How can I quit smoking?

DEAR DOCTOR K:

I have tried to quit smoking several times but just can’t. The patch and Chantix didn’t work. Support groups aren’t for me. Are there any other approaches that might help?

DEAR READER:

Keep trying. It often takes smokers several tries before they are successful. I spoke to my colleague, Dr. Thomas Lee, editor-in-chief of the Harvard Heart Letter, who has heard this question from many of his patients. Here are our thoughts.

Because nicotine is highly addictive, withdrawal symptoms, especially cigarette cravings, can feel impossible to deny. At the end of this article, you’ll findĀ a chart of the most common withdrawal symptoms and suggestions for ways to get through them.

Smokers today have a number of tools to fight tobacco addiction. These include nicotine replacement (nicotine patches, gums, lozenges, inhalers and sprays); non-nicotine medications such as bupropion (Zyban, Wellbutrin) and varenicline (Chantix); counseling and behavior-change therapy; and social support. None are miracle workers.

You mentioned the nicotine patch. Try it again, this time in combination with a nicotine gum, lozenge or inhaler to help to handle breakthrough cravings the patch can’t counteract.

You also said that Chantix didn’t help. Chantix helps cut down cravings and withdrawal symptoms and, by partially blocking the effect of nicotine, reduces smoking’s “reward.” Try Zyban, a drug that helps reduce the desire to smoke, which may work better for you.

Even if you don’t want to join a support group, call the national quit line at 800-QUIT-NOW. You can get free, helpful support from the comfort of your home.

Some of my patients have two misconceptions about the risks of smoking that discourage them from trying to quit. The first is that smoking leads just to lung cancer, and because they haven’t known many people with lung cancer, it can’t be that common. In fact, smoking increases the risk for many kinds of cancer, including cancers of the colon, liver, kidney, pancreas, stomach and cervix, as well as a kind of leukemia.

Smoking also greatly increases the risk of heart disease, the No. 1 cause of premature death among men and women; strokes; and other serious lung disease besides lung cancer. Plus, it thins the bones and causes the skin to age prematurely.

The other misconception is, “What’s the use; the damage is already done.” If you’ve been smoking for decades, you may have some permanent damage in the lung. But two hours after your last cigarette, nicotine starts leaving your body. One month later, much of the lung damage starts to heal. One year later, your risk of a heart attack or stroke is much lower. So is your risk of lung cancer.

Work with your doctor or a smoking cessation specialist to figure out a plan tailored for you.

I haven’t had many patients successfully quit smoking on their first try, but I’ve seen many people who keep trying succeed. There are more ex-smokers in the United States today than there are smokers. It won’t be easy, but you can do it!

Common withdrawal symptoms and ways to cope with them

Symptom Cause Duration Relief
Craving for cigarette Body’s craving for nicotine Most intense during first week but can linger for months Wait out the urge; distract yourself; take a brisk walk.
Irritability, impatience Body’s craving for nicotine 2 to 4 weeks Exercise; take hot baths; use relaxation techniques; avoid caffeine.
Insomnia Body’s craving for nicotine temporarily reduces time spent in deep sleep 2 to 4 weeks Avoid caffeine after 6 p.m.; use relaxation techniques; exercise.
Fatigue Body adjusting to lack of stimulation from nicotine 2 to 4 weeks Take naps; do not push yourself.
Lack of concentration Body adjusting to lack of stimulation from nicotine A few weeks Reduce workload; avoid stress.
Hunger Craving for cigarettes may be confused with hunger pangs Up to several weeks Drink water or low-calorie drinks; eat low-calorie snacks.
Coughing, dry throat, nasal drip Body ridding itself of mucus in lungs and airways Several weeks Drink plenty of fluids; use cough drops.
Constipation, gas Intestinal movement decreases with lack of nicotine 1 to 2 weeks Drink plenty of fluids; add fiber to diet; exercise.