Be a Quitter! Kick Smoking to the Curb

When it comes to smoking, we have both some good news and some bad news to discuss. 

Let’s start with the bad news: 42.1 million Americans still smoke regularly.1 Tobacco use remains the largest preventable cause of disease, disability, and death in the United States, and there are over 480,000 premature deaths annually that are related to tobacco use. This means that around one out of every five deaths that occur each year in the United States is related to smoking.2

Now for some good news: people are smoking less and less all the time. Between 2005 and 2016, the percentage of US adults who smoke has decreased from 20.9% to 15.5%.3 In adults who have ever used cigarettes, 59% have quit as of 2016, which has increased from 50.8% in 2005. Going back even further in time, there were more than twice as many smokers (as a percentage) in 1965 compared to today.3

Although the change is happening gradually and slowly, this is a war that we appear to be winning. This is partly because of greater public awareness of the harms of smoking, but is also attributable to improvements in treatments. Doctors are recommended to consistently ask patients about tobacco use, and encourage and assist patients in their attempts to quit.4 Studies have shown that this campaign of identifying and supporting tobacco users is effective. Frequently, explaining treatment options is a good way to get patients "over the hump" and into a mindset of actively quitting.

This is the desired mindset; the mindset that doctors hope all tobacco users develop. The rewards of quitting smoking are real, and dramatic. Quitting tobacco decreases the risk for cardiovascular diseases, pulmonary diseases, and many types of cancer.5 Not only this, but quitting saves former smokers tons of money. If a person smokes a pack of cigarettes per day, they save more than $2000 per year after quitting. For those who quit, their sense of smell improves, and food tastes better. The staining of teeth and fingernails ceases, and skin and hair has a younger, healthier appearance. Clothes and breath don’t smell like smoke anymore. In short, there are a great deal of desirable benefits that can be achieved by quitting tobacco. 

The truth is, many smokers would like to quit, but they predictably run into a number of roadblocks. For example, sometimes people who are motivated to quit live with a smoker who does not share the same motivation. This lack of support and constant exposure to temptation can be quite a barrier. Others suffer from mental illness, poor motivation, or stress, all of which hamper efforts to quit. Sometimes people are worried about the withdrawal symptoms, or have attempted to quit in the past and feel frustrated and ashamed of past failures.6 But whatever the reasons may be, they should absolutely be viewed as surmountable challenges as opposed to rigid impasses.

People who struggle with tobacco use tend to go through a handful of stages in their attitude towards quitting:

  • The first stage is called the “precontemplation“ stage. In this stage, people are unmotivated to take action in the foreseeable future. As discussed above, a lot of the time roadblocks can play a role in decreasing an individual's motivation for change. 
  • The next stage is called “contemplation“. In this stage, the individual is at least considering the possibility of quitting sometime in the next 6 months. At this point, the tobacco user’s viewpoint on quitting is essentially that they can “take it or leave it“. 
  • The third stage is called “preparation“, and this is where people may have already taken some steps towards quitting, and plan to take action within the next month. It’s at this point that it becomes very important to partner with a medical provider. This partnership helps with support and accountability, and greatly increases the chances of success. 
  • Following preparation, the next step is the “action“ stage. This is when an individual is making an active attempt to quit smoking. The key during this time is to remain vigilant and prevent relapse. Once again, the support and accountability from a health professional is crucial. 
  • The fifth stage is happily called “maintenance“. At this point, an individual has successfully quit using tobacco, and is focused solely on preventing relapse. It’s during this time that they should be very careful about being in “high-risk situations“, such as drinking alcohol in a setting where others are likely to be smoking. Frequently all it takes is one small trigger to lead to a relapse.7

To help improve the smokers chance of successful abstinence, there are a number of medications that have proven to be of significant benefit:

  • Nicotine replacement. Nicotine is the addictive substance in tobacco, but does not carry the same inherent risks of tobacco itself. Nicotine replacement is commercially available as gum, patches, lozenges, inhalers, or nasal spray. These therapies help replace nicotine and alleviate withdrawal symptoms and cravings. Nicotine replacement has been shown to increase the chances of successfully quitting tobacco by 50 to 70%.8 It is fairly safe, but not a good option during pregnancy or in patients who have recently had a cardiovascular event.9 
  • Varenicline is a prescription medication that reduces cravings and decreases withdrawal symptoms. This drug increases the chances of quitting successfully by 2 to 3 times.10 There are potentially some substantial side effects with this medication, however, including an increased risk of cardiovascular events, insomnia, and bizarre dreams.11 This medication should be thoroughly discussed with a trusted healthcare provider before initiating treatment. 
  • Bupropion is also a prescription medication, commonly used as an antidepressant. Studies have shown that this medication doubles the chances of successfully quitting.12 This drug also needs to be discussed with a healthcare provider. It is not a safe option for people with a history of seizures or eating disorders.

Additionally, there are interventions that don’t involve medication and have proven effective as well. One of these is behavioral counseling by a trained therapist.13 This treatment isn’t as effective as the discussed medications, but may be a good option for those who are hesitant to take pharmaceuticals or for pregnant patients. Another support system that can improve success is the telephone “quitline”. This allows individuals attempting to quit access by phone to trained counselors. The number is 1-800-QUIT-NOW (1-800-784-8669). People who access this counseling by phone or twice as likely to successfully quit then those who do not.14

In summary, it’s very gratifying when a trend is moving in the right direction, and smoking cessation appears to be one of these trends. More and more people are quitting, and along with the cigarettes leave behind diseases, expenses, and death. As we have discussed, pharmacotherapy (medications) are very effective at helping people quit. Other interventions such as the telephone quitline, behavioral counseling, and establishment of support systems are effective as well. If you are a smoker, don’t hesitate. Start planning, get a healthcare professional on your side, develop a strategy, put forth the effort, and become another success story! 

Lastly, if you are not a smoker, but know and love someone who is, make sure to pass this information along to them!

References

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