10 Secrets to Help You Quit Smoking

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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A recent study made headlines reporting that quitting smoking abruptly has a better quit rate than using a gradual approach. This wasn’t news to many doctors—the “cutting-down” approach has never seemed to work as well as quitting cold turkey.

Well, what else do we know?

  1. First—smokers who quit abruptly are more likely to keep from using from tobacco than those who use a gradual cessation method. Cold turkey is your best bet for quitting, 8 weeks later, those who quit cold turkey remain abstinent at higher rates than those who try “cutting-down.”
  2. Pick a pre-specified quit date so you can reduce your smoking by 75% in the 2 weeks prior to quitting.
  3. When you quit, rely on nicotine replacement therapy (NRT) for help—it works. Three types of nicotine are available without a prescription: patch, lozenge and gum. Two need a prescription: Nicotrol, as a nasal spray and oral inhaler.
  4. On your quit day, start with a 21 mg/day patch and stay on that dose for weeks 1-4. Then, decrease to a 14 mg/day patch for weeks 5 – 6, and to 7 mg/day patch for weeks 7 – 8. Hint: you can cut your 14 mg patches in two when you get to that point.
  5. Try using two NRT methods in the beginning. The long-acting nicotine patch is the best way to control baseline nicotine withdrawal symptoms. Adding a short-acting form of NRT (lozenge, gum, inhaler, or nasal spray) helps control cravings during the day on an as-needed basis.
  6. Gum, lozenge or spray? The choice of which short-acting nicotine replacement therapy used really depends on your preference. The gum is most common. Peak nicotine levels occur 20 minutes after chewing the gum.
  7. Do they work? Yes. In multiple studies nicotine replacement products have been shown to be better than placebo (doing nothing). They increase quit rates approximately two-fold! There aren’t that many studies comparing one product with another but there isn’t any evidence of a difference between the patch, gum, inhaler, and nasal spray.
  8. Best strategy: using a combo of long acting NRT with a short acting is better than either alone.
  9. What about Chantix? No trial has compared Chantix to combination nicotine replacement therapy. Either can be used as first line (your first option for treatment). However, Chantix requires a visit to your doctor and keeping a close eye on your mood.
  10. Bupropion (Zyban) may also be used. This is a good option for those concerned about weight loss after quitting smoking. If you do want to rely on bupropion you’ll need to see your doctor and start the medication three weeks before your quit date.

Dr O.

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