marie
06-16-2007, 01:28 PM
The desire to stop smoking
Many smokers continue smoking not through free choice but because they are addicted to cigarettes. A large part of this addiction arises from dependence on nicotine delivered rapidly to the brain with each puff. A report by the Royal College of Physicians found that nicotine complied with the established criteria for defining an addictive substance.” [1] (For further information see ASH factsheet: Nicotine and addiction ) Addiction does not mean that it is impossible to stop doing something, it just means that there are powerful urges and needs that have to be overcome in order to do so. Anything that can strengthen the resolve to resist these urges and needs or reduce their frequency or intensity can help in overcoming the addiction.
The large majority of smokers report that they want to stop when asked.[2] Almost nine out of ten (88%) of smokers state that they want to quit because of a health concern. After health reasons, the next most common reason given for wanting to give up is a financial one. 2 Probably around half of all smokers make at least one attempt to stop in a given year [3] but only about 2-3% of smokers succeed long term. [4] It is not clear why some attempts to stop succeed and others do not: smoking fewer cigarettes per day, not needing to smoke first thing in the morning and not suffering from mental health problems, or other addictions are favorable signs.
Beneficial health changes when you stop smoking
Stopping smoking is always urgent but never too late. Every cigarette smoked damages the lungs in a way that may not show up until later in life. After the age of 35-40 years every year of continued smoking loses 3 months of life expectancy.[5] Many smokers think that they will be more miserable when they stop but actually all the evidence is that they will have better mental health [6] and be happier. [7]
Some of the health benefits from stopping smoking can occur quite quickly as the table below shows. Other health improvements may take many years, depending on how long a person has smoked. [8]
Time since quitting
Beneficial health changes that take place
8 hours
Nicotine and carbon monoxide levels in blood reduce by half, oxygen levels return to normal. Circulation improves.
24 hours
Carbon monoxide and nicotine eliminated from the body.
48 hours
The decline in lung function and excess risk of lung cancer halts.
1 month
Appearance improves – skin loses its grayish pallor and becomes less wrinkled
3 - 9 months
Coughs and wheezing declines
1 year
The excess risk of a heart attack reduces by half compared to that of a smoker.
15 years
Risk of heart attack falls to the same as someone who has never smoked.
Withdrawal symptoms
Withdrawal symptoms are the physical and mental changes that occur following interruption or termination of drug use. They are normally temporary and are a product of the physical or psychological adaptation to long-term drug use, requiring a period of re-adjustment when the drug is no longer ingested. In the case of smoking, some of these are: [9]
Withdrawal symptom
Duration
Proportion of those trying to quit who are affected
Irritability / aggression
Less than 4 weeks
50%
Depression
Less than 4 weeks
60%
Restlessness
Less than 4 weeks
60%
Poor concentration
Less than 2 weeks
60%
Increased appetite
Greater than 10 weeks
70%
Light-headedness
Less than 48 hours
10%
Night-time awakenings
Less than 1 week
25%
Craving
Greater than 2 weeks
70%
Weight gain
The possibility of weight gain is often of particular concern to those who want to give up smoking. Weight gain is often progressive for a period of at least a year and, on average, ex-smokers will gain around 5kg in weight.10 However, this is the weight gain made without recourse to any special attempts at dieting or exercise and it presents a minor health risk when compared to the risk of continued smoking. In addition, improved lung function and some of the other health benefits of giving up smoking are likely to make exercise both easier and more beneficial. See QUIT’s guide to stopping smoking without putting on weight for further advice.
Pipes & cigars
Some smokers switch to pipes or cigars in the belief that this is a less dangerous form of smoking. However, such smokers may incur the same risks and may even increase them, especially if they inhale the pipe or cigar smoke. [10] For further information on pipes and cigars see the ASH factsheet: Pipes and Cigars . Similarly, waterpipes (shisha or hookah pipes) are potentially just as hazardous as smoking other forms of tobacco. For further information see the ASH factsheet: Waterpipes.
Smoking cessation aids
The chances of success of a given quit attempt are unfortunately very low, which is why it is vital to keep trying. Most ex-smokers had to try many times before they succeeded. Fortunately there are many things that smokers can do to improve the odds. These fall into two categories: medications and psychological support.
Medications
Medications aim to help smokers to stop by reducing the chemically-driven need to smoke while at the same time not themselves providing the same satisfaction as smoking and so not becoming the object of dependence. The assumption is that all the time that the smoker is not taking in nicotine from cigarettes the brain is gradually getting back to normal so that when the course of medication is completed, most smokers will be able to deal with the motivation to smoke without help.
Nicotine replacement therapies (NRT) usually taken for 8 to 12 weeks, these include nicotine chewing gum, skin patch, lozenge, nasal spray or ’inhalator’. They can be bought from pharmacists or some shops or obtained on prescription. They are designed to reduce the chemical need to smoke but not to provide the same satisfaction as smoking and so are much easier to come off. Clinical trials have consistently found NRT to help between 1 in 10 and 1 in 20 quit attempts. Thus the effect is small but very valuable. [11]
Bupropion (Zyban) is only available on prescription as a course of tablets lasting around 8 weeks. Zyban is safe for most healthy adults but there are side effects, the most serious of which is the risk of seizures (fits). This risk is estimated to be less than 1 in 1000 but other less serious side effects such as insomnia, dry mouth and headaches are more common. Clinical trials have found that Zyban helps about 1 in 10 quit attempts where it is used to succeed over and above those that would have succeeded anyway. [12]
Varenicline (Champix) comes as a course of tablets lasting 12 weeks with the option of a further 12 weeks for those that are not smoking at the end of the initial treatment. Like NRT and Zyban, it works by reducing the need to smoke caused by loss of nicotine and also makes cigarettes less satisfying. It was launched in the UK in December 2006 and is available on prescription. Clinical trials have found varenicline to be more effective in helping people stop smoking than either bupropion or placebo. The initial course helps an estimated 1 in 7 quit attempts to succeed over and above those that would have succeeded anyway and a further 12 week course helps another 1 in 20 to achieve long-term success.
For further information see the ASH guidance at: http://www.ash.org.uk/html/cessation/ASHVareniclineguidance.pdf
Psychological support
Psychological support aims to strengthen the smoker’s motivation not to smoke and to advise on ways on avoiding, escaping from or minimising urges to smoke with simple practical strategies.
Stop-smoking groups. Most GP surgeries either run or can refer smokers to free NHS specialist-facilitated stop smoking groups. Although many smokers may be put off by the idea of groups, people who attend them report that they are enjoyable social occasions in which they learn a lot from each other about how to tackle problems associated with stopping smoking and their resolve not to smoke is strengthened by not wanting to let the group down. Clinical trials have found that such groups help about 1 in 20 quit attempts to succeed over and above those that would have succeeded anyway. [13] Most smokers attending these groups will also use medication to maximise their chances of success.
Individual face-to-face support. All GP surgeries should be able to provide or refer smokers to a stop smoking advisor to help with stopping smoking. This may be provided by a fully trained specialist who is employed by the NHS for this role or a practice nurse, pharmacist or other health professional who has received training and does this as well as their other activities. The idea is to give practical advice and support in a non-judgmental manner. The effectiveness of this support probably varies with the advisor but clinical trials have found that when given by fully trained specialists it can help about 1 in 20 quit attempts to succeed in addition to those that would have succeeded anyway. [14] Most smokers seeing an advisor will also use medication to maximise their chances of success.
Telephone support. Some NHS stop smoking services (accessible through GPs) provide psychological support over the telephone. QUIT is a national charity that has a free-phone number where smokers can get telephone support. This is very similar to the kind of support offered by stop smoking advisors attached to GP surgeries but obviously without the need to travel to appointments. Clinical trials have found that this kind of support has a similar level of effectiveness to face-to-face support. [15] QUIT’s helpline number is 0800 00 22 00. There is also an NHS helpline which does not provide support directly but can tell smokers how to get support locally: 0800 169 0169.
Unproven aids to cessation
All of the above approaches have been evaluated in clinical trials in which success rates in smokers using the aid have been compared with similar smokers using a placebo, nothing or something else. There are a number of commercial companies selling materials, devices and treatments, often claiming higher levels of effectiveness, which have not be evaluated in this way. Success at stopping smoking is somewhat unpredictable and many people will report have succeeded after using one of these treatments but unless the aid has been subjected to comparative trials that are either independent of the company or audited by an independent agency, smokers would be advised to treat claims of effectiveness with caution.
http://www.mainstage-mgmt.com/images/groucho/groucho_cigar2.jpg
Many smokers continue smoking not through free choice but because they are addicted to cigarettes. A large part of this addiction arises from dependence on nicotine delivered rapidly to the brain with each puff. A report by the Royal College of Physicians found that nicotine complied with the established criteria for defining an addictive substance.” [1] (For further information see ASH factsheet: Nicotine and addiction ) Addiction does not mean that it is impossible to stop doing something, it just means that there are powerful urges and needs that have to be overcome in order to do so. Anything that can strengthen the resolve to resist these urges and needs or reduce their frequency or intensity can help in overcoming the addiction.
The large majority of smokers report that they want to stop when asked.[2] Almost nine out of ten (88%) of smokers state that they want to quit because of a health concern. After health reasons, the next most common reason given for wanting to give up is a financial one. 2 Probably around half of all smokers make at least one attempt to stop in a given year [3] but only about 2-3% of smokers succeed long term. [4] It is not clear why some attempts to stop succeed and others do not: smoking fewer cigarettes per day, not needing to smoke first thing in the morning and not suffering from mental health problems, or other addictions are favorable signs.
Beneficial health changes when you stop smoking
Stopping smoking is always urgent but never too late. Every cigarette smoked damages the lungs in a way that may not show up until later in life. After the age of 35-40 years every year of continued smoking loses 3 months of life expectancy.[5] Many smokers think that they will be more miserable when they stop but actually all the evidence is that they will have better mental health [6] and be happier. [7]
Some of the health benefits from stopping smoking can occur quite quickly as the table below shows. Other health improvements may take many years, depending on how long a person has smoked. [8]
Time since quitting
Beneficial health changes that take place
8 hours
Nicotine and carbon monoxide levels in blood reduce by half, oxygen levels return to normal. Circulation improves.
24 hours
Carbon monoxide and nicotine eliminated from the body.
48 hours
The decline in lung function and excess risk of lung cancer halts.
1 month
Appearance improves – skin loses its grayish pallor and becomes less wrinkled
3 - 9 months
Coughs and wheezing declines
1 year
The excess risk of a heart attack reduces by half compared to that of a smoker.
15 years
Risk of heart attack falls to the same as someone who has never smoked.
Withdrawal symptoms
Withdrawal symptoms are the physical and mental changes that occur following interruption or termination of drug use. They are normally temporary and are a product of the physical or psychological adaptation to long-term drug use, requiring a period of re-adjustment when the drug is no longer ingested. In the case of smoking, some of these are: [9]
Withdrawal symptom
Duration
Proportion of those trying to quit who are affected
Irritability / aggression
Less than 4 weeks
50%
Depression
Less than 4 weeks
60%
Restlessness
Less than 4 weeks
60%
Poor concentration
Less than 2 weeks
60%
Increased appetite
Greater than 10 weeks
70%
Light-headedness
Less than 48 hours
10%
Night-time awakenings
Less than 1 week
25%
Craving
Greater than 2 weeks
70%
Weight gain
The possibility of weight gain is often of particular concern to those who want to give up smoking. Weight gain is often progressive for a period of at least a year and, on average, ex-smokers will gain around 5kg in weight.10 However, this is the weight gain made without recourse to any special attempts at dieting or exercise and it presents a minor health risk when compared to the risk of continued smoking. In addition, improved lung function and some of the other health benefits of giving up smoking are likely to make exercise both easier and more beneficial. See QUIT’s guide to stopping smoking without putting on weight for further advice.
Pipes & cigars
Some smokers switch to pipes or cigars in the belief that this is a less dangerous form of smoking. However, such smokers may incur the same risks and may even increase them, especially if they inhale the pipe or cigar smoke. [10] For further information on pipes and cigars see the ASH factsheet: Pipes and Cigars . Similarly, waterpipes (shisha or hookah pipes) are potentially just as hazardous as smoking other forms of tobacco. For further information see the ASH factsheet: Waterpipes.
Smoking cessation aids
The chances of success of a given quit attempt are unfortunately very low, which is why it is vital to keep trying. Most ex-smokers had to try many times before they succeeded. Fortunately there are many things that smokers can do to improve the odds. These fall into two categories: medications and psychological support.
Medications
Medications aim to help smokers to stop by reducing the chemically-driven need to smoke while at the same time not themselves providing the same satisfaction as smoking and so not becoming the object of dependence. The assumption is that all the time that the smoker is not taking in nicotine from cigarettes the brain is gradually getting back to normal so that when the course of medication is completed, most smokers will be able to deal with the motivation to smoke without help.
Nicotine replacement therapies (NRT) usually taken for 8 to 12 weeks, these include nicotine chewing gum, skin patch, lozenge, nasal spray or ’inhalator’. They can be bought from pharmacists or some shops or obtained on prescription. They are designed to reduce the chemical need to smoke but not to provide the same satisfaction as smoking and so are much easier to come off. Clinical trials have consistently found NRT to help between 1 in 10 and 1 in 20 quit attempts. Thus the effect is small but very valuable. [11]
Bupropion (Zyban) is only available on prescription as a course of tablets lasting around 8 weeks. Zyban is safe for most healthy adults but there are side effects, the most serious of which is the risk of seizures (fits). This risk is estimated to be less than 1 in 1000 but other less serious side effects such as insomnia, dry mouth and headaches are more common. Clinical trials have found that Zyban helps about 1 in 10 quit attempts where it is used to succeed over and above those that would have succeeded anyway. [12]
Varenicline (Champix) comes as a course of tablets lasting 12 weeks with the option of a further 12 weeks for those that are not smoking at the end of the initial treatment. Like NRT and Zyban, it works by reducing the need to smoke caused by loss of nicotine and also makes cigarettes less satisfying. It was launched in the UK in December 2006 and is available on prescription. Clinical trials have found varenicline to be more effective in helping people stop smoking than either bupropion or placebo. The initial course helps an estimated 1 in 7 quit attempts to succeed over and above those that would have succeeded anyway and a further 12 week course helps another 1 in 20 to achieve long-term success.
For further information see the ASH guidance at: http://www.ash.org.uk/html/cessation/ASHVareniclineguidance.pdf
Psychological support
Psychological support aims to strengthen the smoker’s motivation not to smoke and to advise on ways on avoiding, escaping from or minimising urges to smoke with simple practical strategies.
Stop-smoking groups. Most GP surgeries either run or can refer smokers to free NHS specialist-facilitated stop smoking groups. Although many smokers may be put off by the idea of groups, people who attend them report that they are enjoyable social occasions in which they learn a lot from each other about how to tackle problems associated with stopping smoking and their resolve not to smoke is strengthened by not wanting to let the group down. Clinical trials have found that such groups help about 1 in 20 quit attempts to succeed over and above those that would have succeeded anyway. [13] Most smokers attending these groups will also use medication to maximise their chances of success.
Individual face-to-face support. All GP surgeries should be able to provide or refer smokers to a stop smoking advisor to help with stopping smoking. This may be provided by a fully trained specialist who is employed by the NHS for this role or a practice nurse, pharmacist or other health professional who has received training and does this as well as their other activities. The idea is to give practical advice and support in a non-judgmental manner. The effectiveness of this support probably varies with the advisor but clinical trials have found that when given by fully trained specialists it can help about 1 in 20 quit attempts to succeed in addition to those that would have succeeded anyway. [14] Most smokers seeing an advisor will also use medication to maximise their chances of success.
Telephone support. Some NHS stop smoking services (accessible through GPs) provide psychological support over the telephone. QUIT is a national charity that has a free-phone number where smokers can get telephone support. This is very similar to the kind of support offered by stop smoking advisors attached to GP surgeries but obviously without the need to travel to appointments. Clinical trials have found that this kind of support has a similar level of effectiveness to face-to-face support. [15] QUIT’s helpline number is 0800 00 22 00. There is also an NHS helpline which does not provide support directly but can tell smokers how to get support locally: 0800 169 0169.
Unproven aids to cessation
All of the above approaches have been evaluated in clinical trials in which success rates in smokers using the aid have been compared with similar smokers using a placebo, nothing or something else. There are a number of commercial companies selling materials, devices and treatments, often claiming higher levels of effectiveness, which have not be evaluated in this way. Success at stopping smoking is somewhat unpredictable and many people will report have succeeded after using one of these treatments but unless the aid has been subjected to comparative trials that are either independent of the company or audited by an independent agency, smokers would be advised to treat claims of effectiveness with caution.
http://www.mainstage-mgmt.com/images/groucho/groucho_cigar2.jpg