Smoking Cessation. Where do I Start?

Carolyn Vachani, MSN, RN, AOCN
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: March 23, 2012

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The US Surgeon General stated that quitting smoking is the single most important step that smokers can take to enhance the length and quality of their lives. It has been reported that over 70% of smokers want to quit and as many as 50% attempt to quit every year. Unfortunately, the addiction to tobacco is real and difficult to overcome, even more so without support. Support can come from other ex-smokers, family and friends, supportive websites (quit nets) and phone numbers (quit lines), medication and formal support programs. Despite these resources, it often takes multiple attempts for a person to give up smoking for good. So where should a person who wants to quit start?

Get Started

The first step to quitting is deciding you want to quit and making a commitment to quitting. Sounds simple, but it is critical. You can't quit because (insert friend or family member) wants you to, you have to want to quit. Write down the reasons you want to quit and put them somewhere you can refer to them for inspiration when times get tough.

Got your list? Good, now pick a quit date and gather support. Experts suggest setting a quit date within 2 weeks and sticking with it. Let friends and family know and ask them to support you. Maybe that means taking a walk with you or meeting for lunch when you really want a cigarette. It may mean just being understanding when you're just not acting like yourself and perhaps in a bad mood. Having a friend to talk to who has quit can be helpful. If you don't have one, consider joining an online support group through one of the state or federal Quitnet pages.

Make an appointment to discuss your plan with your healthcare provider and ask them for suggestions to help you be successful. They can recommend medications, information about what to expect (withdrawal symptoms, common challenges) or referrals to organized cessation support programs. Continue to involve your healthcare provider during the quitting process. They can be good sources of information and support. (Read about smoking cessation aids.)

Have you tried to quit before? You are not alone! On average, it takes smokers seven attempts to quit for good. Think about past attempts. What was successful about the attempts to quit, and what caused them to ultimately be unsuccessful? Think of ways to avoid those previous pitfalls. There are some common obstacles, including living with someone who smokes. Ask them to quit with you or not smoke in front of you. Being in a place where others are smoking can be far too tempting, so avoid those situations for a while. Alcohol is often associated with smoking, so try to avoid the bar scene for a while. Many ex-smokers report feeling better and breathing better within a few days of quitting, but this can make them think it is okay to smoke again. Remember, quit means quit, not just a puff here and there. One puff quickly reverts back to the old habit by increasing the urge to smoke, making quitting harder. So practice abstinence from smoking!

Think about situations that you normally light up in; can you avoid them? Change your daily routine to not be in those familiar situations. Do you smoke in the car on the way to work? Can you take public transportation or carpool with a nonsmoker until that habit is broken? Have to pass the smokers on your way out to lunch? Can you take another route, pack a lunch or ask a non-smoking support buddy to come along? Planning ways to deal with common situations will make it easier to deal with them after your quit date. Keep yourself busy during the first few weeks. Visit friends, start exercising, get to those around the house jobs you've been putting off!

Remember that smoking is not just a habit, but an addiction. While we all know people who have quit "cold turkey", the best chance of success comes with support. Support comes in the forms we have already discussed, but can also come in the form of a nicotine replacement or medication. Learn about medical options to aid in quitting and talk with your healthcare provider about which is right for you.

The day before your quit date is final preparation time. Throw away all your tobacco- that means all of it! Check your car, your purse, your coat pocket. You don't want any unnecessary temptations! Get rid of (or hide) the paraphernalia that goes along with smoking; lighters, matches and ashtrays. Make sure you have things on hand to keep your mouth occupied that isn't necessarily food, such as sugarless gum, mints or candy.

The first few weeks will be tough, but remember your reasons for quitting and call on your support people. You may experience nicotine withdrawal, which can manifest as irritability, depression or sadness, headache, inability to concentrate and a craving for cigarettes. Nicotine replacement therapies can help with these symptoms. Withdrawal symptoms typically last 2 weeks and then start to decrease, so hang in there!

If you happen to have a cigarette, get right back on the quitting horse. Think of what led to the slip and how to prevent it from happening again. Call on your support people or healthcare provider, call a quit line or visit a quitnet chat room. Remind yourself frequently what a great accomplishment every smoke free day is for you. You are setting a great example for other smokers and improving your health. Quitting is not easy, but you will be rewarded with improved health and well being. Not to mention all the money you will save!

Resources

Smoking Cessation Aids: This article reviews the available treatments, both pharmacologic (drug) and non-pharmacologic, to aid in successful smoking cessation.

1800QUITNOW: a resource of the Department of Health and Human Services, this toll free telephone number, 1-800-QUIT-NOW (1-800-784-8669), serves as a single point of access to state based quit lines, which every state has, ensuring that all smokers in the United States have access to support and the latest information to help them stop smoking.

Smokefree.gov: information and professional assistance from the National Cancer Institute.

Quitnet: an online resource started in 1995 by a smoking cessation physician in Boston. It was adopted and further developed by Boston University School of Public Health. In 2000, Quitnet.com, Inc was formed and now serves people worldwide.

Tobacco Free Kids: one of the nation's largest non-governmental initiatives, with the goal of protecting children from tobacco addiction and exposure to secondhand smoke. They offer talking points and support for parents.

Determined to Quit: a free, interactive tool designed to help people quit smoking successfully. While it is run by the State of Pennsylvania, you do not have to be a resident to participate.

Quitnowpa.com: This site, provided by the Pennsylvania Department of Health, features resources in Spanish.

The American Cancer Society: There are many excellent resources and printed materials (brochures/booklets) available from the American Cancer Society. Learn more by visiting their website or by calling their toll-free number, 1-800-227-2345. Representatives can also help you find local in-person support resources.

Freedom From Smoking Online: This online resource for adults is an adaptation of the American Lung Association's gold standard, group clinic that has helped thousands of smokers to quit for good.

CDC Tobacco Information Page: Contains lots of helpful information covering: statistics, kids and smoking, quitting, research information (Surgeon General's Reports), etc.

Nicotine Anonymous: a 12 step Fellowship of men and women helping each other live nicotine-free lives.

U.S. Environmental Protection Agency: Information about smoking, second hand smoke and smoke-free homes and cars pledges.

To find local quit smoking programs or groups, try contacting your health insurance company or local hospital or call the American Cancer Society help line (1-800-277-2345). Ask someone you know who has quit or your primary care physician for recommendations. Use good judgment - if a program seems to good to be true or charges a lot of money, ask your healthcare provider about it first.

Do you live in the Philadelphia Area? You may qualify for smoking cessation studies at the Center for Interdisciplinary Research on Nicotine Addiction.