Last update: January 2018 - Please read disclaimer before proceeding.

 

Making the decision

People who smoke can be divided into three groups with respect to their views on quitting; the ‘not ready’ group, the unsure group and the ready group. People in the unsure or ready groups should phone their GP for an appointment and then keep reading. (This of course includes everyone reading this web page as everyone doing so must at least be thinking about quitting!!) Here are just some of the immense benefits to be gained from quitting.

Benefits of quitting smoking - A lifetime of improved health

Quitting benefits for teenagers / young people

  • Smoking causes a gradual greying and wrinkling of the skin. Skin may improve to a degree after quitting, but the earlier a person stops the better for their skin.
  • Reduced teeth staining
  • Reduced skin staining (hands)
  • Reduced ‘flabby tummies’ (smoking inhibits abdominal 'fat burning')
  • Hair, breath, clothes, house and car all smell better to others (and to the past smoker)
  • Increased self-confidence from successfully completing the difficult task of quitting
  • A person smoking 20 cigarettes per day will save at least $3,500 a year by quitting. (Enough for a good holiday; each year!!)

 

Quitting can be difficult

Quitting smoking is a very difficult task and one that should not be underestimated or taken lightly. Only five per cent of smokers manage to quit without any relapses and on average successful quitters have had four prior unsuccessful quitting attempts. About 40 per cent of smokers make at least one attempt to quit a year.

The main problem associated with quitting is that the nicotine in tobacco is an addictive substance. About 33 per cent of people who try tobacco smoking at any time during their lives become nicotine dependant.

Barriers to quitting

In general, women have more difficulty quitting than men and nicotine replacement is less effective in women. For this reason women need more intensive support than men when quitting.

Most of these topics are dealt with in more detail later in this chapter.

Stopping smoking in people with mental ilness

People with mental illness want to quit just as much as those without such illness but they are often not as confident due to previous failed attempts. It is often felt that smoking is a mechanism that people with a mental illness use to cope with their illness. This is not true as stopping smoking actually improves stress and depresion and successfully stopping imroves confidence. People with mental illness will often need more assistance because:

There is an increase in incidence of mental illness in all groups of people who attempt quitting, whether they have a pre-existing mental illness or not. None of the medications used to assist in quitting increase the risk of mental illness occurring with quitting.

Specialist help

For those who have had problems quitting in the past or who have other conditions that might make quitting difficult (e.g. those with other addictions and those with significant mental illness), referral to a quitting specialist is an option. Your GP or the Quitline (137 848) may be able with this; or visit the Australian Association of Smoking Cessation Professionals website. (www.aaspc.org.au.)

Quitting whilst in hospital - follow up is required

It is not uncommon for people to quit smoking suddenly whilst in hospital following adission for a significant smoking-related illness. These people have a much better chance of success if they are followed-up after discharge.

 

(Back to top)

The five stages of quitting 

There are five stages to quitting smoking. As stated above, quitting is difficult with the average number of quitting attempts before achieving success being four.  To succeed at this difficult task, it is important to go through each stage thoroughly. The reason that most people fail at attempts to quit smoking is that they do not allocate enough time to planning and implementing their quitting strategy.

Each of the following five stages will now be discussed in detail.

  1. Decide to quit
  2. Prepare for quitting
  3. Plan ways of dealing with quitting
  4. Quitting
  5. Staying a non-smoker

1. Decide to quit

To succeed, people must want to quit and decide that it is an important priority in their life. In order to do this the smoker has to decide that the benefits of quitting outweigh the disadvantages. (All people see things differently.) For example, for some people health benefits are not enough incentive to try quitting. For others the advantages do not outweigh the disadvantages until they have to think about the risks they are exposing a new baby to. People should try making a list of the advantages and disadvantages for them.

When people who are just starting smoking or who are at present only occasional smokers are considering quitting, they need to remember that 33 per cent of people have a genetic predisposition to dependence and they may find it quite difficult to quit in the future if they delay their decision to quit now. Thus, many people find it difficult and do need help.

When deciding to quit, it is important

  • not to feel that asking for help is some sign of weakness
  • not to think that you are too addicted and that nothing will help. Remember there are aids such as medications and psychological techniques (cognitive behaviourla therapy) that improve success rates by up to four times compared to quitting alone.
  • not to think that it is too late to gain benefit
  • I will be lucky and not be affected. Some disease affect everyone, such as chronic bronchitis and skin changes.
  • to remember that you will be helping others too.

Discussing quitting with a doctor or a trained ‘quitting advisor’ at the government sponsored ‘Quitline’ (phone 137 848) or http://www.quitnow.gov.au) can be a great help.

Some questions worth asking when you are thinking of quitting

  • Where would I like to be in my life in 5 years time? Would I still want to be smoking regularly?
  • Am I ready to start smoking? Is my life situation about to change in a way that smoking will be a problem? For example, am I likely to become a parent soon? Will I want to live with someone who doesn't smoke?
  • Is my like currently being adversely affected by smoking?
  • Do I wish to continue supporting companies that are happy to try to promote smoking, an addictive habit that they know will cause ill health, to both myself and other me,mbers of my family / friends?
  • Are my lungs already affected? Your doctor can do tests to see if this is the case.

The advantages of quitting are discussed above?

2. Prepare for quitting

Preparation for quitting requires an understanding of both nicotine addiction and personal reasons for smoking. (Reasons include out of habit, pleasure, social pressure, emotions such as stress, and nicotine addiction.)

Gauging nicotine dependence

It is important for smokers to gauge how difficult it will be to quit and an important part of this process is determining their level of nicotine addiction / dependence. Keeping a written record of when smoking occurs prior to quitting will help smokers recognise smoking habits that indicate an increased likelihood of addiction and identify times that they will need to be especially vigilant after quitting if they are to avoid relapse.

Some smoking characteristics that indicate a high level of dependence and thus increased difficulty in quitting include the following:

  • Smoking within 30 minutes of waking
  • Smoking more than 10 cigarettes per day
  • Significant withdrawal symptoms / cravings with previous quitting attempts (usually within 24 hours of quitting).
  • Previous failed attempts at quitting, especially if the person was only able to quit previously for short periods of time.

People with a high level of dependence are likely to have more difficulty quitting and require more intensive and frequent support.

The Fagerstrom tobacco dependency questionnaire: The Fagerstrom tobacco dependency questionnaire is a very helpful aid in assessing a smoker's level of dependence. (See below.)

Fagerstrom tobacco dependency questionnaire

Question

Response

Score
1. How soon after you wake do you smoke your first cigarette?

Within 5 minutes

3

Within 6 to 30 minutes

2

After 30 minutes

1
2. Do you find it difficult to refrain from smoking in places where it is forbidden?

Yes

1

No

0
3. Which cigarette would you hate to give up?

The first one in the morning

1

Any other

0
4. How many cigarettes do you smoke a day?

10 or less

0

11 to 20

1

21 to 30

2

Over 30

3
5. Do you smoke more frequently in the morning than the rest of the day?

Yes

1

No

0
6. Do you smoke more if you are so ill that you are in bed most of the day?

Yes

1

No

0

Score (0 to 10)

/10

Score:

  • 0 to 2 indicates very low dependence;
  • 3 to 4 indicates low dependence;
  • 5  indicates medium dependence;
  • 6 to 7 indicates high dependence
  • 8 to 10 indicates very high dependence.

A score of 5 or above indicates the smoker will probably need drug therapy to cease smoking.

 

Source: Heatherton TF, Kozlowski LT, Frecher RC & Fagerstrom KO (1991) The Fagerstrom Test for Nicotine Dependence:  a revision of the Fagerstrom Tolerance Questionnaire, British Journal of Addiction, 86 pp 1119-27

Pre-existing medical problems and quitting 

People who have pre-existing medical problems should see their doctor prior to quitting as the condition may be affected by quitting. Some important areas of concern are as follows.

  • Altering existing medications: The effect of medications can be changed by stopping smoking and it is important to discuss medications with your doctor to see if dosages need adjustment. (In some cases stopping smoking can allow a reduction in dosage which can reduce side effects.)
  • Existing mental Illness: Stress associated with quitting can adversely affect people who have suffered or are suffering from depression, anxiety or other mental illness and these people need extra counselling before and during quitting. People with a history of depression can have a recurrence of these symptoms while quitting and have more problems with withdrawal symptoms. Thus, they will often require antidepressant medication when quitting. They are also more likely to be nicotinedependent and thus require nicotine replacement therapy. Monitoring for depression symptoms for several months after quitting should also be part of their treatment plan, as should extra encouragement and reassurance.
  • Obesity: Weight gain is common when quitting and many people will need dietary / exercise advice to prevent this occurring, especially those who are already overweight.
  • Excessive alcohol and caffeine consumption: The effect of caffeine and alcohol is increased by quitting and the intake of both will need to be reduced.
(Back to top)

3. Plan ways of dealing with quitting

There are numerous ways to make quitting easier. By far the most important is to visit a GP for general advice regarding quitting and problems that might occur, such as weight gain. Even in committed quitters the quitting success rate without help is only 15 per cent, with over 50 per cent having relapsed within a week. Quitters should not underestimate their task.

Methods of quitting
By far the most successful quitting method is stopping suddenly and completely. This can be done with or without nicotine replacement therapy. Gradually reducing smoking is not recommended as it encourages smokers to compensate by inhaling more deeply and buying stronger cigarettes. People who choose this method should still decide on a day that they will stop completely and ideally this should be within two weeks of starting to reduce their level of smoking.

Anticipating and coping with nicotine withdrawal
Nicotine withdrawal is a significant problem for many quitters, especially those who have had problems quitting previously or who have a high level of nicotine dependence (see above). It is also a problem for adolescents who wish to quit. As well as cravings, withdrawal symptoms include;

  • depressed mood
  • insomnia / changed sleeping patterns
  • irritability / restlessness
  • anxiety
  • lack of concentration
  • increase in appetite / weight gain

Anyone who experiences cravings and any four of the above symptoms is said to have significant withdrawal problems. Cravings tend to last for a few minutes at a time but can be quite intense. They gradually wane over time but can go on for years.

Headaches, lightheadedness, cough, constipation and mouth ulcers can also occur. Symptoms that were a problem during previous quitting attempts should be identified so that measures can be taken to avoid them occurring again or minimise their likely impact.

The withdrawal period starts about two hours after stopping, is at its peak at about day four, and ceases for most people within fifteen days of stopping smoking; although it can last for up to four weeks. Increased phlegm and cough can last six to eight weeks but these are good symptoms as they indicate the person’s lungs are getting rid of accumulated tar and mucous.

Anticipating and avoiding weight gain with quitting
A weight gain of two to four kilograms is not uncommon during quitting and unfortunately women tend to gain more weight than men. Patients who successfully quit on average put on 5kg in the first year.

Fear of gaining weight is a common reason for women to delay quitting. (Having said this, about 20% of quitters don't gain weight.) Weight gain occurs because the appetite suppression and increased metabolic rate that are associated with nicotine intake cease after quitting. Also taste improves, allowing greater enjoyment of food, and the person tends to put more food in their mouth to keep their hands busy. The use of nicotine replacement acts to delay this weight gain but doesn’t usually stop it (i.e. the weight gain occurs after stopping NRT). Thus, it is important to anticipate this problem and get dietary advice before quitting. Having some lower energy foods like fruit and vegetables readily available at work and at home is very helpful. Obviously increasing physical activity can help work off any additional energy (calories / kilojoules) consumed after quitting and has been shown to aid quitting.

The influence of alcohol and caffeine on quitting
Alcohol and caffeine use also needs review. In general, smokers tend to consume higher levels of these drugs as both caffeine (from coffee, tea, chocolate and cola drinks) and alcohol have less effect in the presence of nicotine. Thus, both should be reduced when stopping smoking.

Alcohol: With regard to alcohol, consumption while quitting smokiing presents the additional problem of reducing quitting motivation and reducing intake is likely to increase the chances of quitting successfully. It is best in the first few weeks to have no alcohol or very little alcohol. The exact approach to alcohol requires discussion with your GP as people who regularly consume alcohol may have issues with alcohol withdrawal if they stop suddenly. (For people who have successfully overcome an alcohol use problem, quitting smoking has not been shown to increase the likelihood of alcohol abuse relapse. About 20% of smokers also have a problem with excessive alcohol consumption.)
Caffeine: Caffeine intake should be reduced (about halved) when ceasing smoking. It is also mportant to recognise any links with caffeine consumption and smoking and try to break these. For example, if you have a coffee with your first morning cigarette.

The side effects of caffeine, including irritability, restlessness and insomnia, are more likely to be noticed if caffeine is not reduced during quitting. When stopping / reducing caffeine intake, it is important to realise that caffeine withdrawal symptoms, such as headache, can occur.  This will not help the quitting process. (Halving intake over a few days should not cause a caffeine withdrawal problem.) Remember that caffeine is present in tea, cola drinks and chocolate as well as in coffee. (See section on caffeine.)

Quitting and depression / anxiety
About 30 per cent of people seeking assistance with quitting have a history of depression as many people with depression (and anxiety) take up smoking to try and relieve their symptoms; mostly unsuccessfully. The nicotine withdrawal associated with quitting has been shown to bring on another depressive episode in about 25% of previously depressed people and this will require assessment and treatment by a doctor. (It usually only lasts up to four weeks.) People who have a history of depression should mention this to their GP before quitting so that any recurrence can be anticipated.
Similarly, anxiety tends to increase with quitting and learning appropriate coping mechanisms is especially useful for the many smokers with a past history of this problem.
Any person with a history of mental illness needs to be carefully monitored during quitting.

It is worth pointing out that nicoteine is actually a stimulant drug and thus, once quitting has been successfully accomplished and the withdrawal syptoms subside, people actually feel less stressed.

Passive smoking exposure and relapse
Exposure to other people’s smoke (i.e. passive smoking) often leads to relapse. It is therefore important to 'live in' an environment that is as smoke free as possible while quitting. This especially applies to home and work.

The influence of cannabis use on quitting
The smoking of other substances, most commonly cannabis, increases the likelihood of failure. Thus, all forms of smoking should be ceased when attempting quitting. The reverse is also true, with cigarette smoking adversely affecting attempts to quit cannabis use.

Support from family and friends
Support from friends and family is a considerable help with quitting. Some find quitting with another person, a quitting partner, beneficial. Printing out and displaying at work and at home a list of the reasons for deciding to quit often acts as agood motivator (perhaps with a picture of loved ones, such as children).

(Back to top)

4. Quitting

The first task in actually quitting is to set a specific day to quit. A low-stress day that is not too far away is a good choice. The day before quitting, quitters should check their house, car workplace etc for cigarettes, lighters and ashtrays and throw them out. Coping with cravings and withdrawal symptoms can be helped by having specific ‘distraction’ tasks or activities planned. Some people find the four ‘Ds’ strategy helpful.

  • Delay: Delay acting on the urge to smoke
  • Deep breathing: Taking a few long slow breaths has been found to help some people. (Keep to a maximum of three breaths, otherwise dizziness from hyperventilation may result.)
  • Drink: Drinking water slowly.
  • Do something else: Short exercise routines that can be done almost anywhere are a good idea or have a good book close by. Worry beads for empty hands are sometimes a help.

Eating needs to be watched as it is easy to start snacking. As stated before, having some low-energy foods like fruit and vegetables around helps avoid excessive weight gain.

It is important to realise that just one cigarette will hurt resolve and is the usual way back to regular smoking. However, one cigarette does not always mean failure. People can learn from a mistake and avoid it next time.

Rewards during quitting (and after) should be part of the quitting plan. And there is more money to spend!!

Regular support during quitting is very important. This can be provided by regular visits to the doctor to monitor progress and to discuss nicotine replacement if needed. Quitters can also call the government sponsored ‘Quitline’ at any time, 24 hours a day. (Phone number: 131 848 or http://www.quitnow.gov.au).

 

Australian Government Quitline Apps to help quitting

Quitline has two free apps to help quitting. (The use of such apps have been shown to increase long term quitting success rates by as much as 60%.)

  1. Quit now - My Quit Buddy: An app for anyone wanting to quit
  2. Quit for you - Quit for two: An app for pregnant women or women planning to become pegnant who want to quit.

 

5. Staying a non-smoker - Avoiding relapse

The urge to smoke can return and this often occurs at times of stress. In the early stages of being a non-smoker, try to anticipate and reduce stress wherever possible. Ex-smokers can use the strategies they learned while stopping smoking and should get support from their GP or friends as needed.

The first two weeks is the most dangerous period for resumption of smoking and, without help, 62 per cent of people will relapse during this period. This is the period where intensive support is most needed and the help of ‘Quitline’ and a GP are very beneficial. After this time, those most likely people to relapse are:

  • those exposed to other people smoking.
  • those consuming excessive amounts of alcohol.
  • those who experience severe withdrawal symptoms.
  • those who cope poorly with life stresses.
  • adolescents (most relapse within a year of quitting)

Two years after quitting the relapse rate falls to only four per cent.

It is important to realise that most people need three to four attempts at quitting to succeed. If a ‘failed attempt’ occurs, it should be seen as increasing the person’s quitting knowledge and increasing the likelihood that the next attempt will be successful.

Minimising the risk of relapse by identifying high risk situations / triggers

In the past, avoiding triggers or situations associated with smoking has been advocated as a method of preventing relapse. This might include avoiding visiting past regular smoking venues, seeing past smoking mates, or eating/drinking habits associated with smoking (especially alcohol and coffee). Early in the quitting attempt, when cravings are often a problem, avoiding such triggers is often helpful. (When going out, 'early quitters' should try going to smoke-free venues.) Realistically, however, it is usually not possible to remove all these ‘associations’ for the long term and gradually increasing exposure to such situations allows their possible negative influence to be minimised. Planning coping strategies to help with confronting these situations is an important part of this process and the help of a supportive friend or partner is of great benefit.

The most important cues for smoking are usually found in the smoker’s own home. It is here that most support is needed, including making the home a non-smoking environment.

Factors that help prevent relapse

  • Frequent follow-ups for people who have a history of short quitting attempts
  • Refraining from other forms of smoking
  • Anticipating and treating withdrawal symptoms early
  • Reducing alcohol and caffeine intake while quitting
  • Increasing exercise. This helps improve mood and reduce the risk of weight gain.

Relapse in pregnancy

About 25 per cent of pregnant women who smoke make an attempt to quit during the pregnancy. Unfortunately about 70 per cent of these women relapse either during their pregnancy or after the birth of their child. For pregnant women who have quit, it is important that part of every antenatal and postnatal consultation be devoted to discussing their cigarette use and any problems that they may be encountering. The home should become ‘smoke free’ to ensure the newborn baby’s best health. (It is an ideal time for the woman’s partner to consider quitting also.)

(Back to top)

Drug therapies for quitting smoking

The ability to quit seems to vary greatly between individuals. Many are able to quit fairly easily with normal ‘Quit’ campaign strategies. Those motivated individuals who find quitting difficult are probably in the group with a genetic basis for their nicotine dependence. These highly addicted individuals are also the ones most likely to suffer the medical problems associated with smoking and often need more intensive 'quitting treatment' which usually involves drug therapy.

Stay on medication for an adequate period: It is important to dstay on medication for the prescribed time. Overcoming habits such as smoking require time and during this time relapse is more common. Thus, medications are needed. Stopping medication early is a bit like taking a plaster off a fracture too early; when the bones are still too weak.

The most helpful therapies are:

Nicotine replacement therapy

Nicotine replacement therapy (NRT) works by desensitising nicotine-sensitive receptors in the brain and helps reduce withdrawal symptoms when commencing quitting. It is most helpful in people smoking over 15 cigarettes per day but can be used by people smoking less. than 15. It must be used as a replacement for cigarettes. Smoking must be avoided completely while using them! (People who smoke less than 15 cigarettes per day should talk to their doctor about whether they need NRT and the dose that is appropriate for them.)

People who use NRT are twice as likely to quit successfully as those who do not and, as stated above, it works best when a longer-acting NRT product is used with a shorter-acting product. The short-acting NRT product can be used when cravings occur or in situations where there is a higher risk of smoking e.g. social situations that the person used to smoke in.

NRT is should be considered for adolescents wishing to quit as they suffer the same withdrawal symptoms as adults.

All forms of NRT are effective as long as high enough nicotine levels are attained. If they are not, then the person may smoke as well to get the extra nicotine desired. Some smokers attain nicotine levels in the blood as high as 40 ng/ml with each cigarette, while patches usually give levels of 10 to 15 ng/ml. Therefore, two patches may be required at the same time. Nicotine gum gives a level of about 15 ng/ml. Replacement therapy should continue for at least eight weeks and the dose does not need to be decreased during this time. (Gradually reducing the dose has not been shown to improve quitting rates and eight weeks treatment has been shown to be as effective as treatment for longer periods.) Eight weeks of therapy is generally advised. The success rate is significantly less if NRT is ceased before this time.

While NRT is available over the counter at pharmacies, it is best to discuss its use with a medical practitioner as part of a total quitting strategy.

NRT side effects: NRT is relatively free of side effects. Less common side effects include sweating and nervousness, muscle / joint pains, dry mouth and diarrhoea. Jaw and tooth pain from the over-vigorous chewing of gum and rashes from patches can also occur. Patches applied for 24 hours a day can also cause sleep disturbances.

NRT overdose symptoms: Overdose symptoms can occur if dosage levels are too high but are more commonly due to smoking while taking NRT. Symptoms include pallor, cold sweats, nausea, palpitations, agitation, and, less commonly, vomiting, diarrhea, abdominal pain, headache, tremor, dizziness, confusion, disturbed hearing and vision, and weakness.

NRT in pregnancy and children: NRT is not recommended in pregnant or breast feeding women or in children under 18 years of age.

NRT in people with heart disease: In most cases NRT can be safely used as a replacement for cigarettes in patients with stable heart disease as it is safer than continuing to smoke; but see a doctor first! People with unstable coronary heart disease (i.e. recent heart attack, unstable angina or severe arrythmias) or a recent stroke must seek their doctor’s advice before starting NRT.

NRT should not be used by non-smokers!!!!

Forms of nicotine replacement

There are a number of different forms of NRT. Dosage depends on the degree of addiction and on whether only one form is being used or whether a short acting and longer acting forms are being used at the same time (combined NRT). Thus, the doses mentioned below are only a guideline and your dosage(s) should be determined in consultation with your medical practitioner.

Gum: Gum comes in 2mg and 4mg strengths. Additional side effects of gum include hiccups, gastrointestinal disturbances, and jaw and tooth pain from over-vigorous chewing. They are not suitable for people with dentures.

  • The 4mg size is recommended for those smoking more than 20 cigarettes per day or who need have their first ccigarette within 30 minutes of waking. 6 to 10 can be taken per day
  • The 2mg size is for less addicted people. 8 to 12 can be taken per day.

Lozenges: Lozenges also comes in 2mg and 4mg strengths. They are sucked over 20 to 30 minutes rather than chewed. The stronger lozenges are for morte addicted people. Both can be taken up to every 2 hours. There are also mini-lozenges that come in 1.5mg and 4mg strengths and are sucked for about half the time.

Nicotine oral sprays: They can be used up to 4 sprays per hour. (Spray under tongue or onto side of the moth.)

Nicotine strips: They contain 2.5mg of nicotine. They can be used up to 9 times per day.

Patches: Patches should be placed on dry, non-hairy skin above the waist. Side effects of patches include a burning sensation, itching and rashes nder the patches. Rotating the patch site helps avoid such problems. Twenty-four hour patches may cause sleep disturbances and result in daytime sleepiness. Patches can be removed at bedtime to prevent such problems. (There is enough residual nicotine in the skin to ‘cover’ the person while they get to sleep.) Sixteen hour patches are also available.

Nicotine patch dosage guidelines

Patient

Initial dose

Over 10 cigarettes per day and weight over 45kg

21mg/24hr or 15mg/16hr patch

Less than 10 per day or weight less than 45kg or has cardiovascular disease

14mg/24hr or 10mg/16hr patch

NRT Inhaler: Nicotine inhalers are intended for those who feel they need the hand to mouth ‘routine’ of smoking. People who are hypersensitive to menthol should not use NRT inhalers. Up to 6 to cartridges per day can be used.

E-cigarettes: These are battery powered devices that deliver nicotine as a vapour. While they may reduce cravings and with drawal symptoms, they undermine stopping the behaviour of holding a cigarette. They also may be used by non-smokers and act as a gateway to smoking conventional cigarettes. As there are suitable alternative forms of NRT, they are probably best avoided.

(Back to top)

Other drugs

Varenicline

Varenicline acts on nicotinic receptors in the brain to relieve cravings and withdrawal symptoms and reduce the rewarding effect of smoking. It is should be started 1 to 2 weeks before quitting.

Patients start with a small dose (0.5mg oncer per day) and build up to the maintainance dose of 1.0mg twice a day over about a week. It is usually taken for about 12 weeks but can be used for up to 24 weeks. It is quite effective on its own for assisting quitting, doubling the persons chances.

Nausea occurs in about 30% of people but can be reduced by increasing the dose gradually and taking it while eating. It is contra-indicated in pregnancy, in lactating women or in people under the age of 18 and needs to be used with caution in people with mental illness. The dose should be reduced in people with reduced kidney function and avoided in people with severely reduced kidney function.

Bupropion

Bupropion (product name Zyban) is an antidepressant drug and has been shown to be effective alone (i.e. without nicotine replacement) in treating nicotine dependence. While it is a useful therapy option in some people, it is not as effective as combined NRT or varenicline. It can also be used with NRT. (Blood pressure needs to be checked as it can rise when both medications are taken.)

It takes several weeks to work and is used for about seven to ten weeks. It provides both an anti-craving effect (reduces withdrawal symptoms) and an antidepressant effect. (It is no more beneficial in assisting quitting in previously or currently depressed people than it is in those with no history of depression.)

Drug interactions (especially with other antidepressant medications) occur, as do adverse reactions, such as insomnia (42 per cent of people), headache (26 per cent), dry mouth (11 per cent), itch and rashes (3 per cent). There is question about whether there is an increased incidence of anxiety and an elevated suicide risk. An important side effect is the risk of seizures, which occurs in about 1 in 1,000 people. (This rate is higher in people with a past history of seizures.) These side effects mean that many people choose to use NRT instead.

These issues need to be discussed with a medical practitioner before taking the drug. Great care also needs to be used in people with a past history of any mental illness, especially schizophrenia. Safety in pregnancy and when breast feeding and in people under the age of 18 has not been established.

Bupropion is contraindicated in people who:

Bupropion is only available by prescription in Australia; as a 150mg sustained release tablet. It is usually started one tablet daily for three days and then the dose is increased to one tablet twice daily. It is usually used over a seven to ten week period. It is started about one week before the person stops smoking.

Nortriptyline

Nortriptyline, another antidepressant, has also been shown to be of benefit in helping quitting. It is not commonly used now as as it has more side effects.

(Back to top)

Cognitive behavioural therapies for quitting

Cognitive behavioural therapy (CBT) from a psychologist or a GP trained in CBT can assist with quitting. CBT treatments available to assist in quitting include stress management, managing the rituals and daily activities that are associated with smoking, and dealing with exposure to oral and visual stimulation associated with smoking. These are especially beneficial in treating relapse. Challenging false assumptions that surround cigarette use is also often beneficial. Examples include the belief that:

It is important that counselling is used in a pro-active way, rather than reactively, so that potential problems can be anticipated and emmerging issues can be addressed early on. This means that:

Non-recommended therapies

Both hypnotherapy and acupuncture have been shown to have little impact on nicotine addiction and their benefit is uncertain, as is the effect of aversion therapy. Anxiolytic drugs (sedatives) are not effective and should not be used. Low nicotine-tar cigarettes are not helpful as smokers just smoke more of them, giving them even higher levels of other inhaled chemicals, such as carbon monoxide.

(Back to top)

Medications that are affected by quitting / reducing nicotine intake

Numerous medications interact with nicotine and are affected by reducing nicotine intake. If you are on any medication you should ask your doctor whether the dose needs to be adjusted when quitting. Medications that are likely to need dosage adjustment when quitting include the following:

 

Recognising possible lung caner symptoms

Reporting symptoms that may possibly indicate the presence of a lung cancer as soon as they appear may help detect early cancers and allow the disease to be cured in some cases. Any of the following symptoms can be an indication that lung cancer is present. (It needs to be emphasised that they also occur in many other diseases and people with these symptoms will probably not be shown to have cancer. However, this cannot be assumed and symptoms need to be investigated!)

Smokers past and present need to be especially observant as most lung cancer cases occur in present (and past) smokers.

(Back to top)

The future - Screening for lung cancer

Most patients with lung cancer die from the disease because they are diagnosed too late for treatment to achieve a cure. However, if lung cancers can be caught early enough, cures can be achieved. (Stage 1 lung cancers have a cure rate of 70 per cent.)

At present there is no evidence that screening for lung cancers using chest X-rays increases life expectancy.
Research is presently being done in the use of CT scans for this purpose but it is too early to say whether it is likely to provide any benefit for past or present smokers.

 

Further information

Infact (a good worldwide site regarding all issues about smoking)
www.infact.org

Quitline’
A Government sponsored service to information and help for people considering quitting smoking.
Phone number: 137 848 (at any time, 24 hours a day).
http://www.quitnow.gov.au

Australian Association of Smoking Cessation Professionals website.
www.aaspc.org.au.

 

(Back to top)