.
Nicotine patches may be purchased over the counter in a variety of locations (local and chain
pharmacies, discount stores, etc.). Prices may vary between brands, with generic patches
being the least expensive.
The patch gets to the nicotine addiction. The nicotine patch provides a safer source of
nicotine - that enters the body slowly and in lower concentrations than in cigarettes. Patch
therapy is generally safe and well tolerated. The most common adverse reactions are skin
irritation and sleep disturbance. The nicotine patch helps take care of the nicotine addiction so
you can work on breaking your smoking habit. The full course of nicotine patch treatment starts
with a 21 mg patch for the first 4 - 6 weeks, a 14 mg patch for the next 2 weeks and a 7 mg
patch for final 2 weeks.
During the last week, taper off the 7 mg patch reducing the hours you wear the patch daily until
you reach zero (if you experience sleep disturbances you can remove the patch at night):
The use of a combination of all 3 methods can increase your rate of success.
To use method 1, 2, and 3 - Start the Zyban or Wellbutrin and tapering, the medication takes 1-
2 weeks to see the full benefits of curbing the urge to smoke. When you have tapered down to
15 to 20 cigarettes per day start the patch. REMEMBER, you cannot smoke on the patch. You
continue to use the medication through the full course of treatment. Use your distracters, get
some exercise and eat healthy.
To use method 2 and 3 (If you cannot use the Zyban or Wellbutrin medication) -
When you have tapered down to 15 - 20 cigarettes or less a day, start the patch. REMEMBER,
you cannot smoke on the patch. Continue use of the patch through the full course of treatment.
Use your distracters, get some exercise and eat healthy.
If you cannot use the medication or the patch - You can use Method 2 only (the tapering
method), tapering down to 5 cigarettes a day and then quit. Use your distracters, get some
exercise and eat healthy.
OTHER OPTIONS?
The nicotine gum and nicotine lozenge have proven beneficial as an alternative, for those
who cannot use the nicotine patch, with some success. There is a charge to you for nicotine
gum and lozenges. Follow the package directions for use. The nicotine gum and lozenge can
be purchased over the counter in a variety of locations (local and chain pharmacies, discount
stores, etc.).
The nicotine nasal spray and nicotine inhaler are available by prescription. The nasal spray
is sprayed directly into each nostril and absorbed through your nasal membranes, where it
enters your bloodstream and is then sent to your brain. The inhaler looks something like a
cigarette holder. You puff on it, and it gives off nicotine vapors into your mouth. You absorb the
nicotine through the lining in your mouth, where it enters your bloodstream and goes to your
brain.
HAVING TROUBLE? The Call Center staff is on hand from 7 a.m. to 7 p.m. (Central Time)
Monday through Friday to answer any questions you may have on the process, to assist you
revising your plan as needed, to give you tips on any problems you may be having and to
provide support and encouragement.
What is recovery?
Many people in the process of kicking the cigarette habit go through a period of discomfort
known as withdrawal; we prefer to call it recovery. Symptoms vary from mild to severe,
depending on the extent of dependence to nicotine, and these symptoms do not necessarily
affect everyone. Recovery symptoms vary from person to person.
Withdrawal usually occurs by the third day and can be diminished if the following suggestions
are followed. In an attempt to speed up the recovery process, it is recommended that people
drink lots of fluids – especially during the first few days. Drinking 6-8 glasses of water or fruit
juice a day is a must! In this way, nicotine is flushed out of the system more rapidly.
2. When an urge for a cigarette catches you unaware, take 3 regular deep breaths. Hold the
last breath in for a few seconds and then exhale slowly. This procedure should help you
relax as well as use the muscles normally used for inhaling.
3. Try to avoid caffeinated drinks. Coffee (caffeinated) often creates a craving for cigarettes.
4. Try to avoid alcoholic beverages – alcohol creates a deficiency in oxygen that may lessen
the ability to concentrate. The urge to have a cigarette may develop as a “pick-me-up.”
5. Chew on something, non-caloric, to relieve tension in muscles that would normally be used
for exhaling.
6. Avoid excess sugar to avoid excess calories. Substitute low-calorie snacks like celery, carrot
sticks, plain popcorn, breadsticks, etc.
8. Remember…drink fluids like water or fruit juice and be patient; you will live through
this…over 50 million people already have!
EATING IS NOT A SUBSTITUTE FOR SMOKING!
As you decrease the number of cigarettes you smoke it is important to remember that you
should not increase your caloric intake - risking weight gain. Like many people who are limiting
their cigarettes, you may feel the need to have something in your mouth to replace the
cigarettes. Try sucking on a cinnamon stick or swizzle stick.
However, if you like to snack, learn to “snack smart.” Limit your snacking by eating good regular
meals. Learn new ways to cope with snacking triggers such as anxiety and boredom: try deep
breathing and other relaxation exercises. Keep safe and nutritious snacks nearby: raw
vegetables, unbuttered popcorn and fruit. Drink plenty of water and low-calorie beverages
without caffeine. (Caffeine is a stimulant and may make you feel edgy or nervous while going
through withdrawal. There is also a very strong psychological association between smoking and
drinking alcohol or caffeinated beverages.)
Controlling your daily calorie intake is the secret to controlling your weight. There are 3500
calories in a pound of body fat. When you take in 3500 more calories than your body uses, you
gain a pound of weight. When you burn off 3500 extra calories, you lose a pound. So a balance
between the amount of calories you eat and the amount you burn each day should maintain
your weight at a constant level.
Try Exercise
Build moderate exercise into your daily routine to burn unwanted calories and to help reduce
tension and stress. You’ll feel more relaxed and alert rather than exhausted and vulnerable.
Here are just a few ideas to get you started:
Perhaps you will want to begin a more rigorous exercise program. You could take a walk before
or after dinner or learn something new and different, like karate or dancing. Aerobic-type
exercises, such as walking, jogging, swimming, and bicycling are best for improving your cardio-
respiratory endurance.
CHANGES YOUR BODY GOES THROUGH WHEN YOU QUIT
Within 20 minutes of the last cigarette:
Blood pressure drops to normal
Pulse rate drops to normal
Body temperature of hands and feet increase
8 Hours:
Carbon Monoxide level in blood drops to normal
Oxygen level in blood increases to normal
24 Hours:
Chance of heart attack decreases
48 Hours:
nerve endings start regrowing
ability to smell and taste things is enhanced
72 Hours:
bronchial tubes relax, making breathing easier
lung capacity increases
2 Weeks to 3 Months:
Circulation improves
Walking becomes easier
Lung function increases up to 30%
1 to 9 Months:
Coughing, sinus congestion, fatigue, shortness of breath decreases.
Cilia regrows in lungs, increasing ability to handle mucus, clean the lungs, reduce
infection, body’s overall energy level increases
5 Years:
Lung cancer rate for the average smoker decreases from 137/100,000 people to
72/100,000
10 Years:
Lung cancer rate drops to 12/100,000 people
Precancerous cells are replaced
Other cancers such as those of the mouth, larynx, esophagus, bladder, kidney, and
pancreas decrease
15 Years:
Chances of many types of cancer are similar to that of someone who has never smoked.
ALL BENEFITS ARE LOST WHEN YOU SMOKE JUST 1 CIGARETTE A DAY!!!!
TIP SHEET: “Special Cigarettes” and How to Cope With Them
1. Wake up Cigarette
Drink glass of fruit juice immediately on waking – try orange juice – many find that
smoke and orange juice do not mix well
Brush teeth with mint flavored toothpaste
Arrange for a morning paper and read it
Try something special for breakfast – e.g. fresh pineapple or something to bake
(prepare)
Switch to juice
Try flavoring coffee a different way (European, Mocha)
Nibble on a low-cal treat that appeals to you
3. After Breakfast Cigarette (for filling “Dead Time” between breakfast and work)
Read a paperback
Watch people, notice hair styles, clothes, shoes, etc.
Eat hard candy (sugarless) or sugarless gum
7. Telephone Cigarette
Doodle
Change your normal telephoning position (switch hands on the receiver)
Find a toy to play with
8. Before Lunch Cigarette
Alter routine
Eat slower
Take a brief walk
Visit someone in another department
Read
Deep breathing exercises
14. Nightcap Cigarette (not with drink, rather last cigarette of day)
Brush teeth with mint flavored toothpaste and use mouthwash – don’t want to spoil their
taste
Spend your evening reading in bed (not in chair) when you feel drowsy, go to sleep.
WHAT TO DO … When the Craving Comes
1. When you are challenged by a strong urge to smoke, take a few deep breaths and
remember your determination to be free.
2. Think of your most important reason for wanting to stop. Say it out loud in front of the
mirror.
3. Do not start feeling sorry for yourself. It’s the people who are still smoking who should be
pitied. You were smart enough to follow a program and stop smoking.
4. Immediately turn your attention to something else. Remember that the most intense
craving lasts only a few minutes – 5 to 10 at the most.
5. Do something with your hands. Knit. Doodle. Play with coins. Write a letter.
6. Be good to yourself in every possible way. Even indulge yourself a little. Enjoy a special
treat on weekends (a good meal, a show, etc.) with the money you’ve saved.
7. Frequent places where you don’t smoke rather than places where you do.
10. Concern yourself only with today—tomorrow will take care of itself. Get through today
without smoking.
THE 4 D’s can lessen discomfort associated with the physical urge to smoke
1. DEEP BREATHE – Deep breathing (whether sitting, standing or lying down) is an effective
way of dealing with tension from cigarette cravings.
A. With your mouth closed and your shoulders relaxed, inhale as slowly as deeply as you
can while silently counting to eight. As you do that, push your stomach out.
B. Hold your breath while counting silently to eight
C. Exhale slowly, while counting silently to eight.
D. Do this slow, deep breathing cycle of exercises five times.
2. DRINK WATER – Drink lots of liquids, especially water and fruit juice. Many ex-smokers
report that this helps to alleviate the physical urge to smoke.
3. DELAY – When your craving is a mild one, it is possible to wait it out. After a few moments,
you will find that the urge fades and then disappears.
4. DO SOMETHING ELSE – Here is a list of activities that you can do when the urge to smoke
strikes:
Schedule long blocks of quiet time. Write them down in your appointment book.
Look at your schedule for the upcoming week. Block out at least one weekday evening and
one weekend day to be reserved for an enjoyable, non-work related activity, something you
will really look forward to.
Set up lunch dates with friends. Ideally these should be people who have nothing to do with
your work, people with whom you can talk about personal matters.
Look for opportunities for short unstress breaks – a quick walk, five minutes of stretching
exercises, a quiet cup of tea.
Look for opportunities to become physically quiet – a brief nap, a bath or shower, getting (or
giving) a massage.
Get some exercise – it can be a great stress break. When you’re feeling tense, there’s
nothing better than a long, slow jog, a hike in the park, or a stint of gardening or yard work.
Enjoy time with your pet. Taking your dog for a walk combines both companionship and
exercise. And a few things are more satisfying than sitting quietly with a purring cat in your
lap.
MAKING PROGRESS
• Each month, on the anniversary of your quit day, plan a special celebration.
• Periodically, write down new reasons you are glad you quit and post these reasons where
you will be sure to see them.
• Make up a calendar for the first 90 days. Cross off each day and indicate the money you
saved by not smoking.
• Set other intermediate target dates and do something special with the money you have
saved.
IF YOU HAD A SLIP OR TWO
1. Treat the slip as an emergency. Take immediate action to recover. For example, throw
away the cigarettes or leave the party.
2. Remind yourself that a slip is just a mistake, not a total relapse back to smoking. You can
be better prepared next time.
Quitting smoking takes practice. It takes more practice for some than for others. Having a
couple of cigarettes is different from actually going back to smoking. Don’t slip. Don’t go back to
smoking. But if you do, here are some helpful hints to get you back on track.
2. Tomorrow, list your trigger situations and some plans on how you can cope with each
situation without smoking.
TRIGGER MY PLAN
3. Decide which part of the day is the hardest to get through without smoking.
6. The third day, quit smoking for one day (24 hours). Arrange to have your Facilitator call
you to support you.
7. At the end of the day, reward yourself for whatever progress you’ve made.
You just need to keep practicing until you make it permanent. You can do it!
MEDICATIONS FOR SMOKING CESSATION
Sarcoidosis Tuberculosis
Quitting tobacco
1-800-548-8252
• Now you can receive smoking cessation support 24 hours a day in the comfort of
your own home!
www.ffsonline.org