Want to Quit Smoking?

Technology is helping to make winners of quitters.
The internet has long been rife with self-help sites for those who wish to give up smoking, but new technologies are emerging to give smokers a leg up in their struggle.
There are websites that offer interactive resources to motivate quitters and keep them on track, mini-computers that can help you track your progress, and software for hand-helds that makes it easier for doctors to pitch in.
"These technologies offer a lot of promise -- they are very intriguing," said Scott Strayer, a physician who developed software called the Handheld Computer Smoking Intervention Tool for the National Cancer Institute.


The software allows clinicians to access data about smoking cessation, drug interactions, addiction evaluations and other information to use in interviews as people begin the effort to quit.
The role of computers is evolving, said Strayer, a family practice physician who teaches at the University of Virginia. He hopes the next generation of hand-held medical devices will be able to track smokers' progress and link their quitting regime with their health records, to give doctors a portable and unobtrusive profile of their patients' efforts.
Though there has been little clinical research, Strayer said websites with interactive capabilities like social networking also can improve the chances of kicking the habit for good.
A study published last month in the New England Journal of Medicine found smokers tend to quit in groups and that real-life social networks add to the pressure to quit.
Researchers at the University of California-San Diego said they looked at 12,000 socially interconnected people over 32 years. They did not examine online communities, but some researchers believe that what works in the real world also would work online.
WIDER SUPPORT
One of the best online communities is at a site run by a suburban Boston woman, Terry Miller (quitsmoking.about.com). It offers an environment of mutual encouragement and support among its thousands of members, who gather dots, stars, keys and wings as they progress.
Miller, a 51-year-old mother of two, logged on to the site after smoking for 26 years. That was six years ago and Miller now operates the site, which she says has helped thousands of people quit.
Miller says the online community actually may work better than a real-life social circle at helping people. For example, the support community online is far bigger, it's made up entirely of individuals on a shared journey, and it's available to quitters round-the-clock.
"In all of the years I've been participating at the ... forum, the idea of stepping outside of oneself to help another has been the foundation of the community. It's contagious and self-sustaining," Miller said. Though she has no firm evidence, Miller believes the success rate for people who join the site is much higher than the 7 percent who succeed in the general population.
Beth Bock, a professor in the Department of Psychiatry and Human Behavior at Brown University Medical School, has been studying online resources for aspiring quitters for years. Her latest research, due to be published shortly in the Journal of Medical Internet Research, found that while web-based resources are plentiful, it may be difficult to locate the best sites.
An analysis of the top results for search terms like "quit smoking" or "smoking cessation" found three of every four sites offering little or no quality resources; many merely sold smoking-cessation products or listing articles.
The best sites followed U.S. Public Health Service guidelines, which include assessing how ready smokers are to quit, assisting them with plans, providing practical counseling tips and suggestions, offering social support, recommending mediation and arranging follow-up.
Interaction is crucial, Bock said, and while some sites provide ways for smokers to interact with each other, they could be doing much more.
PRESSING THE BUTTON
The QuitKey mini computer helps quitters keep track of their progress.

Then there are devices like the QuitKey, a computer small enough to carry on your key chain, and which can prod you, step by step, along the path to nicotine freedom.
In step one, you smoke normally but press a button, to allow the device to track your tobacco habits. The little computer creates a profile of your addiction. Then, in stage two, it prompts you when to smoke, gradually reducing the number of cigarettes per day until it reaches zero.
If all else fails, there is a South American website called Build Your Own Death Project (irreal.cl/byodp) that offers a novel way of reminding smokers of the deadly consequences their habits can have.
The site allows smokers to download, print and assemble cigarette packaging with skeletons, ghosts and other ghoulish graphics on them and names like "Cancers," "Muerte" and "Suicide."

Quit smoking with a proven approach

I read with interest the open letter from Dr. Brad Rodu to Sen. Obama in the June 22 Perspective section ("Quitting ins't that easy"). In this open letter, Dr.Rodu advocated the use of smokeless and spit tobacco (which I will refer to only as spit tobacco) to reduce the cravings of nicotine addiction and reduce the harm from cigarettes. He minimized the risk from spit tobacco in his comments.

As a physician who has spent my professional career helping those with nicotine addiction, I would like to offer an alternative view. Using spit tobacco for smoking cessation is an area of controversy among anti-tobacco advocates. Many of us who have cared for patients with their tongues or half their jaws removed because of spit tobacco would not advocate its use. Moreover, UST, Philip Morris, RJ Reynolds and other producers of spit and smokeless tobacco are marketing flavored packets designed to attract and addict young people. And many spit tobacco products deliver more nicotine than cigarettes.

While I support using a variety of techniques for smoking cessation for my patients, I would suggest that a safer method than spit tobacco is using approved nicotine replacement such as patches, gum and lozenges. In fact, the most recent update of the CDC Guidelines for Smoking Cessation doesn't recommend use of spit tobacco but does recommend the use of combinations of nicotine replacements, such as patches plus gum, finding that the results were as good as using other pharmacologic therapy. And the cost is comparable to using spit tobacco. Moreover, all smokers have access to the national quit line (1-800-QUITNOW) and many states provide nicotine replacement therapy for those who can't afford it or whose insurance doesn't cover it.

I would urge all smokers trying to quit to use a proven approach which is safer than spit tobacco.

HOW TO QUIT SMOKING

Quick, what's the greatest threat to a smoker's health? Lung cancer is a good guess, and a wrong answer. Cigarettes cause 124,000 lung-cancer deaths in America each year, but they kill even more people (138,000) via heart disease. Smokers suffer heart attacks at twice the rate of nonsmokers--and they're less likely to survive them. Fortunately, these effects are reversible. Quit smoking, and your risk of a heart attack drops almost immediately, returning to that of a never-smoker within five to 15 years. Breaking the addiction isn't easy--some 40 percent of smokers try each year, and most of them fail. But a failed attempt is not a final defeat. What distinguishes successful quitters is their willingness to keep trying. Smoking cessation is a marathon, not a 50-yard dash, and winning takes practice. Here are some strategies for reaching the finish line.

Think ahead. It often helps to set a date to quit and to spend some time preparing yourself for the challenges you'll encounter. The first ones are physiological. Tobacco smoke delivers nicotine, a powerful psychoactive drug, to the nervous system. Most smokers become irritable, restless, anxious or depressed when they try to go without it, and many have trouble concentrating and sleeping. Fortunately, these withdrawal symptoms are transient. They usually peak within two to three days and then wane steadily. So think beyond the discomfort of the moment. If you can make it to day four, life will get easier.

Use crutches. Medical treatment makes the transition easier. Nicotine administered through patches, gums, lozenges, inhalers or nasal sprays can alleviate withdrawal symptoms, and the prescription drug Zyban (bupropion) can help reduce craving. Studies suggest that quitters who use any of these aids double the chances of success. For best results, you should continue using them for two to three months.

Change your routine. Nicotine isn't the only reason quitting smoking is hard. Cigarettes become a part of a smoker's everyday routine. If you're accustomed to lighting up whenever you have a cup of coffee, finish a meal or encounter a stressful situation, you may need to recondition yourself. Simple tricks can help you sidestep temptation. Some people try switching from coffee to tea for a while, or using a toothpick as an after-dinner pacifier. New rituals are easy to adopt, and they quickly become old ones.

Seek support. Quitting is easier if you have people to lean on, so don't go it alone. Friends, co-workers and family members can provide much-needed moral support, especially if they've been through the process themselves. Physicians and psychotherapists can offer valuable counseling. And though smoking-cessation programs can't guarantee results, they can increase your chances of success. Free information and counseling are now available nationwide at 800-QUIT-NOW or through Web sites such as smokefree. gov, cdc.gov/tobacco and quitnet.com.

Smoking is a powerful addiction, but it can be beat. Former smokers now outnumber current ones in this country, and indoor-smoking bans are giving people new incentives to quit. Medicines now in development could soon make smoking cessation easier, but no one should wait for them. Today's treatments are effective, and too few smokers are benefiting from them.

RIGOTTI, AN ASSOCIATE PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL, DIRECTS THE TOBACCO RESEARCH AND TREATMENT CENTER AT MASSACHUSETTS GENERAL HOSPITAL. FOR MORE INFORMATION ON SMOKING CESSATION, GO TO HEALTH.HARVARD.EDU/NEWSWEEK.

You Can Quit Smoking

Learn how to get help to quit smoking and improve your chances of quitting. This document explains the best ways for you to quit as well as new treatments to help. It lists new medications that can double or triple your chances of quitting and quitting for good. It also tells about ways to avoid relapses and talks about concerns you may have about quitting, including weight gain.

All information is based on scientific research about what will give you the best chances of quitting.

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Nicotine: A Powerful Addiction

If you have tried to quit smoking, you know how hard it can be. It is hard because nicotine is a very addictive drug. For some people, it can be as addictive as heroin or cocaine.

Quitting is hard. Usually people make 2 or 3 tries, or more, before finally being able to quit. Each time you try to quit, you can learn about what helps and what hurts.

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Quitting takes hard work and a lot of effort, but you can quit smoking.

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Good Reasons for Quitting

Quitting smoking is one of the most important things you will ever do:

• You will live longer and live better.
• Quitting will lower your chance of having a heart attack, stroke, or cancer.
• If you are pregnant, quitting smoking will improve your chances of having a healthy baby.
• The people you live with, especially your children, will be healthier.
• You will have extra money to spend on things other than cigarettes.

Five Keys for Quitting

Studies have shown that these five steps will help you quit and quit for good. You have the best chances of quitting if you use them together:

1. Get ready.
2. Get support.
3. Learn new skills and behaviors.
4. Get medication and use it correctly.
5. Be prepared for relapse or difficult situations.

1. Get Ready

• Set a quit date.
• Change your environment.

1. Get rid of ALL cigarettes and ashtrays in your home, car, and place of work.
2. Don't let people smoke in your home.

• Review your past attempts to quit. Think about what worked and what did not.
• Once you quit, don't smoke—NOT EVEN A PUFF!

2. Get Support and Encouragement

Studies have shown that you have a better chance of being successful if you have help. You can get support in many ways:

• Tell your family, friends, and coworkers that you are going to quit and want their support. Ask them not to smoke around you or leave cigarettes out.
• Talk to your health care provider (for example, doctor, dentist, nurse, pharmacist, psychologist, or smoking counselor).
• Get individual, group, or telephone counseling. The more counseling you have, the better your chances are of quitting. Programs are given at local hospitals and health centers. Call your local health department for information about programs in your area.

3. Learn New Skills and Behaviors

• Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task.
• When you first try to quit, change your routine. Use a different route to work. Drink tea instead of coffee. Eat breakfast in a different place.
• Do something to reduce your stress. Take a hot bath, exercise, or read a book.
• Plan something enjoyable to do every day.
• Drink a lot of water and other fluids.

4. Get Medication and Use It Correctly

Medications can help you stop smoking and lessen the urge to smoke.

• The U.S. Food and Drug Administration (FDA) has approved five medications to help you quit smoking:
  1. Bupropion SR—Available by prescription.
  2. Nicotine gum—Available over-the-counter.
  3. Nicotine inhaler—Available by prescription.
  4. Nicotine nasal spray—Available by prescription.
  5. Nicotine patch—Available by prescription and over-the-counter.
• Ask your health care provider for advice and carefully read the information on the package.
• All of these medications will more or less double your chances of quitting and quitting for good.
• Everyone who is trying to quit may benefit from using a medication. If you are pregnant or trying to become pregnant, nursing, under age 18, smoking fewer than 10 cigarettes per day, or have a medical condition, talk to your doctor or other health care provider before taking medications.

5. Be Prepared for Relapse or Difficult Situations

Most relapses occur within the first 3 months after quitting. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Here are some difficult situations to watch for:

• Alcohol. Avoid drinking alcohol. Drinking lowers your chances of success.
• Other smokers. Being around smoking can make you want to smoke.
• Weight gain. Many smokers will gain weight when they quit, usually less than 10 pounds. Eat a healthy diet and stay active. Don't let weight gain distract you from your main goal—quitting smoking. Some quit-smoking medications may help delay weight gain.
• Bad mood or depression. There are a lot of ways to improve your mood other than smoking.

If you are having problems with any of these situations, talk to your doctor or other health care provider.

Special Situations or Conditions

Studies suggest that everyone can quit smoking. Your situation or condition can give you a special reason to quit.

• Pregnant women/new mothers: By quitting, you protect your baby's health and your own.
• Hospitalized patients: By quitting, you reduce health problems and help healing.
• Heart attack patients: By quitting, you reduce your risk of a second heart attack.
• Lung, head, and neck cancer patients: By quitting, you reduce your chance of a second cancer.
• Parents of children and adolescents: By quitting, you protect your children and adolescents from illnesses caused by second-hand smoke.

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Questions to Think About

Think about the following questions before you try to stop smoking. You may want to talk about your answers with your health care provider.

1. Why do you want to quit?

2. When you tried to quit in the past, what helped and what didn't?

3. What will be the most difficult situations for you after you quit? How will you plan to handle them?

4. Who can help you through the tough times? Your family? Friends? Health care provider?

5. What pleasures do you get from smoking? What ways can you still get pleasure if you quit?

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Here are some questions to ask your health care provider.

1. How can you help me to be successful at quitting?

2. What medication do you think would be best for me and how should I take it?

3. What should I do if I need more help?

4. What is smoking withdrawal like? How can I get information on withdrawal?

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Quitting takes hard work and a lot of effort, but you can quit smoking.

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Additional Resources

You may want to contact these organizations for further information on smoking and how to quit.

For general information:

American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
(800) AHA-USA1 (242-8721)

American Cancer Society
1599 Clifton Road, NE
Atlanta, GA 30329
(404) 320-3333

American Lung Association
1740 Broadway, 14th Floor
New York, NY 10019
(212) 315-8700

National Cancer Institute
Bethesda, MD 20892
(800) 4-CANCER (422-6237)

For pregnant women:

American College of Obstetricians and Gynecologists
409 12th Street, SW
Washington, DC 20024
(202) 638-5577

For More Information

The information in this booklet was taken from Treating Tobacco Use and Dependence, a U.S. Public Health Service-sponsored Clinical Practice Guideline. This guideline was developed by a non-Federal panel of experts sponsored by a consortium consisting of Federal Government and nonprofit organizations:

• Agency for Healthcare Research and Quality (AHRQ).
• Centers for Disease Control and Prevention (CDC).
• National Cancer Institute (NCI).
• National Heart, Lung, and Blood Institute (NHLBI).
• National Institute on Drug Abuse (NIDA).
• Robert Wood Johnson Foundation (RWJF).
• University of Wisconsin Medical School's Center for Tobacco Research and Intervention (CTRI).

For information about the guideline or to get more copies of this booklet, call toll free: 800-358-9295, or write:

Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907

U.S. Department of Health and Human Services
Public Health Service

Use "The Force" to Quit Smoking (Special Star Wars Tribute)

Tomorrow (May 19th) has reached near "holiday" status here in the U.S., thanks to George Lucas. Yes, tomorrow is the U.S. opening of Star Wars Episode I: The Phantom Menace. I've got my tickets for opening night!

If you aren't familiar with the Star Wars movie series (http://www.starwars.com) you probably live on another planet. I've been a Star Wars nut ever since I saw the first movie in 1977 at the age of 9. I was blown away by the incredible special effects and story. The mythical story paints a clear picture of the battle of good versus evil, and touches people on many levels. Perhaps that explains at least part of the movie's popularity: Star Wars reflects the emotion and the fear and the excitement and the good and the evil inside each of us.

The Star Wars movies follow the Jedi Knights who possess amazing powers provided by "The Force". Ben Kenobi, one of the Jedi, tells Luke Skywalker what The Force is: "The Force is what gives a Jedi his power. It's an energy field created by all living things. It surrounds us and penetrates us. It binds the galaxy together." Ben goes on to tell Luke, "You must learn the ways of The Force..."

The wisdom of the Jedi and The Force found in the first three Star Wars movies can help you quit smoking if you'll apply that wisdom. You must learn the ways of The Force to quit smoking.

Ben taught Luke about The Force in the first movie, Star Wars. He tells Luke, "A Jedi can feel The Force flowing through him." Luke asks, "You mean it controls your actions?" Ben explains, "Partially. But it also obeys your commands."

The Force will obey your commands to "quit smoking." You are not destined to smoke for the rest of your life. You DO have control over your own destiny and the actions that you take. Use The Force now to take charge of whether or not you smoke or quit.

In the second movie, The Empire Strikes Back, Luke travels to a remote planet to receive training from Yoda, a Jedi master. During the course of Luke's training, Yoda provides many nuggets of wisdom that can help you become a non-smoking Jedi.

"A Jedi must have the deepest commitment. The most serious mind," Yoda tells Luke. The same holds true for you if you want to quit smoking. You must commit yourself fully to the task of quitting. You can't quit halfway. If you plan to quit, you must quit completely. Get serious about your commitment to quit.

Later, Yoda tells Luke "A Jedi's strength flows from The Force, but beware of the dark side." The dark side of The Force is the evil side of The Force. In many ways you might think of the dark side as your smoking addiction, or the cigarettes you smoke, or even the cigarette companies.

Luke asks Yoda, "Is the dark side stronger?"

"No," Yoda responds. "No. Quicker, easier, more seductive." Wow! Doesn't that just about sum up smoking? It's much easier to continue smoking rather than to quit, so seductive is the habit. No one said becoming a smoke-free Jedi would be easy!

Luke then asks Yoda, "But how am I to know the good side from the bad?" Yoda answers, "You will know when you are calm, at peace, passive."

A great way to begin beating your smoking habit it to practice relaxation techniques. If you find yourself giving in to your cravings when you are stressed, you are turning to the dark side! Relax! Breathe deeply. Clear your mind and sit quietly. Learn to control your stress with your mind, not with cigarettes.

One day, after Luke learns to move and float rocks using The Force, his X-Wing fighter spaceship sinks into the swamp near Yoda's home. Luke exclaims, "We'll never get it out now."

Disappointed, Yoda says to Luke, "So certain are you. Always with you what cannot be done."

Luke replies, "Master, moving stones around is one thing. But this is totally different."

Somewhat disgusted by now, Yoda shouts "No! No different. Only different in your mind. You must unlearn what you have learned."

Half-heartedly, Luke says "Alright, I'll give it a try."

"No! Try not. Do, or do not. There is not try," Yoda tells Luke.

How many times have you said I'll TRY to quit smoking, knowing full well that you don't really believe you can quit and don't really plan to quit? You must understand that quitting is not a game. Quitting is real life. If you are going to quit--QUIT! Don't just try. QUIT! If you stumble and start smoking again after quitting then quit again until you quit forever. Quit, or quit not. There is not try.

After Luke "tries" and fails to levitate his X-Wing out of the swamp, he tells Yoda "I can't. It's too big."

Yoda then gives Luke another lesson. "Size matters not. Look at me. Judge me by my size, do you? [Yoda is barely two feet tall]. And well you should not. For my ally is The Force, and a powerful ally it is."

The Force is a metaphor for God or religion or faith. Countless smokers have told me how their faith in God has helped them to quit smoking. By placing your faith in a higher power, you allow the infinite power of the universe (whatever you consider that to be--I'm not trying to advocate any particular religion here) to help you quit smoking. You remove the total burden from yourself. You'll gain strength from asking God to help you quit. You can move mountains with the help of your faith and prayer.

Luke didn't have the faith he needed to get his X-Wing out of the swamp. "You want the impossible," he tells Yoda.

Moments later, Yoda effortlessly raises the X-Wing out of the swamp and over to the side. In disbelief, Luke says, "I don't believe it!"

"That is why you fail," Yoda tells him.

Belief is absolutely critical to your success. Studies show that believing that you have the ability to quit is one of the most important indicators of future success. If you believe you have the ability to quit and believe that you will quit, you are much more likely to quit than someone who has no faith in themselves. Believe, and be free of cigarettes!

Later in the movie, Luke sees a vision of his friends, in which their lives are in danger. Luke feels that he needs to cut short his training and go to their aid. Yoda and Ben both encourage Luke to stay and continue with the training, fearing he will be at risk unless he completes his training.

Luke tries to assure them that he is ready. "I feel The Force," he tells them.

"But you cannot control it. This is a dangerous time for you, when you will be tempted by the dark side of The Force," Ben warns.

Similarly, when you are in the process of quitting, you must constantly guard against the dark side of temptation. Don't get sucked in by the notion that you can have "just one" cigarette. Remember, as Yoda says, "Once you start down the dark path, forever will it dominate your destiny." As time goes by, you will learn how to deal with your cravings and how to handle stress, without smoking. But it takes time. If you smoke just one cigarette, expecting to be able to control your urges, you're in for a real surprise. Just one puff can put you back at a pack-a-day habit in no time.

Luke finally leaves Ben and Yoda and goes to help his friends. He ends up fighting Darth Vader, a Jedi Knight who has turned to the dark side of The Force. Vader's plan is to turn Luke to the dark side and utilize his powers to further his own evil plans. "Join me and together we can rule the galaxy," Vader tempts Luke.

Cigarettes tempt you with inflated claims of looking cool, feeling relaxed and fulfilled. Unfortunately, cigarettes have an ominous dark side. Do I have to spell it out? You know cigarettes cause numerous health problems, cost a lot, and make you smell bad. Make sure you evaluate the temptation for what it really is: the desire for self-destruction.

If only our lives were as simple as buying a movie ticket! Good things in life take effort and work. Apply the lessons here to your own quit smoking program and I think you'll find you can make some of your own special effects!

May The Force be with you!

Quit Smoking Workbook (Chapter 15: Quit Date)

Quitting smoking is an act that requires preparation. If you've worked methodically up to this point in the workbook, you may be ready to choose your own personal quit date within the next two weeks. Mark this date on a visible calendar. This will serve as a reminder to you that the act of quitting smoking is not something that you are doing on a whim but rather something that you are preparing for and planning to accomplish.

As you approach the date marked on your calendar, you'll need to prepare yourself for the actual quitting process. Since smoking has been part of your whole existence including your physical self, your emotional self, and part of your general surroundings, each of these areas needs preparation for the quitting process.

Preparation of Surroundings

Cigarette smoking has been part of your life and as such has probably left its mark all around you. In your efforts to quit smoking it is important for you to remove the evidence and reminders of your smoking habit. This will serve to decrease temptation from these reminders as well as to strengthen your commitment to the quitting process through visible reminders.

1. Two weeks prior to quit date, limit your smoking to one room in your home. This room should be the least comfortable place. For example, choose the laundry room, the basement, or the porch. Move all of your smoking paraphernalia, such as ashtray and lighter, to that room. Limiting where you smoke will help you to cut down on the quantity of cigarettes that you smoke by making the process more inconvenient. A pack of cigarettes that is next to the couch and in front of the television set will probably be smoked. Further, by limiting where you smoke you also eliminate many of the cues and triggers you identified in earlier chapters. If you tend to smoke when watching television or finishing a meal, you will begin to break that association by learning to smoke without engaging in either activity. Smoking should become merely an act of inhaling and putting out your cigarette and not a part of your daily routines.

2. Clean out your car. Remove all evidence that your car was that of a smoker. Vacuum out the carpet, remove the ashtray and lighter, and discard any remaining cigarettes. After your car is clean, make this a non-smoking area for yourself and other guests who ride in your car. By preparing your car, you will begin to break any associations that you may have between driving your car and smoking a cigarette. For example, if somebody cuts you off when you are driving and normally you would reach for a cigarette, you will now be forced to adopt an alternative strategy to manage this frustration. Also, as a non-smoking area your car will become a safe haven for you when you are tempted to smoke. Now you have eliminated one more trigger or cue for your smoking.

3. Clean and deodorize your home. Since you have now limited your smoking to only one room in your home, you can begin to clean and prepare the remaining rooms for your actual quit date. Get your carpets and draperies cleaned. Remove the odor of cigarettes from your furniture and clothing. Discover and remove those hidden cigarettes that may be lurking in the couch cushion, under the bed, or in the back of the refrigerator. During those initial days after your quit date, you may be tempted by any stray cigarette that you can find. Remove the temptation now before your quit date.

Preparation of Your Physical Self

Once your surroundings are prepared it is time to get yourself physically in shape for the quitting process. As you've seen in the preceding chapters, nicotine is a physically addicting chemical and as such your body may experience some withdrawal symptoms after you quit smoking. To make the process a little more comfortable, it is important to get yourself physically prepared for these changes.

1. Visit your dentist. Get your teeth cleaned. This will serve to remind you that you are about to begin life as a non-smoker. With the tar and nicotine removed from your teeth you are literally starting fresh without cigarettes.

2. Monitor your alcohol consumption prior to and immediately after quitting. The effects of alcohol are intensified when used in conjunction with cigarettes. That is, when alcohol and cigarettes are used together they each bring out the most harmful physical effects of the other. Further, when you drink alcohol your inhibitions are decreased and you are therefore more likely to relapse into smoking. For many smokers alcohol is also paired or associated with smoking. Therefore, when you have a drink you may automatically begin thinking about a cigarette, which puts you more at risk for relapsing into smoking. It maybe important for you to avoid alcohol during the first couple of months after quitting until you are beyond the most difficult phase of quitting. Then you can slowly reintroduce alcohol consumption back into your life.

3. Reduce your caffeine consumption prior to quitting. Nicotine acts on the body by changing your metabolism. If you are used to consuming a fair amount of caffeine as a smoker, your body may not be able to tolerate the same amount after you quit smoking. If this is the case, you may experience a jittery/nervous sensation which may not be related to tobacco withdrawal but rather caffeine intoxication. Several weeks before your quit date begin to reduce your caffeine consumption. Remember, caffeine is not just found in coffee but also in chocolate, soda pop, etc. Once you have quit smoking you will then be in a better position to re-establish an appropriate amount of caffeine for you.

4. Get plenty of rest. During your first smoke-free week it is important to get plenty of rest. You probably have been bombarding your body with the drug nicotine for many years. Once you stop the drug your body needs time to readjust without the drug. This healing process can be difficult and exhausting for the first couple of weeks. Plenty of rest will help move you physically through this process with greater ease. Think about this phase as a time for recovery.

5. Drink plenty of fluids. The healing process requires good nutrition and plenty of fluids. Try to drink fruit juices, which tend to cut down on the craving for nicotine for many people.

6. Use healthy oral substitutes. During the initial few weeks after quitting it is important to have healthy foods prepared for snacking. For example, keep celery, carrots, raisins, apples, pickles, sunflower seeds, etc. readily available for snacking. These snacks will help you when a craving strikes and you need something oral to satisfy you. However, make sure that the snacks you are choosing are low in calories and high in bulk. This will help with the craving but minimize the weight gain. [Note from QuitSmoking.com: Our E-Z Quit artificial cigarette is an excellent and healthy oral substitute.]

7. Chew sugarless gum and hard candy. During the first few weeks after you quit smoking your throat may feel dry or you may have a "tickle" cough; sucking on ice chips, hard candy, or chewing gum can help. Also, you can use the candy or gum as a substitute when you have a craving.

Preparation of Your Emotional Self

One of the biggest challenges to quitting smoking is preparing yourself emotionally. Many smokers talk about feeling a sense of loss when thinking about quitting smoking. You may find yourself thinking about quitting smoking as losing a friend or at the very least losing your coping strategy. Either way you describe it you may sense the loss of security and control when you quit smoking. To overcome these feelings you need to prepare yourself emotionally for the process of quitting smoking, and for life after cigarettes.

1. Repeat to yourself your reasons for needing to quit smoking. Although this has been stated many places throughout this book it bears repeating because it is so important. Your reasons for needing to quit smoking will provide you with the strength and willpower to get through the quitting process. Review these reasons. Reinforce them to yourself several times a day. Write them down and carry them with you. Place them in a visible area for yourself.

2. Plan activities for your first smoke-free week. The worst thing that can happen on your quit date or the weeks that follow is to find yourself in a situation where you are craving a cigarette and you have no alternative strategy available to you other than reaching for a cigarette. Plan activities that are inconsistent with smoking such as doing crossword puzzles, jogging, swimming, washing dishes, going to the grocery store, visiting the library or church, etc. Idle or empty time can be dangerous during the initial quitting process. Stay active and busy.

3. Occupy your hands with other objects. Use pencils, toothpicks, paper clips, rubber bands, etc. to occupy your hands when you feel something is missing without a cigarette.

4. Beware of cigarette advertisements. As a smoker you have probably been bombarded with literature on cigarettes, offered many coupons and rebates on cigarettes, and tempted by magazine and billboard ads. Don't be tempted. It may be helpful for you to analyze and seriously consider what these ads are really saying to you. For example, ask yourself how companies have been able to sell you a product that causes serious medical diseases that can lead to death. Why is it that the individuals who are portrayed in these ads always have smooth skin and white teeth? Nicotine alters the elasticity in the skin and yellows your teeth. Is your health really only worth that 50 cent coupon? Why do cigarette ads always show healthy, young, attractive individuals who are very happy? Most smokers tend to suffer from some effects of their smoking habit such as coughing and more frequent episodes of colds, bronchitis, and pneumonia. Many smokers continue to smoke as a way of dealing with depression and stress. What is so cool and refreshing about tar sticking to your lungs, and 4,000-plus substances being deposited in your lungs (including arsenic, formaldehyde, and carbon monoxide)? After years of smoking many smokers would not be able to participate in the vigorous activities that are shown in cigarette ads, nor are they able to breathe in and smell the fresh mountain air that is shown. Cigarette advertisements are successful in luring individuals into smoking and continuing to smoke by appealing to your perceived vulnerabilities. Everyone wants to be seen as attractive, successful, sexy, and fun. The reality is that by being pulled in by these ads you are risking your life to help the tobacco company make money. If you remind yourself of these realities you will be less likely to be tempted and intrigued by these ads. Rather you should be angry that they are making money at your expense.

5. Never allow yourself to think that one cigarette won't hurt. Many smokers relapse because they fall into the trap of believing that they can control their smoking and one cigarette won't hurt. This is harmful thinking because the majority of smokers may be able to have one for a while but eventually this will lead to two and before you realize it you will be back smoking the same quantity of cigarettes. Further, in order for your body to begin healing itself and to complete the withdrawal process you need to have all nicotine out of your system. By smoking one cigarette you re-introduce nicotine back into your system which delays healing.

6. "Smoking is no longer an option for me." Immediately after quitting you may find yourself looking for excuses to justify smoking. Excuses are easy to find when you are looking for them. However, if you have told yourself that smoking is not an option for you anymore you will need to find another option when your feel stressed or nervous, or when you are finishing a meal or waiting for a friend. On your quit date remind yourself that smoking is no longer an option for you and therefore you must handle whatever situation presents itself to you. This statement will empower you to find and use alternative coping strategies.

Fear of "Losing a Friend"

As your quit date approaches, you may find yourself feeling sad--as if you were about to lose a friend. Frequently, smokers will describe their cigarettes as a good "friend." Smoking may have helped them deal with periods of stress in their life, been a source of comfort when they felt lonely and depressed, and in some ways proved a companion when they felt socially awkward angry or isolated. If you share these feelings you may be fearful of what life will be like without this "friend." The following exercise is one developed in workshops. Smokers have reported that when they put this "friend" in a different context they could let go with a little more ease. By following the instructions below you, too, will be able to see your "friend" in a new way.

Close your eyes and picture your cigarette. Imagine that the cigarette is as tall as you are and you are standing side by side. Put your arm around the cigarette. You are now feeling comfort and support from your "friend." You believe that this "friend" will support you, will help you to feel in control, will take away your worry and stress, and will provide companionship for you when you are lonely. Imagine that the two of you are walking arm in arm. You believe in this "friend" and you trust this "friend." You are now approaching a grassy knoll. As you get closer to the hill, you see a hole in the ground with dirt piled around it. Your "friend" brings you closer to the hole. You feel the cold air and see that it is a grave site. Your name is on the gravestone. Arm in arm your "friend" walks you around the hole. You and your "friend" walk around and around the hole. You continue to get closer and closer to the edge of the hole. You begin to lose your footing and you reach for your "friend." You are afraid. You keep reaching and reaching and reaching for your "friend" but your friend keeps walking you closer and closer to the dark hole. Is this your "friend"?

The above exercise can be frightening and sobering. However, it is important for you to focus on the reality of your smoking. A friend would not want you to be in harm's way. A friend wants what is best for you. Although you may not find yourself using the word "friend" when you think about your cigarettes, you may be using and relying on them as such. Remember, a true friend does not just put a bandage on a situation but rather helps to guide you towards long-term coping. Cigarettes may make you feel better for the moment but in the end they lead you closer and closer to years of suffering. Cigarettes are not your friend.

Enlisting Social Support for Your Quit Date

1. Use your support systems. Remind your friends and family that you are going through the quitting process and that it is important to you that they support you. Smokers who have more social support have more success in quitting. Avoid friends or family members who may be jealous of your attempt and success at quitting smoking, particularly if they themselves have failed in the past to quit smoking. Rely on individuals who really want to see you succeed, including those who have successfully quit smoking or who are nonsmokers.

2. Be assertive and direct when asking for support. Be assertive when asking that others not smoke around you or place you in high risk situations. Be specific in your request for support or help. For example, you may ask that others be tolerant of irritable behavior during the first couple of weeks, suggest that others not smoke around you, and seek out rewards and praise from others for your efforts. Everyone needs encouragement and praise for persevering through the difficult process of quitting smoking. Don't view this as a sign of weakness.

3. Negotiating with a live-in smoker. Living with a smoker may make your efforts to quit smoking more difficult. Therefore, it is important to work out an agreement prior to your quit date that you can both feel comfortable with. For example, you may request that the smoker not leave cigarettes lying around the house. It may be a good idea to have the smoker smoke in only one room in the house or at least not smoke in your presence during the first couple of weeks after your quit date. Reinforce to the smoker how important quitting smoking is to you and how you value his or her support. Request that the smoker not do things or say things to undermine your efforts to quit smoking. If the smoker really cares about you and your health he or she will want to support your efforts in improving your overall well-being. Sometimes it is difficult for current smokers (even those with good intentions) to really support someone else's efforts to quit smoking. This can occur for several reasons. The smoker may be jealous that you are succeeding at quitting while he or she is not and therefore feel weak by comparison. The smoker may feel abandoned for having lost his or her "smoking partner." This may take some of the social pleasure of smoking away from him or her. Prior to your quit date, it will be helpful for you to discuss these feelings with the smoker in order to prevent any potential sabotage of your efforts and to increase all-around support of you.

4. Working with a smoker. What do you do if a co-worker smokes and is not interested in quitting? It is much easier to negotiate with a family member or friend than it is with a co-worker because loved ones presumably have your best interest at heart. However, this may not be the case with fellow employees. It is important to make a request for support or at the very least for respect of your efforts to quit smoking. Your co-workers may feel that you do not have a right to impose on them or they may share feelings such as jealousy. This is all right. You still have a right to make the request and to work out an equitable arrangement regarding smoking in the workplace. For example, you may ask for a transfer to a work area that is smoke-free. You may find your co-workers commenting on your attitude and saying, "You are so crabby you're driving us crazy--just smoke a cigarette." Remind yourself and them that part of your irritability is related to nicotine withdrawal and therefore it is short-term. This short-term irritability is probably related to physical changes in your body. However, it is important that you not use this as an opportunity to intentionally treat others poorly. Monitor your own behavior and mood. Get distance from a situation if you feel yourself getting irritated. This will help reduce any potential conflict in the workplace. Finally, you may also need to discuss the office smoking policy with your employer. Be aware of your rights.

How Family and Friends Can Provide Support

Friends and family members can play an important role in your efforts to quit smoking. It is important for them to stay supportive of you and your desire to quit and at the same time not to be confrontational or punitive. Many smokers report that the type of support they get from their family and friends ranges from nagging to encouraging them to smoke because their mood and behavior is "out of control." This can leave you feeling like a failure and this discouragement may lead to a return to smoking.

Answering the following questions will help you define specifically what role your family and friends play in your efforts to quit smoking.

What are some things that your family has said to you regarding your efforts to quit in the past?

What are they currently saying about your present efforts to quit smoking?

What have your family members done in the past when you have attempted to quit smoking? For example, have they offered you a cigarette when you got crabby?

What have your friends said to you in the past regarding your attempts to quit smoking?

What are your friends currently saying to you regarding your attempt to quit smoking?

Is there a difference between the support you receive from your smoking friends versus your non-smoking friends?

Ideas for Supportive Family and Friends Tell the smoker that you have confidence in his or her ability to remain smoke-free. Repeat this message frequently throughout the quitting process up through the first year. Offer to provide support to those quitting smoking by leaving them alone if they need isolation, visiting frequently if they need reassurance, or providing baby-sitting services if the smoker feels unusually stressed during the initial quitting period (e.g., the first couple of weeks). Recognize that quitting is a difficult process and as such the smoker may exhibit unusual behavior, such as increased irritability, forgetfulness, nervousness, and what may appear as insensitivity to others' needs. Keep in mind that this will be temporary. Keep the smoker as a person separate from the act of smoking. Significant others should continue to support the smokers no matter what difficulties he or she may encounter in the quitting process, including possible relapses. Offer to accompany the smoker to places that are non-smoking. Discourage other smoking friends from consciously or unconsciously tempting the smoker with cigarettes. Be positive. Give day to day encouragement about steps already taken to quit smoking and avoid pointing out slips or problems that the smoker may encounter. Be non-judgmental by trying to put yourself in the smoker's shoes. Attempt to understand that smoking has been a very large part of the smoker's life and quitting can be a difficult process. Smokers who are committed enough to attempt to give up a physically and psychologically addicting drug like nicotine deserve unconditional support. Plan rewards for your friend during special anniversary times, such as the first week, month, year, etc. These rewards could include taking him or her to dinner, or sending flowers, notes of encouragement, or other gifts. What kinds of things could you do to offer support to your smoking family member or friend?

Your Quit Date and the Weeks That Follow

1. Visualize and reinterpret your physical symptoms as "symptoms of recovery." In chapter 14 on nicotine substitution you saw a list of physical withdrawal symptoms that you may experience during the initial phase of quitting. Keep in mind that these symptoms are short-term and necessary to the healing process. Try to think about them as "symptoms of recovery." This means that when you are feeling irritable and restless or are having a "craving" remind yourself that although these symptoms may not feel good they remind you that your body is healing. If your body were transparent you would be able to see positive changes occurring. However, since you cannot see the changes you need to use these "physical symptoms" as a reminder or cue that your body is healing. "The pain is healing pain." Each time you feel "uncomfortable" think about what is happening in your body. Use the following imagery exercise to guide you through this healing process.

Close your eyes and imagine your lungs. See the black tar sitting on the tiny little air sacs that makes it hard for you to breathe at times. Each time you feel "uncomfortable" imagine this tar gradually being lifted off your lungs. Each breath that you take feels easier. You feel the clean air healing the wounded lung tissue. You see the 4,000-plus particles that are floating in your bloodstream being washed away. You feel your arteries relaxing and allowing blood to pass more readily through, cutting your risk for strokes and heart attacks. With each passing day you see more and more healing occurring inside your body. With each "discomfort" that you feel you see healing occurring in your body. You remind yourself that these symptoms are short-term.

2. Pay attention to your "high risk" situations. In chapter 7 you filled out a chart that defined your own smoking patterns. Refer to this chart and focus on your "high risk" areas. These are times, such as when you are stressed at work or finishing a meal, when you are most likely to desire a cigarette. During the initial weeks after quitting smoking it is important that you pay close attention to these situations or feelings. Prepare for them and have alternative strategies available. You are most at risk for automatically falling back into your routine of smoking during the first couple of weeks after quitting smoking if you are not vigilant about these "high risk" areas. Try either to avoid these situations or at the very least to have alternative strategies available.

3. Use distraction techniques. When you find yourself tempted to smoke a cigarette get some distance from the thought or situation. Distraction is a wonderful technique for preventing impulsive smoking. Distraction could include physically removing yourself from the situation, shifting your thought to something other than smoking, or engaging in an activity that makes smoking difficult (such as washing dishes, exercising, or visiting a nonsmoking friend). It is important to remember that the "desire" to smoke is generally very brief, lasting only seconds. Initially after quitting you may find that the "desire" for a cigarette feels fairly strong and you may "desire" a cigarette quite frequently. However, with time you will notice that the strength and frequency of the desire will decrease. This is why distraction can be very helpful. If you distract yourself for a brief period of time, the "desire" will fade and over time you will not experience the desire as often. Say to yourself, "This desire will only last for a short period of time and if I give into it and smoke I will have to start the healing process all over again. If I can distract myself the desire will pass and I will be one step closer to reducing the frequency of this desire." Reward yourself each time you successfully distract yourself away from the "desire."

4. Reinforce your reasons for needing to quit smoking. During the initial weeks after quitting smoking you will need to continue to reinforce for yourself your reasons for needing to quit smoking. Remember, these reasons need to be specific and personal to you. These reasons will help get you through the periods of temptation.

5. Repeat to yourself the benefits of quitting smoking. You need to remind yourself that good will come of the discomfort, inconvenience, lifestyle changes, and general effort that you are making during this quitting process. Repeat the following list of benefits to yourself several times a day.

Benefits of Quitting Smoking

1. Circulation improves

2. Decreases or cures allergies (smokers have three times more allergies than nonsmokers)

3. Eliminates chronic bronchitis (which decreases energy level, resistance to infection, and predisposes one to emphysema) in a few months after cessation

4. Reduces number of cavities and increases chance of keeping your own teeth (smokers have three times more cavities and gum disease than non-smokers)

5. Decreases risk of esophageal cancer by 500 percent

6. Decreases risk of kidney cancer by 50 percent

7. Decreases frequency and intensity of headaches

8. Non-smoking women have less discomfort and less problems with menopause

9. Decreases risk of osteoporosis

10. Increases lung and breathing capacity

11. Increases female fertility by 50 percent

12. Significantly decreases your risk for lung cancer and emphysema

What Happens When You Quit Smoking?

Within 30 minutes of quit smoking, your pulse rate slows down and blood pressure drops toward normal.

Within hours of stopping, the level of carbon monoxide in your blood drops, enabling the blood to carry more oxygen.

Two days after quitting, nerve endings begin to recover and your sense of smell and taste begin to return.

Within 72 hours of quitting, your lungs’ bronchial tubes expand and lung volume increases.

Months after quitting, shortness of breath diminishes.

In the first year, the risk of heart attack attributed to smoking declines for both men and women.

Two to three years after quitting, the risk of heart attack attributed to smoking is virtually gone.

After 10 years, the risk of developing cancer is about the same as for nonsmokers.