Tuesday, June 20, 2006

Stop Smoking Program

Wondering what to do to help your smoking cessation, why do not you consider attending a stop smoking program. There is plenty of smoking cessation programs available and their success rates are reasonably good.

You can ask your doctor to refer you to a good stop smoking program. Alternatively, ask your friends or relatives who have already attended such program for advice. If none of the options works out – you can search for a stop smoking program on the internet, in the newspaper ads or the yellow-pages-kind of guides.

Regardless who referred you to the program you plan to attend, there are always a few factors to consider. First, you should know what to expect from a stop smoking program. If you imagine it is a magical place that will instantly eradicate your bad smoking addiction. What you will be offered within the course will be counseling services, a quit smoking plan, in certain paces a behavior therapy. Some of the sessions will be held with your therapist only, other may be group sessions where you will meet other people trying to stop smoking.

Since this is a kind of shrink thing you should ask for all information that you can think of – ask for the companies background what are the certificates (as well as other education stuff) of your future therapist, ask for previous customers recommendations. Companies that are reluctant to provide you with similar information or provide just bits and pieces unwillingly are better to be avoided.

What is important to remember is that these programs are not necessarily very expensive. Also (as any other service nowadays) a high price does not guarantee perfect results.

Most people say that stop smoking programs give very satisfactory results. Other found pretty useless. The truth is that if the program includes serious and regular sessions (with duration more that 30-40 minutes) the chances of success are quite big. Of course if we assume the therapist is an educated and experiences professional as well. So when considering which stop smoking program to attend, take into account the number and the frequency of the sessions and their duration.

What some people find useful is attending regular meetings are some ex-smokers organizations (similar of the Anonymous Alcoholic ones). This is a good follow up practice that will help you overcome the smoking habit totally and will invite new friends into your life.

Finally, as in any their thing you try to achieve in life, smoking cessation is a matter of personal decision, consistency and strong will. Make sure you realize and understand the reasons why you want to stop smoking and do your best to achieve this goal.

Rene's website helps light and heavy smokers to quit smoking forever. Please visit the site for more information on Stop Smoking Program

Monday, October 10, 2005

Stopping Smoking? Consider Hypnosis!

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Stopping Smoking? Consider Hypnosis!
By Matt Godson

Nicotine Replacement Patches? Gum? Pills? There are many stop smoking "products" on the market that you can choose. So why should you consider hypnosis?

1) Hypnosis is a "process", not a "product"

Hypnosis permanently changes your attitude towards smoking. Its power comes from your desire to become a non-smoker. Hypnosis literally "switches off" any thoughts of smoking.

Patches and Gum do the opposite - by using these products you are subconsciously saying "There is something that I need in a cigarette, therefore I need to substitute the cigarette with something else." You may replace one habit with another.

2) Hypnosis is Healthy and Safe

You’re trying to rid your body of toxins ... so why would you replace the nicotine in cigarettes with the nicotine in gum or in patches? Nicotine is a poison?

3) Hypnosis is Fast and Easy

Using Hypnosis you can be a non-smoker in one hour or less. Patches and Gum often require weeks or months of treatmene

4) Hypnosis is Permanent

Because Hypnosis permanently changes your attitude towards smoking you have very little chance of relapse at any point in the future. You become a non-smoker.

With other products this mental change has not taken place and therefore you are at best an "ex smoker" continually having to consciously fend off and fight the urge to smoke. Making a relapse more likely.

When the shift to becoming a non-smoker takes place with Hypnosis one no longer has to battle against cigarettes. They will simply fade away as an "enemy".

5) Hypnosis may be Tax Deductible. Patches and Gum are not.

If you are US taxpayer, you can deduct the cost of smoking cessation programs from your taxes.

From the IRS website (http://www.irs.gov/faqs/faq-kw139.html)

Are expenses for smoking cessation programs deductible?

You can include in medical expenses amounts you pay for a program to stop smoking. Unreimbursed amounts you pay for participation in a smoking cessation program and for prescribed drugs designed to alleviate nicotine withdrawal are expenses for medical care that are deductible subject to the 7.5% of adjusted gross income limitation if you itemize deductions on Form 1040, Schedule A (PDF), Itemized Deductions.

However, you cannot include in medical expenses amounts you pay for drugs that are designed to help stop smoking that do not require a prescription, such as nicotine gum or patches.

6) Hypnosis is more effective than Patches or Gum

Hypnosis has a 70-80% success rate for those committed to becoming a non smoker. Because the burdens on the patch or gum user are so great, those manufacturers can only boast a 50-60% success rate.

Furthermore most reputable hypnotherapists will offer a guarantee (see http://www.freshstartmethod.com/guarantee.php )of effectiveness stating that if you do not become a non smoker, you do not pay.

And thats not something you'll see on a box of nicotine replacement products!

Matt Godson, Clinical Hypnotherapist http://www.freshstartmethod.com Godson runs FreshStart(tm) the internet stop smoking solution

Stop smoking

Article Source: http://EzineArticles.com/











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Quit Smoking With Nature’s Help

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Quit Smoking With Nature’s Help
By Renee Suchy

Smoking is very dangerous to your health. Most smokers feel that there is nothing that they haven’t tried in order to quit. However, they may not be aware of the many natural means available which others have used to finally end this very destructive habit. It is possible to quit smoking, if you devise a plan, cleanse and support the body and use natural methods to curb nicotine cravings.

Most, if not all, people in the United States believe that smoking is unhealthy. Why then do people smoke? The answer lies in the addictive nature of nicotine. Over 80 percent of smokers declare that they want to quit and plan to do so at some point. Even heroin addicts admit that nicotine is truly the hardest drug habit to kick. (Haas, p.964)

Almost one-third of cases of pancreatic carcinoma can be attributed to cigarette smoking. Most lung cancers are caused by cigarette smoking. (Smokers are five to ten times more likely to suffer from lung cancer than nonsmokers). The more cigarettes you smoke per day and the earlier you started smoking, the greater the risk of lung cancer.

Children of smokers have an increased risk of sudden infant death syndrome, respiratory infections and lung cancer.

"Children of smokers have a much higher incidence and severity of asthma, bronchitis, colds and ear infections. They also have impaired lung development and reduced lung function tests." American Journal of Public Health, p. 209, Feb. 1989)

If you eat a balanced diet, drink a lot of clean water and take a vitamin supplement daily, you may feel that you are generally healthy. However, if you smoke, this is typically not the case. Heavy smokers do not get as much of a benefit from a healthy diet. Blood levels of Vitamin C are much lower in smokers. Zinc, Vitamin A and folic acid are often depleted in the bodies of smokers.

Now that we have covered just a few of the negative effects of smoking on the body, let’s figure out how to quit - and without drugs! It may come as a surprise to you that there is a way to be free of this horrible addiction without using prescription medication for help.

Let’s now cover some ideas on how to actually go about quitting.

Have you tried to quit before and failed? Did you quit for awhile and then start again? You may feel that because you tried and failed, that it proves that you can’t quit. However, this is not the case. In reality, you get points each time you attempt to quit. You inevitably learned something each time you tried, which gets you that much closer to being successful in quitting. Most quitters did not do it on their first try. So just think of it as your "practice" run! (3)

A main part of your quit smoking plan, is to figure out which interventions you will use when you are hit with a craving to smoke. Try to avoid being around other smokers. Learn some deep breathing exercises that you can use to de-stress. Exercise is also a great way to limit stress and keep you busy.

Something to consider once you have decided to quit smoking, is how to get the toxins out of your body. One theory is that many dependencies originate in the liver. Cleansing and detoxifying the liver is a crucial first step toward breaking free of these addictions. Detoxifying the liver will reduce the cravings for nicotine. (ESP, p. 279)

You can use echinacea to help flush the nicotine out of the lymph system and lungs. Vitamin C is a great chelator of toxic substances in the body. (Which means it will "grab" the offenders and flush them out through the waste system). A usual dose of C is 1000 mg four times per day. N-Acetyl-cysteine 1000 mg, two doses of glutamine 1000 mg, four capsules of Evening Primrose Oils and 20 Sun Wellness Chlorella tabs are a good regimine for removing nicotine toxicity from the body. (Page p. 548)

It is important during your detox and quitting time that you "avoid junk foods and sugar that aggravate cravings" (Page p.548) Ginseng can help you to normalize sugar cravings, as can stevia, stevioside or FOS. Trace mineral and mineral deficiencies can play a part in some addictions. Magnesium, potassium, calcium and zinc should all be included in the diet when trying to quit smoking. (ESP, p.279)

The main concern when quitting tobacco are the cravings! There are many choices when it comes to this issue. Essential oils, vitamins and herbal teas are all on the list of items in the "cravings" category.

Eating a diet which promotes body alkalinity is said to show less desire for tobacco. To calm your nerves, try Magnesium 800 mg daily, stress B-complex 100 mg daily, valerian/wild lettuce drops in water. (Page, p.548) Young Living Essential Oils offers a blend called "Peace and Calming" which, some people have reported, was all they needed during their quitting time.

Oil of clove is also reported by many people to be extremely effective in their war with nicotine cravings. In Stanley Burrough’s “Master Cleanser” book, he states "For those who wish to quit smoking, place a small amount (of clove oil) on your finger - place it on back of the tongue and you immediately lose your desire to smoke. This is an easy way if you really want to quit." Peppermint oil has also been reported to be effective. Just a touch of it on the tongue, in the same manner as you apply the clove oil will do it.

Single oils which may be helpful in smoking cessation in addition to clove and peppermint, are cinnamon and nutmeg. Other blends of oils recommended for reducing addictive behavior are Harmony, Thieves, Exodus II, Peace and Calming, JuvaCleanse and JuvaFlex. These can be directly inhaled or diffused, applied topically on the temples and/or back of the neck four times daily, or used as a warm compress over the liver.

Quitting smoking is not an easy task to undertake. However, if you give your body the right tools, you can repair the damage done by smoking, you can reduce your cravings and YOU CAN QUIT! Try some of these simple, natural and effective helpers. Nature is the best medicine, so believe in yourself and watch it happen!!

Some resources for people who would like more information:

Young Living Essential Oils, http://www.fragrantfamily.com/sadiesgift
Easyway by Allen Carr order at www.half.com or www.amazon.com
American Lung Association, www.alamn.org (then click “quit smoking”)
Committed Quitters, www.committedquitters.com
National Cancer Institute, www.smokefree.gov
The Stop Smoking Center, www.stopsmokingcenter.net
The Master Cleanser by Stanley Burroughs, order at www.half.com or www.amazon.com

Bibliography:

1. Haas, Elson. Staying Healthy With Nutrition . Berkeley: Celestial Arts, 1992.

2. Essential Science Publishing(2004). Essential Oil Desk Reference, 3rd Ed., www.essentialscience.net

3. American Lung Association pamphlet Quitting For Life, 2003

4. Linda Page, Ph.D. Healthy Healing: A Guide to Self-Healing for Everyone, 12th Edition. Healthy Healing, Inc., 2004

5. Retrieved March 4 , 2005 from http://www.getoutraged.com/facts_top_pg2.html

Renee Suchy has been a Health Unit Coordinator for seven years, and is currently working toward earning both a Bachelor of Natural Health Studies degree and a Doctor of Naturopathy degree. She has also been studying aromatherapy for over a year. You can visit her site for therapeutic grade essential oils at http://www.fragrantfamily.com/sadiesgift

Article Source: http://EzineArticles.com/











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Do You Really Want To Stop Smoking? Or Do You Use The Weight Gain Excuse?

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Do You Really Want To Stop Smoking? Or Do You Use The Weight Gain Excuse? by: Keith Watson

I do not smoke, never have, and admit to being one of those 'pain in the butts' (OK, bad pun!) that go on about the foul stench, and anti-social behaviour of smokers, especially in public places.

You can imagine my joy when one of my local pubs recently banned smoking. Shortly after the ban had come into force I spotted a guy poised with cigarette in hand, and was about to get huffy and even confrontational. Fortunately I held back and continued my beer - but was puzzled. The cigarette was unlit and yet he was putting it near his mouth, flicking the imaginary ash and generally acting as if he was smoking it. Curious about this I eventually enquired, only to find out this was his own rather unorthodox approach to keeping his hands busy and therefore, as he put it, keeping his weight down.

Although everyone knows that smoking is detrimental to health, it's surprising how many smokers cite fear of putting on weight as a reason to not quit smoking.

The simple fact is that it is not quitting smoking that affects your weight, but the change of habit can result in you increasing your food intake.

But there are plenty of ways to ensure this does not happen to you.

There is no need for a special diet when you stop smoking, but you must use your common sense. If you eat chocolates instead of smoking then you are very likely to gain weight!

Monitor your diet for a fortnight before you stop smoking - write a food diary, noting everything you eat and when. You simply use this to make sure that what you eat post-quitting follows a similar pattern.

In a similar way, note how much exercise you can do as a smoker. When you stop smoking, you can begin to compare how much more exercise you can do with ease. This will inspire you to the possibility of becoming fitter in other ways, and will actually help you through the tough period of giving up the addiction.

Even moderate amounts of exercise can reduce tobacco cravings. A recent study found that women that maintained a rigorous exercise regime coupled with a stop-smoking programme were twice as likely to succeed as those who didn't. Frankly, exercising is incompatible with smoking, and you are also more likely to be mixing with non-smokers.

Let's face it, if you smoke 20 cigarettes daily, you are putting your hand to your mouth at least 200 times a day. When you quit, you need to keep your hands busy. How about peeling fruit for snacks, doing jigsaws or maybe even knitting.

Keep visualising yourself as a fit non-smoker, especially when your motivation starts to flag. You can always get help with this through the use of hypnotherapy. As in so many behavioural issues, it is simply a matter of re-programming our mind. Giving up smoking is tough, and self-hypnosis is a method that many are discovering as a simple way to help keep the mental attitude and motivation on course.

Like the chap in the pub, you may find your own method of coping with your quit smoking challenge, and well.. if it works - great!

Good health!

About The Author


Keith Watson - 25 years as a registered nurse. Now writing about and promoting a holistic approach to health issues. To learn more about hypnosis as a therapy, visit http://www.adam-eason.com.











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Exercise And Quitting Smoking

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Exercise And Quitting Smoking by: Brenda Patterson

When you plan to stop smoking, bring about other changes in your life style as well. Take a look at all those things that have become a kind of routine and break that routine. Try to do things differently and will make a lot of difference.

What we are trying to do as part of this exercise is that we are trying to create a new environment for you. It is not possible for you to shift to a new apartment so bring about a few changes in the way things are as part of your exercise to quit smoking. Let every thing have a new feel about it. If there was a favorite chair in which you used to sit when you smoked, change the upholstery of the chair or maybe you could stash away the chair into a corner.

Try to set a new routine. Try working out or going to the gym. If that is not possible, try waking up a little earlier and go for a short morning walk. If you can make that a run or a jog, it is going to be very stimulating and is going to be the best way to start your day.

Exercise does not necessarily mean pumping metal. If you do have the time to go to a gymnasium everyday, then that is well and good. But I suppose most of us do not have the time for a regular work out in a gym. So what is the other alternative? Do it at home of course.

But whether it is at home or at a multi-gym, there is something that I want to tell you. Regularity is the rule of the day. It is not getting started that is the difficult part, it is sticking to a regular exercise routine that is difficult and this is what proves to be the stumbling block for most people.

Most people have a wonderful start. In fact it is truly spectacular. They buy track suits and gym-wear, running shoes and a whole lot of other gear. Their first day at the gym is almost a celebration. Then as the days go on, they find it increasingly difficult to meet the domestic and professional demands and so their routine slows down and finally comes to a complete workout burn out.

One mistake that many people make is that they choose the evenings or a work out. If that can suit your lifestyle, then that’s fine. But for most of us, by the time the evening lifts up its curtains we are completely pooped. We find ourselves physically and mentally drained. And at that time our bodies will be just too tired for a work out. So it is best to set aside some time for exercise in the morning itself.

There are two advantages of setting apart time in the morning. The first advantage is that in the morning our bodies are fresh and full of energy. Now over here I want to make one point clear.

Many people believe that exercise depletes the body of energy but the case is just the opposite. Exercise pumps up more blood through the different parts of the body and warms up the body, so in fact, after exercise we feel more charged and ready to face the challenges of the day.

The second advantage is that in the morning we can plan for the whole day without letting the exercise routine affect the rest of our activities.

What about those of us who have never worked out before? In such cases you might need to start off under the personal supervision of an instructor and that may require that you go to a gym. But what I would suggest is that there are two simple things that any one can do for which you do not need the help of any instructor.

You know what these are? They are walking and swimming. Any body can walk and those of you who know how to swim can swim. For these two activities you do not need much gear and experts say that these two exercises have no side effects and are excellent stress busters.

So in the morning wake up just half an hour earlier, put on your walking shoes and hit the roads. Most roads will be less crowded at this hour and less polluted too. It is a wonderful way to start a day.

Take a break form coffee and try tea instead. If you are moving around the house, try playing music. Redecorate your room by adding a few pictures here and there preferably of scenery. And while you are redecorating, do what I mentioned earlier that is get rid of every thing that even remotely reminds you of smoking.

Plan your day in such a way that you have something enjoyable to do at the end of the day. It does not have t be something that involves money. We do not want you end up bankrupt. It can be something as simple as spending some time with the family playing a board game or something. Or it can be going out for a walk together.

But I would like to add that watching television just does not fit into this list. The reason is because T.V is not something that demands too much of our attention. We can easily do something else while we are watching TV and what can be easier than taking a smoke while our eyes are glued to the T.V. While you are working on breaking the habit of smoking, you need to move about with people. You need the company of people who can take your mind off that craving and TV doesn’t help you do that.

Make a list of those things that build up your stress. Try to steer clear of them. If that is not possible try to find out some stress busters and use them. Do not use stress as an excuse to start smoking. There are a hundred other methods of beating stress. As mentioned earlier, you could try breathing exercises, mediation or even music. There is another excellent way of beating stress and that is using the distressing ball. If you do not have one of those, try wriggling your fingers and toes. That too is a natural method of beating stress.

The point that we are trying to drive home over here is that you need a break from whatever you have been doing for this exercise of quitting to work. Since it is impossible to change your job or your home, you have to bring about as many changes as possible to get that whole new feeling.

About The Author


Brenda Patterson

Are you ready to kick the habit? Don't go at it alone. We have well over 20 FREE tips, tricks, and suggestions to kicking the smoking habit once and for all! Come to http://www.yoursmokingsite.com today!











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42 Years Of Smoking by Frank Hague

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42 Years Of Smoking by Frank Hague


It is amazing I am not dead.

Why and how I managed to quit smoking.

Fifty three years ago I had a friend who was a girl (not an official Girlfriend).

Her mom smoked and worked away from home all day, an opportunity her daughter utilized to pinch her smokes and share them with me. Both our parents smoked as well.

So off and on I became accustomed to smoking; my smoking habit got a real boost when I joined the merchant marine service at the age of seventeen, because sailors are allowed to purchase cigarettes tax-free outsideof territorial waters.

Eventually I began smoking more and even more cigarettes and had to get out of bed two or three times nightly for an additional nicotine fix.

Life without cigarettes was just not imaginable.

Going on an airline was sheer torture because I was not allowed to smoke for two or three of hours.

On a flight from Canada to Singapore I sneaked a few of smokes in the washroom in spite of the fact that airplanes were already putting people in jail for smoking on board.

As the years went by half of my mother's family died of lung cancer.

My father's only sibling died of lung cancer.

My mother died of a brain tumor - she used to be a heavy smoker.

My father developed lung cancer.

After he got lung cancer he visited me; he looked like a pathetic skin on bones human, wearing a corduroy suit, however even at this point he still stood outside SMOKING IN OUR GARAGE.

My brother's wife has breast cancer; my brother smokes cigars, and second-hand smoke is known to cause breast cancer.

I personally began having coughing spells in the nighttime and the vision in my left eye began to deteriorate.

Me quitting smoking? Impossible : I've no willpower.

Because I knew I couldn't possibly quit I never even bothered to acquire Nicorette or any other smoking-cessation product.

So after a whole lifetime of smoking I knew I was going to die of lung cancer too.

However WAIT: the story isn't finished yet.

On September fourth, 2002 I was browsing in a Calgary bookstore called Black and Noble and a book jumped out at me.

It was a 385 page book called "How to Stop Smoking" by a British accountant named Allan Carr.

I glanced at the 1st couple of pages where the author boasted that his book was the only way to quit smoking without any withdrawal symptoms or even without a nocotine patch.

I bought the book because I was curious to see how anyone could write 385 pages about how to quit smoking.

I finished the book in 9 days.

On September 13, 2002 at 3 pm I took my last drag from a cigarette and exhaled it through a Kleenex. That was my last cigarette. Since then I have never even thought about smoking again. People can smoke all around me and I'm not even slightly tempted.

This book really changed my mindset. The book "How to Stop Smoking" by Allan Carr is not available in American bookstores, but can be found in Canada and at internet bookstores such as Amazon. I no longer have my smoker's cough and the vision in my left eye is back to normal.


About the Author
Frank Hague quit smoking at the age of 58, however, his little brother still smokes although his wife has breast cancer. http://www.youwillquit.com











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The Secret of Stopping Smoking - Without Cravings or Weight Gain

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The Secret of Stopping Smoking - Without Cravings or Weight Gain
By David Trevena


Do you remember hearing about that person who’d smoked their whole life since aged ten, forty a day, then woke up one morning and decided to quit? Crumpled the pack into the bin and never thought about it since. No cravings, no withdrawal symptoms. How did they do that?

A woman gets pregnant and stop smoking. She tells her friends, it was easy! What’s the fuss about? Then, a few years later, friends invite her to a party, offers her a cigarette and she thinks, ‘one won’t hurt’, and pretty soon she is back smoking again. She tells me, ‘I don’t have any willpower’. ‘You don’t?’ I ask. ‘So how did you stop for three years then?’ ‘That was then, I don’t have any now.’

But it wasn’t willpower that helped her quit - she had a reason.

Think of the time when you reached a decision, yet it was so easy it was almost as if there was no decision involved. You probably went on to accomplish your aim effortlessly and when people looked at you and commented, ‘lucky’!, you knew it wasn’t, because luck is when preparation meets opportunity. More likely the majority of your unconscious beliefs supported your decision.

You know of other times in your life, or a person you know who is always struggling, one step forward and two steps back, going round in circles, never getting anywhere. It’s not that they are weak, it’s just that they have conflicting (often termed negative) beliefs or mixed feelings.

These examples help us understand why some people find it so hard to quit, when others find it so easy. This is the first secret,

When you reach a decision, it’s easy to quit

However, reaching a decision can be tricky, can’t it? Because the problem for many people is that they have conflicts or mixed feelings about quitting. Although they know all the reasons to quit, (health, anti-social, money, smell, partner/ children etc) in spite of their best intentions, part of them still wants to smoke. ‘It’s my crutch,’ or, ‘a drink and a cigarette goes together’. You fear losing something if you quit.

In spite of all it’s dangers, smoking provides some people with a valuable benefit or ‘secondary gain’. A women with two young children tells me, “I really want to give up smoking, but when the children are misbehaving, it’s my opportunity to take ten minutes out for myself to de-stress. It’s ‘my time’. If I give up smoking, what will I do? (By the way, our client can learn a technique which relaxes them in seconds, anytime, any place).

Another example. Smokers often say, ‘It helps me relax’. If you think about it, this is puzzling because your heart rate usually goes up by ten beats a minute when you smoke - owing to all the stimulants in the tobacco. Hardly the response one would expect if you were relaxing.

As you grew up, into your twenties, you tended to smoke during social occasions. It was a bonding experience, sharing the pack of cigarettes around with your friends. Those sociable, fun, pleasurable experiences then became associated with smoking. This is rather like the TV advertisement, which mixes images of glamorous, exciting locations and attractive people with the product they are selling. After a while their product looks more interesting!

Recently a client explained: ‘It’s not that smoking relaxes me, it’s just that when the craving comes, unless I respond to it immediately, the tension mounts, then when I have that first puff, I feel a sense of relief.’ If you believe smoking helps you relax (and many smokers do) you are probably forgetting that the craving to smoke was the cause of your feeling stressed in the first place!

While we are on the subject, did you know that as well as taking the pleasure out of life, stress is a major cause of ill health? When you experience too much stress, your immune system is undermined and your defences against disease and ill health are weakened. You’ve heard the expression, ‘I was run down when I caught a cold’. When your immune system is depressed, you are vulnerable to whatever virus is about at the time. Of course there are viruses floating in the air, just as there are carcinogens (cancer producing agents) floating around in our bloodstream constantly. However, when you are healthy, your immune system neutralises them easily.

The second secret of quitting is to reduce stress.

You will have noticed that most people started smoking between the age of ten and twenty. Sociologists refer to this as the socialisation period, when we are extremely sensitive to being part of the group and anxious about being excluded. Remember back when you were at school? We started smoking then because we desperately wanted to fit in, we succumbed to peer group pressure.

Years later, you decide to quit and you may have experienced cravings, anxiety, bad temper and irritability. Yet these are common signs of habit breaking and not necessarily of chemical addiction. The part of you which protects your habits is battling with the part of you which wants to stop.

You’ve heard the expression, ‘Devil on one shoulder and angel on the other?’ Most people use this as a metaphor for mental conflict, when the two parts of the mind are battling against each other. When that happens, part of you is affirming, ‘I must not smoke’, ‘I must not smoke’, while the other part is egging you on saying, ‘Go on, just have one, one wont hurt.’

The problem is, as you know, one will hurt. It will re-trigger the habit and before long you will be smoking as many as you were previously.

It is these mental conflicts, or mixed feelings, which are the cause of the cravings and misery you may have experienced when you tried quitting previously. Finally you succumb to the pressure and light up that one and before you know it, you are right back into the habit again. That’s what happened to Francis Boulton of Royston:

“It is very disabling when you can't quit. I’d tried everything, gum, inhalers, patches and willpower. You start making excuses. ‘Not much point trying because I'll make everyone's life a misery. When I'd given up before I ended up with cravings, got aggressive as though everyone was against me. Starting an argument as a way of giving me an excuse to have the cigarette. I wasn't nice, very antisocial. I had got to the point of giving up giving up.

A close friend of mine had it done and I never would have imagined him giving up. He smoked more than me. It’s definitely given him a boost. He’s down the gym every day now, totally changed his life. Just like him, I had one session. It was fantastic, I had no pangs, nothing. You feel, if I can give this up, then I can do anything.

That was 18 months ago and I’m still excited. People ask me and I just say there’s not much to it, it’s just simple, there’s no hocus-pocus, no magic, you are not asleep, it’s hard to explain why it works because it’s so simple. I tell them, it just works.

I don’t endorse hypnosis to give up smoking. I endorse you. I work in London and there are lots of stop smoking services springing up, taking advantage. I recommend the Hertford Stop Smoking Centre. What does it matter if you take a day off and travel there? Just try it; it will change your life. - Francis Boulton of Royston

When we say smoking is a habit, we are not discounting the very real battle you may have experienced when attempting to quit. Habits are very powerful. Imagine trying to ‘forget’ how to swim or trying to ‘forget’ how to drive a car!

And remember, this particular habit began at a formative period in your life, when you were very sensitive to being excluded from the group. Because you wanted to fit in, you were determined to smoke. Remember that first cigarette? You coughed, choked, felt ill, nevertheless you were determined to smoke. Personally, I would have smoked if it killed me!

I remember, aged 15 in the woods at the back of the playing fields with a roll-up machine and pack of liquorice papers. I wanted to look like Clint Eastwood. That’s when all the Spaghetti Westerns first came out.

A client exclaimed, ‘That’s right! I used to practise in front of the mirror!’ She was checking to see she was holding it like the current film star. Another said, ‘I used to practise inhaling front of the mirror’. Do you remember inhaling? It was the macho thing in my group, you felt like a sissy if you couldn’t inhale.

But what about nicotine? Isn’t it addictive? It’s true that about 80% of the clients who visit us believe they are addicted.

A client I saw three years ago told me that his brother rang him prior to his session. Reminded him, ‘Even though I quit ten years ago, using willpower - and I’m never going to start again - I still get these cravings.’

You’ve probably heard a number of stories like that. Yet your GP will tell you that all the nicotine is out of your system within 48 hours. So what about all those people who still have cravings, weeks, months, years after quitting?

If you remain convinced that nicotine is addictive, you have to wonder why all the research indicates that patches, gum, in fact all the nicotine replacement methods aren’t very effective.

Method % who quit No. of subjects No. of trials
Nicotine patch (self referral) 13 2,020 10
Nicotine patch (Doctor initiated) 4 2,597 4
Nicotine gum (self referral) 11 3,460 13
Nicotine gum (Doctor initiated) 3 7,146 15

Effectiveness of nicotine replacement therapies to achieve smoking cessation. Chockalingham & Schmidt (1992). Law & Tang (1995).

The best results I’ve heard for patches is 16% effective. And yet that’s about half the success rate of a placebo (a fake medicine containing nothing). You have to ask yourself, how can ‘nothing’ be almost twice as effective as the most successful of the nicotine replacement therapies? This is what Stephen Porter of Hertford said:

“I’d stopped smoking previously for periods of two to five years but it’s always been an enormous fight, and one was always conscious that one would like a cigarette even after years of quitting. Patches were a complete and utter waste of time. I’d spoken to others who had stopped so I booked the appointment.

This time it was very easy. I had no desire to smoke after the one session. This was a huge difference from my previous experience. When I walked out after the session there was no desire, no withdrawal symptoms. I couldn’t really understand it, found it hard to believe. I tell people that what HSSC do is very effective. It has made it extremely easy for me to say no. It’s up to me now whether I chose to smoke – rather than being controlled by the tobacco habit. But since I don’t have any cravings, why would I want to?

After the session I quickly lost the smokers cough and, since I was on 40 a day, financially it’s made a huge difference. I don’t have to go to the cash machine so often. I’d certainly recommend this to other smokers, the bottom line is, it works.” - Stephen Porter, Hertford

Our discussion of the power of habits reminds me of a situation when I was calling on a friend socially. I didn’t have time to stop, so was chatting at the door. Perhaps a few minutes passed when I heard his telephone rang inside the house. My friend seemed oblivious to this, but I found my concentration wavering. The telephone rang again, there didn’t seem to be any movement inside the house, I found myself getting more and more agitated.

Then it rang a third time, and (although I didn’t actually do this), I could imagine elbowing past my friend and diving for the telephone, snatching it up with a gasp of relief! I would feel so relaxed, but my heart would have been pounding.

If this ‘rings a bell’ for you, it’s because you have also been trained to pick up the telephone before it rang three times. Maybe we need patches to stop picking up ringing phones!

This leads us to the third secret: You don’t need willpower to quit!

I tell clients that they don’t need willpower to quit, because willpower implies fighting against something. Many of our clients tell us that quitting was easy:

“I really didn’t expect it to work, but I proved myself wrong. Standing there with a drink, with friends smoking away it was no problem at all. I actually kept a pack of cigarettes in the car for 10 months, just in case, but I never felt tempted. I was on forty a day but I’ve never had cravings since that one session in November 2002.” – Simon Bennet, Bishops Stortford

I remember teasing a client, saying, ‘In any battle between me and you, you will win!’ Of course they already knew that, but I wanted them to realise I wasn’t going to fight them. Then I continued, ‘But you have to realise, in any battle between your conscious (one tenth above the surface) and unconscious mind, your unconscious will win, because it’s the nine tenths of the iceberg below the surface’.

So if you want to quit easily, without cravings or willpower, you need to realise that whenever there is a conflict between the conscious and the unconscious mind, the unconscious will win, every time, because the unconscious is around 90% of the total of the mind.

Using our specialist methods, our clients typically report that they quit smoking easily with no cravings. This is because we are able to resolve any conflicts at an unconscious level, and it is these conflicts or ‘mixed feelings’, which are the cause of the cravings experience by many quitters. However, when both parts of your mind are working together, becoming a non-smoker is effortless. That’s what Sally Sperring of Puckeridge discovered:

“I’d seen the Advert in the local paper with people saying how easy it was. I wanted to believe the Ad, but it was almost as though I booked the appointment to prove it wrong. During the hypnosis session I just didn’t feel hypnotised. I honestly thought it wasn’t going to work for me. I really expected that I would be feeling ‘way out’, ‘anaesthetised’ or something, but it wasn’t like that, I was aware of everything. Right after the session, it was just like the advert said. I just didn’t crave a cigarette. It’s wonderful and can’t believe how easy it’s been to be free from the weed at long last after 17 years. People who know me can’t believe how I’ve packed up smoking. I have told my story many times and people are fascinated. I’m over the moon AND I haven’t put on any weight.”

Weight Gain

Many of our clients are concerned about gaining weight. You may have experienced it yourself. When you gave up previously, you found yourself replacing the cigarettes with food. Some experience a kind of emptiness, or a feeling of, ‘something’s missing.’

If you’ve struggled with quitting, you are familiar with the battle between your willpower and the craving to smoke. You feel ‘torn’, ‘mixed up’, and if you are like most people, you feel those emotions in the pit of the stomach.

Years ago we learnt we could stuff down those uncomfortable feelings by filling our stomachs with food. Ah, that feeling of relief! But then a few hours later it comes back again, so you eat some more… and so it goes on. At some point you have gained so much weight that you think, This is ridiculous! I can’t go on like this… So you start smoking again.

But it’s not that smoking keeps you slim, ask any obese person who smokes! But for you, the conflict between your desire to quit and the habit of smoking is now resolved. Without that tense, churning feeling in your stomach, you can finally relax. You are no longer stuffing down your feelings with food. So now the weight can come off.

Our client often tell us they experience something quite different…

“That night, straight after the session, I went out. Lots of people were smoking but it didn’t affect me anymore. The cravings were gone, it was very strange, Really very peculiar. Every time I saw someone else it made me even more determined to remain a non-smoker.

I’m fitter now than I’ve ever been. I’ve joined a gym. I’ve lost over a stone and a half. It’s all been very positive. Three of my friends have also been now.- Danny Spalding, Hertford

In spite of previous experiences of weight gain, Kevin Lyth commented: “As a 20-30 a day smoker I had already tried will power and patches but they hadn't worked. I'd heard about the success of HSSC so I booked.

The session was very interesting. I wasn't expecting an in-depth talk prior to the treatment, but it answered all my questions and really opened my eyes to the truth about smoking.

It's eleven months now. I can smell and taste my food, which I certainly couldn't before. In spite of that, I've never felt any cravings to overeat. I haven't gained weight; in fact I've lost it.”

– Kevin Lyth, Hertford

Mick Andrews, a taxi driver from Harlow: “I keep leaflets in the back of my cab and when people ask, ‘Did you put on weight?’ I tell them, no and I don’t fiddle with my hands either, because I feel like I’ve never smoked.”

The fourth secret: Weight gain is often caused by mixed feelings

“When I’d tried previously, many times it hadn’t worked. My wife and people at work had said, for goodness sake, have a cigarette you look so miserable! This time it was different, just one session, and now, no struggle and no urge to eat or gain weight.

I don’t pressure my wife to stop, because I know it has to be her decision. But I’d say to you, if you want to quit call now. If you don’t, save your money. You will need it to buy your fags for the next six or seven weeks.”

- William Souch, Bishops Stortford

So now you’ve read four of the secrets, how do you feel about quitting now?

Discover Where You Are With This 'Quit Quiz'

Where are you in your decision to quit?

10 20 30 40 50 60 70 80 90 100%

Imagine never smoking again… Which of the following apply?

I can’t imagine relaxing without a cigarette
I’ll never get over my smoking addiction
A drink and a cigarette go together
I know I’ll be irritable without my cigarettes
There’s something missing
I’m afraid I’ll fail at quitting
I feel jittery.

Your Responses:

· If you checked 80% or over, congratulations! You are very clear about your decision to quit

· If you checked any of the questions, then you have mixed feelings about quitting. The more you ticked, the more conflicts you have! These mixed feelings have sabotaged you before. Now for the good news!

The fifth & greatest secret is that these conflicts are easy to resolve.

Prove it for yourself without risk! For the next ten days you can either

1. Book a free consultation. Experience how easy it is.

2. Or, purchase the Quit Kit from our website – money back guarantee. http://www.stopsmokingcentre.co.uk/products.htm

3. Or, if you want to book, just…

Call 0800 093 9714 (during UK office hours)

“I’ve had no cravings since the session. It feels as though I’ve never smoked. The main benefit has definitely been my health. I’ve also realised how freeing it is to be a non-smoker. It was dictating what I did, where I went. I never realised how much it was controlling me. Now I don’t worry about that, I can go anywhere I like. The treatment is life changing – simple as that.” - Sue Smith, Waltham Cross.

Dave Trevena
Stop Smoking in one hour at
The Hertford Stop Smoking Centre
http://www.stopsmokingcentre.co.uk

Article Source: http://EzineArticles.com/











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The Goetz plan: a practical smoking cessation program for college students

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The Goetz plan: a practical smoking cessation program for college students
College Student Journal, June, 2005 by Franklin B. Krohn, Kristin M. Goetz


Smoking is a serious health concern in today's society. College students represent a large portion of the smoking public and could have a unique opportunity to quit smoking with a college smoking cessation program.

One idea for a smoking cessation program is to offer a two-credit college smoking cessation course. The sessions would cover training about the health effects of smoking, smoking cessation aids available and include peer-counseling sessions. Student mentors, who were previous smokers, will provide support for students outside of the classroom and at the end of the semester students who were successful in quitting smoking will have the opportunity to become smoking cessation mentors themselves. Many smokers want to quit, but few succeed in it. Integrating this cessation program in a college course could aid student smokers in their quitting efforts.

Introduction

Tobacco smoking is responsible for approximately 434,000 deaths per year in the United States, which translates into about one in every five deaths. Environmental Tobacco Smoke (ETS) affects not only those who smoke, but those who are non-smokers as well. Because of their exposure to smoke given off by cigarettes, and smoke exhaled by those who smoke, non-smokers are forced to take part in "Passive Smoking". This exposure leaves them at risk to the consequent health effects of tobacco. Use of tobacco is known to cause adverse health effects such as lung cancer and heart disease. In 1992 the Environmental Protection Agency (EPA) issued a report indicating that exposure to environmental tobacco smoke presents a public health risk. Exposure to ETS is responsible for approximately 3,000 deaths per year in the United States due to lung cancer (Fact Sheet. 1993).

California, Texas, Massachusetts, and New York have all enacted smoke-free policies in indoor public places, including restaurants and bars. Tobacco companies and many restaurant and bar owners have strongly opposed such government regulation. Bar owners believe they will suffer an economic impact due to smoking customers not attending their establishment (Tang et al., 2003). However several studies have been conducted to examine the effect that smoking bans in bars and restaurants have, or possibly could have. Biener and Siegel (1997) demonstrated that approximately two-thirds of the 2356 respondents to a Massachusetts Adult Tobacco Survey reported that their patronage of bars and restaurants would not be affected if these facilities enacted smoke free policies. Due to the concerns of ETS approximately 40% of the respondents indicated that they avoided going to a place because of the tobacco smoke, and of these individuals, 40% had specified this as being bars or clubs (Beiner & Siegel, 1997).

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Previous prohibitions in the United States included alcohol and various forms of drugs. Although smoking has not been nationally prohibited, the restrictions placed on it are a form of prohibition. Alcohol prohibition became effective on January 16, 1919 with the 18th amendment to the constitution. This amendment prohibited, "the manufacture, sale, or transportation of intoxicating liquors within, the importation thereof into, or the exportation thereof from the United States and all territory subject to the jurisdiction thereof for beverage purposes" (Schaffer, 2004). National prohibition continued until 1933. Studies have shown that while initially alcohol consumption dropped after prohibition went into effect, it then increased to about 60-70% of its initial consumption (Miron & Zwiebel, 1991). The overall goal of prohibition was unsuccessful. People found ways to manufacture, sell and transport alcohol although it was a violation of the United States Constitution.

Tobacco Facts

Each year smoking contributes to about 115,000 deaths from heart disease, 106,000 deaths due to lung cancer, 31,600 from other cancers, 57,000 from chronic obstructive pulmonary disease, 27,500 from stroke and 52,900 due to other conditions related to smoking. The risk of dying from lung cancer is 22 times higher among male smokers and 12 times higher among female smokers, as compared to those who have never smoked. Smoking cessation can increase one's life expectancy. After quitting smoking the risk of stroke returns to the level of those who have never smoked. Coronary heart disease is the leading cause of death in the United States, and smokers have twice the chance of dying due to this disease versus those who are non-smokers. The risk of respiratory infections such as pneumonia, influenza and bronchitis increases due to smoking, and quitting smoking can reduce the risk. The mortality rate from abdominal aortic aneurysm is also anywhere from two to five times higher in those who are current smokers as compared to those who have never smoked and this risk is reduced to half if smoking is stopped. A few studies have even shown that those who quit smoking after being diagnosed with cancer consequently reduce their risk of acquiring a second primary cancer as compared to those who continue to smoke (Novello, 1990).

These numbers show a great need to reduce the number of smokers as well as preventing people from beginning to smoke. However people who smoke not only harm themselves, but those around them who are exposed to the tobacco smoke as well. ETS is a human lung carcinogen. In children the exposure can lead to an increase in the risk of respiratory infections and the chances that a child may have inner ear fluid. Exposure to ETS also increases the frequency of asthmatic attacks in children who have been diagnosed with asthma (Exposure to Environmental Tobacco Smoke, 2001).

Tobacco and Students

College students who tend to be frequent patrons of bars and clubs represent a large portion of the smoking public. Roughly 70% of college students have tried smoking. About one in five students who reported being current cigarette smokers also reported having smoked cigarettes daily. About half of the students who reported being current cigarette smokers, had also indicated having ever tried to quit (Everett & Husten, 1999). Everett and Husten (1999) reported on other studies conducted by Engels, Knibbe, DeVries, Drop (1998), and Zimmerman, Warheit, Ulbrich and Aus (1990) that heavy drinking and attendance at parties in which drinking occurs will tend to decrease the likelihood that these college smokers will try to quit and also decrease the chances of them being successful in quitting. Biasco and Hartnett (2002) reported that 69% of students surveyed at the University of West Florida agreed that smoking is unattractive, and 81% agreed it is unwise to smoke in an enclosed area. Over 34% agreed that there should be stricter laws against smoking.

Cessation Options

There are various methods available to assist in smoking cessation, some being nicotine chewing gum, nicotine patches, nicotine inhaler, nasal sprays, some antidepressant medications and counseling. The Food and Drug Administration (FDA), has approved the use of five first-line medications (nicotine gum, nicotine patch, nicotine inhaler, nicotine nasal spray and buprorion SR) use of these medications is known as pharmacotherapy (Reducing Tobacco Use: a Report of the Surgeon General, 2000).

Nicotine gum

Nicotine gum is an over the counter aid that is used to help people quit smoking. Nicotine is released when the gum is chewed and the nicotine is then released into the body. Nicotine gum is available in two different dosages, a 2mg dose and a 4mg dose; the 4mg dose may be more helpful for heavier smokers (Reducing Tobacco Use: a Report of the Surgeon General, 2000). The gum can help reduce the cravings that a person may experience when trying to quit smoking. Proper use of this aid includes: chewing one piece of gum very slowly when one feels the urge to smoke, not chewing more than one piece of gum at a time, and gradually reducing the number of pieces of gum chewed each day as the urge to smoke is reduced. One strong precaution when using nicotine gum is not smoking while using this treatment because of the risk of nicotine overdose (MedlinePlus Drug Information: Nicotine, 2003). Previous studies suggest that nicotine gum is an effective aid in smoking cessation and is more effective than placebo gum in cessation (Reducing Tobacco Use: a Report of the Surgeon General, 2000)

Nicotine Patch
The nicotine patch is another option in pharmacotherapy. The nicotine patch is available by prescription and as an over-the-counter medication. It is applied to the skin and releases nicotine through the skin and into the bloodstream. Dosage for nicotine patches are based on body weight, how often one has the desire to smoke, and the brand and strength of the patch that one uses. Proper use of the nicotine patch includes: Changing the patch at the same time each day and applying the patch to a dry clean area on one's upper body (MedlinePlus Drug Information: Nicotine. 2003). Merz, Keller-Stanislawski, Huber, Woodcock & Rietbrock, (1993) indicated that those who used the nicotine patch were about twice as likely to quit smoking. Previous studies have shown that the nicotine patch is an effective smoking cessation aid and those who used the nicotine patch had higher cessation rates than those who used placebo patches.

Nicotine Inhaler

The nicotine inhaler is a prescription medication, which is also used to aid in smoking cessation. It is a plastic tube about the size of a cigarette and contains a plug filled with nicotine and menthol, smokers puff on the inhaler as if it was a cigarette, and each inhaler contains enough nicotine for 300 puffs (Reducing Tobacco Use: a Report of the Surgeon General, 2000). Patients should not smoke when using the nicotine inhaler because of the risk of nicotine overdose, and should not be used for longer than six months (MedlinePlus Drug Information: Nicotine, 2003). Schneider, Olmstead, Nilsson, Mody, Franzon, & Doan, (1996) found that respondents given a nicotine inhaler had cessation rates of 17 percent vs. 9 percent for those who used a placebo at six months, and 13 percent vs. 8 percent at one year.

Nicotine Nasal Spray

Nicotine nasal spray is also a prescription medication that has been approved to treat tobacco dependence. The spray is delivered through the nose and contains .5mg of nicotine (Reducing Tobacco Use: a Report of the Surgeon General, 2000). The spray is used to reduce the effect of withdrawal from smoking. Use is gradually decreased and then finally stopped after the body has adjusted to not smoking. One to two sprays is used in each nostril every hour, and dosage should be adjusted based on the number of cigarettes one smoked each day. A precaution for using nicotine nasal spray is not using the nasal spray for more than three months because it may result in physical dependence of nicotine (MedlinePlus Drug Information: Nicotine, 2003).

Results from previous studies and clinical trials evaluating the effectiveness of nicotine nasal spray suggest that nicotine nasal spray does aid in smoking cessation. Sutherland, Stapleton, & Russell, (1992) indicated that 26 percent of those given nicotine nasal spray were still smoke free after one year compared to 10 percent of those given a placebo.

Bupropion (antidepressant)

Bupropion is a prescription antidepressant that has been approved by the FDA for use in aiding smoking cessation and has been found to be safe when used along with nicotine replacement therapy (Reducing Tobacco Use: a Report of the Surgeon General. 2000). When taking bupropion a target quit date is often set for the second week of treatment. It is not harmful to smoke while taking bupropion, but it will severely reduce chances of quitting (Smith, 2003). Hurt et al., (1997) compared three doses of bupropion (100mg, 150mg, 300mg) vs. placebo determining that the cessation rates were higher in the 150mg and 300mg dosage groups than the placebo groups at one year. Results from this and other studies suggest that bupropion is an effective aid to quitting smoking (Reducing Tobacco Use: a Report of the Surgeon General, 2000).

Counseling

Another option for help to stop smoking is counseling. This option may include individual or group therapy in which smokers are aided by health professionals to quit. There is a correlation between the amount of counseling and the effectiveness of it (Fiore, Bailey, Cohen, 2000). Fiore et al. (2000), reported that four sessions of intensive clinical intervention containing 30 to 90 minutes of counseling was more effective for smoking cessation by two to three times as compared to those with no counseling. Counseling treatments are effective and their effectiveness increases with greater intensity of treatment (Treating Tobacco Use and Dependence: Summary, 2000). A University of Rochester study found that a telephone hotline makes a difference in the success for smokers trying to quit. After one year in the study the participants who were provided with a manual and a hotline averaged around 11.9% cessation rates, as compared 8.1 percent cessation rates for participants provided with only a manual (Study Shows Hotline, 1991).

There are various forms of smoking cessation options available to college students, including; nicotine gum, nicotine patch, nicotine inhaler, nicotine nasal spray, bupropion and counseling. Integrating these into a smoking cessation program on college campuses may help college students in quitting smoking. U.S. Public Health Service published A Clinical Practice Guideline that outlines treatments for nicotine addiction for health care professionals and individuals wanting to quit smoking (Treating Tobacco Use and Dependence: Summary, 2000). Most smokers want to quit but only about two percent accomplish it successfully each year. The guideline states that combining behavioral counseling and pharmacological treatment can produce 20% to 25% cessation rates in one year, as compared to rates of 5% to 10% for less intense treatments such as brief physician advice (Management of Nicotine Addiction Fact Sheet, 2000).

Current College Cessation Programs

A study measuring college smoking policies and cessation programs discovered that 55.7% of respondents reported that their college health centers offered some type of smoking cessation program for college students (Wechsler, Kelly, Seibring, Kuo, Rigotti, 2001). Approximately 48% indicated their school having support groups, 31% of schools offered individuals counseling, and 27.6% offered medical intervention, 5.3% reported schools having workshops, forums, and or lectures, 2.8% of schools had participated in incentive programs, 1.3% had used peer education, and only .4% had used curriculum integration as part of smoking cessation programs. Even with all of these smoking cessation options, 88% of schools with smoking cessation programs indicated they had no waiting list for the programs offered, and 6.2% of schools indicated that smoking cessation programs had been discontinued due to lack of demand for them (Wechsler et al., 2001).

The Goetz Plan

Smoking is a serious health issue plaguing our society. Students attending college could have a unique opportunity to quit smoking with a more effective college smoking cessation program. Cigarette use peaks at ages 18-25 and the average age for daily use is 18 (Baker, Thomas, Brandon, & Chassin, 2004). This is the traditional age range for college students; therefore integrating a smoking cessation program on college campuses is targeting a large portion of the smoking population. College campuses provide a good location for smoking cessation programs. With the majority of college students located on, or close to campus, providing an on campus smoking cessation program can provide a central location for students to participate in the program.

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Smoking cessation before lung resection

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Smoking cessation before lung resectionCHEST, June, 2005 by Susan Murin

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A relationship between cigarette smoking and postoperative pulmonary complications has long been recognized. Both smoking-associated lung diseases and smoking itself have been shown to pose an increased risk for respiratory complications in the postoperative period, as variably defined in different studies, (1,2) but usually including some combination of pulmonary infection, atelectasis, bronchospasm, and prolonged ventilation. The development of pulmonary complications has, in turn, been associated with a higher postoperative mortality rate. (3) Former smokers have a lower rate of complications than current smokers, and, while it is logical to assume that getting our patients to quit smoking before surgery would translate into a lower rate of postoperative pulmonary complications, reality proves more complex. When it comes to smoking, smoking cessation, and perioperative complications, it's not just if you quit, but when you quit, that matters.

The benefits of smoking cessation on the incidence of perioperative pulmonary complications are not immediate. A reduction in the rate of perioperative complications is not seen until a period of abstinence of 5 to 8 weeks in duration. (4) However, more concerning than a delayed benefit from quitting smoking preoperatively is the potential for an adverse effect among recent quitters. Several studies have documented that smokers who cut back but do not quit entirely, (1) or quit but have been abstinent for < 2 months, (4-6) may have a higher rate of complications postoperatively--a higher rate not only in comparison to nonsmokers and those who quit in the more distant past, but a higher rate than continued smokers. While this is not an intuitive finding, it is one for which there is some basis in physiology. For example, sputum volume has been found to be an independent risk factor for pulmonary complications, (7) and smokers who have been abstinent for < 2 months have been demonstrated to have higher volumes of intraoperative sputum than those who have been abstinent for longer periods. (8) When one also considers the delayed improvement in the microbicidal and inflammatory functions of alveolar immune cells after cessation of smoking, (9) delayed recovery of ciliary function, and possible reduction in irritant-induced coughing that may occur with smoking cessation, the counterintuitive finding of increased complications in the first weeks to months after smoking cessation doesn't sound so odd.

The possibility of an increased rate of postoperative pulmonary complications among recent quitters has posed something of a dilemma for physicians caring for patients requiring surgeries for which a several-month delay may be imprudent. For emergent surgeries, of course, there is no opportunity for preoperative smoking cessation, making the point moot. For entirely elective surgeries with no pressure of time, waiting until at least 8 weeks after smoking cessation is recommended, to ensure that the full benefit of smoking cessation on risk reduction for perioperative complications has been achieved. However, for patients who require elective surgeries for which a several-month waiting period may be disadvantageous--such as our patients with lung cancer potentially curable by resection--the best advice concerning smoking cessation has been less clear. Do we advise them to quit immediately, and operate right away, knowing the interval between cessation and surgery will be < 8 weeks, potentially increasing the risk of postoperative complications? Do we advise them to quit and then wait 8 weeks before operating, risking the potential for tumor growth, upstaging, and worse outcome? Do we advise them not to quit until the day prior to surgery--long enough to decrease carboxyhemoglobin levels, but not long enough to increase the risk of complications?

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For patients with lung cancer, smoking is not just a risk factor for perioperative pulmonary complications. It is also the cause of their cancer, a factor associated with decreased survival (10) and poorer quality of life after cancer diagnosis, (11) and a risk factor for subsequent cancers. (12) In addition, smoking is a risk factor for nonpulmonary postoperative morbidities, including cardiovascular events, infections, and wound complications, and the incidence of at least some of these complications has been shown to decrease after only brief periods of smoking cessation. (13) The imperative and motivation to quit, and the practical and symbolic implications of quitting at the time of a diagnosis of lung cancer, are sizable. A cancer diagnosis presents a "teachable moment" for patients, and rates of smoking cessation shortly following a cancer diagnosis, particularly in conjunction with an intensive cessation program, are substantially higher than quit rates in the general population. (14) Given the teachable moment posed by the diagnosis of cancer, the long-term benefits of cessation, and potential benefits in terms of postoperative complications in organ systems other than the lung, there is a strong incentive to advise patients to quit immediately, even when the interval before surgery is < 8 weeks. Nonetheless, I've done so with some misgivings, given the potential for increased perioperative pulmonary complications in the recent quitter, and the imperative to "above all do no harm."

The study by Barrera and colleagues reported in this issue of CHEST (see page 1977) is an important one, taking on the issue of smoking cessation and perioperative complications specifically in patients undergoing pulmonary resection. With an enrollment of 300 patients, this study was not only the largest to date focusing specifically on patients undergoing lung resection, but was also methodologically very sound. It was prospective, enrolled consecutive patients, and considered only pulmonary complications of clear clinical significance: respiratory failure requiting intubation or ICU admission; pneumonia; atelectasis requiring bronchoscopy; pulmonary embolism; and need for supplemental oxygen at hospital discharge. Less clinically important pulmonary complications such as minor atelectasis or bronchospasm not resulting in respiratory failure were not included. Patients were categorized as never-smokers, past quitters (> 2 months previously), recent quitters (< 2 months previously), and ongoing smokers. The majority of patients were past quitters, with relatively few recent quitters and ongoing smokers. Pulmonary complications developed in 17% of the study cohort. The overall rate of pulmonary complications differed between never-smokers and smokers (in aggregate), but it did not differ among subgroups of smokers. Those who were recent quitters did not have an increased risk of pulmonary complications compared to those who continued to smoke. The absence of an increase in significant pulmonary complications among recent quitters undergoing lung resection provides valuable reassurance to the pulmonologists and thoracic surgeons caring for such patients.

The study does have some methodologic shortcomings that warrant mention. Smoking status was by self-report, and was not biochemically confirmed (though data collection methods minimized patients' incentive to mislead). The study was powered to detect a difference in the incidence of pulmonary complications between smokers (as a group) and nonsmokers, rather than between recent quitters and either ongoing smokers or nonsmokers, and there were relatively few patients in the subgroups of greatest interest: recent quitters and ongoing smokers (also true of many other studies of this question). Whereas the overall incidence of pulmonary complications did not differ between the recent quitter and ongoing smoker subgroups (23% in each group), the types of complications did differ; all of the complications in the ongoing smoker subgroup were pneumonias, whereas in the recent quitter subgroup there were fewer pneumonias but 10% of the patients were discharged on oxygen (vs none in the ongoing smokers) and respiratory failure developed in one patient. It is certainly possible that, for any particular complication, a true difference might exist between the recent quitters and continued smokers, but the small number of patients in each of these groups precluded detecting such an effect. To examine the comparative incidence of particular postoperative pulmonary complications would require a much larger study than is reasonably feasible.

Continued from page 1.

Does this study definitively lay to rest questions about smoking cessation, its timing, and pulmonary complications after thoracic surgery? No. But it's good enough to allow us, as clinicians caring for and advising patients who smoke and who require lung resection surgery, to strongly advise them to quit, without concern that we may be doing harm if the interval before surgery is < 1 to 2 months. We can maximize the value of the teachable moment posed by a lung cancer diagnosis without serious concern that we are exposing patients to an increased risk of clinically important postoperative pulmonary complications. So when it comes to smoking cessation before pulmonary resection surgery, the answer is yes, and the time is now.

Susan Murith, MD, MSc

Division of Pulmonary and Critical Care Medicine

UC Davis School of Medicine

Dr. Murin is Associate Professor of Clinical Internal Medicine, Division of Pulmonary and Critical Care Medicine, UC Davis School of Medicine.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.cliestjournal. org/misc/reprints.shtml).

Correspondence to: Susan Murin MD MSc Associate Professor of Clinical Internal Medicine, Division of Pulmonary and Critical Care Medicine, UC Davis School of Medicine; 4150 V St, Suite 3400, Sacramento, CA 95817; e-mail: sxmurin@ucdavis.edu

REFERENCES

(1) Bluman LG, Mosca L, Newman N, et al. Preoperative smoking habits and postoperative pulmonary complications. Chest 1998; 113:883-889

(2) Arozullah AM, Khuri SF, Henderson WG, et al. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 2001; 135:847-857

(3) Stephan F, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 2000; 118:1263-1270

(4) Nakagawa M, Tanaka H, Tsukuma H, et al. Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest 2001; 120:705-710

(5) Warner MA, Divertie MB, Tinker JH. Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients. Anesthesiology 1984; 60:380-383

(6) Warner MA, Offord KP, Warner ME, et al. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc 1989; 64: 609-616

(7) Mitchell CK, Smoger SH, Pfeifer MP, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 1998; 133:194-198

(8) Yamashita S, Yamaguchi H, Sakaguchi M, et al. Effect of smoking on intraoperative sputum and postoperative pulmonary complication in minor surgical patients. Respir Med 2004; 98:760-766

(9) Kotani N, Kushikata T, Hashimoto H, et al. Recovery of intraoperative microbicidal and inflammatory functions of alveolar immune cells after a tobacco smoke-free period. Anesthesiology 2001; 94:999-1006

(10) Fujisawa T, Iizasa T, Saitoh Y, et al. Smoking before surgery predicts poor long-term survival in patients with stage I non-small-cell lung carcinomas. J Clin Oncol 1999; 17:2086-2091

(11) Garces YI, Yang P, Parkinson J, et al. The relationship between cigarette smoking and quality of life after lung cancer diagnosis. Chest 2004; 126:1733-1741

(12) Richardson GE, Tucker MA, Venzon DJ, et al. Smoking cessation after successful treatment of small-cell lung cancer is associated with fewer smoking-related second primary cancers. Ann Intern Med 1993; 119:383-390

(13) Moller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359:114-117

(14) Browning KK, Ahijevyeh KL, Ross P Jr, et al. Implementing the Agency for Health Care Policy and Research's Smoking Cessation Guideline in a lung cancer surgery clinic. Oncol Nurs Forum 2000; 27:1248-1254

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group












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The pharmacotherapy of smoking cessation

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The pharmacotherapy of smoking cessation

Matthew J Peters and Lucy C Morgan
MJA 2002; 176 (10): 486-490
Abstract —
Introduction —
Basic neurobiology of smoking —
Nicotine replacement therapy —
Gum —
Patches —
Inhaler —
Use of NRT in cardiac disease and pregnancy —
Bupropion —
Dose and administration —
Side effects, precautions and contraindications —
Clinical management of the smoker prepared to quit —
Single-agent versus combination treatments —
Extended therapy —
Harm reduction and uncommitted quitters —
Smoking cessation and weight gain —
Mental illness, smoking and cessation —
Conclusion —
Competing interests —
References

Abstract
The great majority of smokers are chronically dependent on tobacco. This dependence arises from the rituals and sensory associations of smoking that are reinforced, within seconds, by a rapid burst of nicotine from the cigarette.

All forms of nicotine replacement therapy (NRT) — gum, patches and inhaler — and bupropion are safe and effective for increasing smoking cessation rates in the short and long terms.

Other than those who are minimally dependent, all patients willing to quit should be offered one of these therapies unless contraindications exist. The effectiveness of drug treatments is multiplied when associated with effective counselling or behavioural treatments.

While NRT is not recommended during pregnancy or in patients with cardiac disease, if the alternative is smoking NRT is almost certainly safe.

Combination NRT (more than one therapy) may be indicated in patients who have failed monotherapy in association with withdrawal symptoms.

There are some specific contraindications to the use of bupropion. Its subsidised availability should not influence prescribers to ignore these.

In Australia, cigarette smoking is the most significant cause of avoidable health harm. To reduce this, individual clinicians should follow the so-called five A's — Ask about smoking; Advise quitting; Assess current willingness to quit; Assist in the quit attempt; and Arrange timely follow-up.1 While this review focuses on the forms of drug therapy that assist cessation, these treatments should be coordinated with the general and specific support and counselling strategies that are also of proven benefit.2

Basic neurobiology of smoking
The great majority of regular smokers are dependent on cigarette smoking, and not simply addicted to nicotine.3 Smoking is highly contextual and associated with certain rituals. These start with the opening of a packet, followed by the lighting process and then the sight and smell of smoke. After inhaling smoke from a modern cigarette, arterial nicotine levels increase markedly within 15 seconds.4 This bolus of nicotine activates the brain-reward system by increasing dopamine release.5 This brain reward system is a common pathway for pleasurable activities (sexual activity, eating) and most drugs of addiction.6

This peak in plasma nicotine level, and the transient activation of the reward system, is followed by a gradual fall in nicotine levels into a state of withdrawal7 that is, in turn, relieved by the next cigarette. Dependence arises from the temporal association of the rituals and sensory inputs with the repeated stimulation and relief of withdrawal.2 This required association explains why nicotine replacement therapy (NRT) products, that deliver nicotine slowly and do not produce high plasma nicotine levels, have minimal addictive potential.8

Nicotine replacement therapy
The aim of NRT is to assist smoking cessation by providing a near-constant level of nicotine above that which is associated with withdrawal. No form of NRT can replicate the rapid nicotine delivery from a cigarette. The NRT formulations available in Australia include gum, patches and oral inhaler. Nicotine nasal spray and a sublingual tablet or lozenge are not presently available in Australia.

Gum
Gums contain nicotine (2 mg or 4 mg per piece) in a resin base. The gum should be chewed slowly, then left between the cheek and gum. Over the next 20–30 minutes, the gum should be chewed intermittently and repositioned. Because nicotine is poorly absorbed in an acid environment, acid drinks such as fruit juices should be avoided. As smokers may be conscious of the per-piece cost, there may also be a tendency to use an insufficient number of pieces or not to continue with treatment for long enough. It is preferable for patients to use gum on a regular basis. While extra doses may not rapidly increase nicotine levels, the process of their use is a ritual that is in some ways analogous to smoking, and this may be an advantage.

Patches
Nicotine transdermal patches are designed to release nicotine slowly. Immediately after application, there may be relatively rapid transfer of nicotine from the adhesive layer. In steady-state phase, nicotine will exist in the patch, in a skin "reservoir" and in the circulation. The presence of the skin reservoir reduces the rate of decay of plasma levels after the patch is removed. Patches come in a variety of dose strengths from 7 mg to 21 mg, and in preparations designed to be used for 16 or 24 hours.

Patches are applied each morning. The 16-hour preparations are useful for smokers who experience insomnia or other nocturnal symptoms. Patches should be applied on a rotational basis to a variety of non-hairy skin sites. Local skin reactions are the commonest adverse effect. This can be minimised by rotation among a number of sites of application, but can be severe enough to require discontinuation.

Inhaler
The inhaler is a plastic cartridge that is inserted into a mouthpiece. Gaseous nicotine is released by deep inhalation through the mouthpiece. Twenty minutes after the first deep inhalation, the device has released about 4 mg of nicotine. This process, as with patches and gums, does not release nicotine rapidly,9 but it does replicate some of the smoking rituals. After use, the device is spent and cannot be reused or recycled.

Use of NRT in cardiac disease and pregnancy
There is now quite extensive evidence that NRT is safe in patients with stable cardiac disease such as angina pectoris (E1)10,11 (for an explanation of level-of-evidence codes, see Box 1). Evidence is lacking in acutely unstable patients, but NRT would produce lower peak and cumulative nicotine exposure levels than smoking, without delivering the increased carboxyhaemoglobin and the many other vasoactive compounds in smoke. The issue of NRT use in pregnancy is a vexed one. In one randomised study, NRT by patch did not increase cessation during pregnancy, but did increase birthweight, perhaps by reducing total smoke exposure.13 The second issue is safety. Prenatal exposures to nicotine have important developmental effects, but, as total nicotine levels are lower with NRT than smoking, if the alternative is active smoking NRT is almost certainly safe in pregnancy.14

Because of residual safety concerns, use of NRT in pregnant women should be aimed at those who are moderately or highly dependent and have been unable to quit by other means.13 NRT is most likely to be effective if combined with high-intensity counselling. Careful supervision of NRT could include monitoring of urinary cotinine levels and use of non-continuous treatment — gum, spray and 16-hour, rather than 24-hour, patches. A key message here is that women contemplating pregnancy should try to quit beforehand, as pregnancy is not a time during which smoking cessation is easy to achieve.15

Bupropion
Bupropion was developed and first marketed as an anti-depressant. Although it is an effective antidepressant,16 it is not marketed for this purpose in Australia. Anecdotal observation of spontaneous smoking cessation in depressed smokers17 led to its further evaluation as an aid to smoking cessation,18 and the later development of the sustained-release form presently marketed as Zyban (GlaxoSmithKline). The suggested mechanism of action is inhibition of neural reuptake of dopamine or noradrenaline, but this may be simplistic.19 Bupropion is not related to other classes of antidepressants presently in clinical use. With the exception of nortryptiline, which has a weak effect, these other antidepressants do not increase rates of smoking cessation.1 There is no evidence that the antidepressant activity of bupropion contributes to its efficacy in smoking cessation.

Dose and administration
Treatment should commence at 150 mg daily for three days, then increase to 150 mg twice daily. The nominal target date for smoking cessation is Day 7 of treatment. However, some smokers lose the desire to smoke before this, and successful, long-term cessation is seen even in those who smoke beyond Day 7.20 The standard treatment period, subsidised under the Pharmaceutical Benefits Scheme in Australia, is nine weeks.

Side effects, precautions and contraindications
Nausea, insomnia and dry mouth are common early symptoms. The time to peak plasma level is three hours. Therefore, if insomnia is prominent, the evening dose may be taken early, but at least eight hours after the morning dose. Seizures are the major side effect of concern. When bupropion was initially used as an antidepressant, the seizure rate was one in 1000, similar to that with other antidepressant medications. With the slow-release formulation used for smoking cessation, seizures are even less common, but warnings associated with pre-existing conditions and concomitant medication, especially monoamine oxidase inhibitors and drugs that lower the seizure threshold, must be strictly followed.

Bupropion is absolutely contraindicated in patients with a history of epilepsy, and there is a relative contraindication in conditions that might increase the risk of seizures, such as type 1 or 2 diabetes. If it is to be used in patients with such conditions, it should only be after careful consideration of the risks and alternative treatment options, balanced against the benefits of cessation in the individual. Hypersensitivity reactions are the other adverse effects of concern. Facial oedema has been reported, as has a serum-sickness-like reaction.21 Adverse cardiovascular effects are rare. At last report, there had been 18 deaths associated with Zyban use reported to the Therapeutic Goods Administration (TGA).22 At present, bupropion should not be prescribed during pregnancy, as there is insufficient evidence to establish its safety.

Clinical management of the smoker prepared to quit
In counselling smokers about the optimal means to achieve cessation, clinicians should make an assessment of dependence. Box 2 shows the Fagerström test for nicotine dependence, which may be useful and is simple to administer.23 If there is not the opportunity to apply the Fagerström test, the number of cigarettes smoked daily and the interval between waking and first cigarette will give a rough guide to the degree of dependence. Some long-term smokers do have minimal dependence. They typically smoke small numbers of cigarettes, and may cease smoking for short or longer periods without withdrawal symptoms. This group is worth identifying, as such smokers should be able to quit without pharmacological assistance.

Drug treatments address some of the biochemical aspects of smoking, but are most effective when counselling or behavioural programs are used to redress the associated contextual and ritual elements (E1).2 The effectiveness of programs and products for smoking cessation needs to be judged against the "natural" rate of smoking cessation that is in the range of 1.5%–3% per year.24,25 Placebo success rates in all published drug treatment trials are typically higher, about 10%–15% at end of treatment and 5%–10% after one year, as participants are self-selected as interested in quitting and receive at least a minimum level of counselling.

Other than those who are minimally dependent, all smokers trying to quit should be advised to use one of the range of safe, effective treatments available (E1).1,2 All forms of NRT about double the chance of successful cessation (E1).26 The number of patients needed to treat to achieve one extra successful quitter is about 10. Patients report a preference for patches over gums, sprays or the inhaler and tend to use patches nearer to the fashion recommended, but these differences do not affect cessation rates.27

If the initial treatment is a nicotine patch, 16-hour and 24-hour patches are equally effective (E1). There is a modest increase in success for increases in delivered dose above 20 mg (E1).28 There is no need to adjust patch dose based on smoking level before cessation.29 Treatment periods should be at least eight weeks. There is no medical need to taper treatment, but the process of tapering is reassuring to some patients. Smoking while using patches has a trivial safety risk, but above all predicts a very low chance of successful cessation. If a patient is still smoking after seven days, the quit attempt should be terminated, with the intention of trying again at a later time.

If gum is used, 4 mg doses are associated with greater chance of cessation in smokers with higher dependency.30,31 Other than those who are minimally dependent, smokers should be advised to use 4 mg pieces (E1). Tapering to 2 mg doses later is intuitively logical, but of unproven benefit. If the nicotine inhaler is chosen, at least six cartridges should be used initially. Tapering the dose is recommended after three months without evidence to support this.

A range of studies have shown that bupropion increases the chance of success 2.1-fold, with the number needed to treat to achieve an extra successful quitter being 7.5.1 The one comparative study published found that bupropion (150 mg twice daily) produced a higher cessation rate than nicotine patch alone (E2).32 However, the quit rate with NRT in this study was lower than that generally found in other studies. In a second study, bupropion and NRT by patch were compared for their effect on late quitting from Week 4 onwards.20 Late quitting was more common with bupropion than NRT but this could be predicted from other studies. The likelihood of successful cessation with bupropion is not reduced in patients previously treated with bupropion.33

The choice of recommending NRT or bupropion will rest on individual patient characteristics and preferences. At present, in Australia, cost is an issue. Bupropion has an advantage in terms of ease of use and is the only smoking cessation agent currently subsidised under the Pharmaceutical Benefits Scheme (some forms of NRT are available on the Repatriation Pharmaceutical Benefits Scheme). Although this presents an economic advantage for the patient, contraindications should never be discounted.

Single-agent versus combination treatments
Current product information advises against concurrent use of different NRT formulations. However, higher abstinence rates are achieved when a patch is combined with ad libitum use of either 2 mg gum34,35 or nasal spray.36 Although there has been no direct comparison, the benefit derived from combination NRT is greater than that seen with higher-dose patches alone.37,38 Intuitively, this strategy should be employed in highly dependent smokers, but there is not yet evidence to support this. At present, the use of combination NRT is reasonable in moderate or highly dependent smokers who have failed cessation with monotherapy, particularly if withdrawal symptoms were prominent. The addition of nicotine patches to bupropion has not increased rates of cessation.32

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Smoking cessation

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Smoking cessation

Smoking cessation is the effort to stop smoking tobacco products. With nicotine an addictive substance, many people find it hard to stop smoking without help. Various approaches are available, both psychological and pharmacological, although success rates are relatively low. The have been numerous advertising campaigns to help people quit smoking in many countries around the world.

Contents
1 Outline
2 Statistics
3 Methods
3.1 Screening
3.2 Modalities
3.3 Alternative techniques
4 References




Outline
Smoking is not safe for anybody, and every smoker should be encouraged to stop. The benefits of quitting include decreased cost, a significantly decreased risk of smoking-related diseases and generally feeling better.

Psychological support, group therapy or cognitive behavioral therapy allows many people to quit. Medication helps these approaches, although medication without psychological support is generally discouraged and some of the medical therapies themselves have proven addictive and, potentially, dangerous.

Success rates are increased by a serious commitment to smoking cessation and regular follow-up. After successfully stopping tobacco smoking, quitters should consider ways they can change their lifestyle to improve their chances of not restarting, especially under stressful circumstances.

Although a significant proportion is successful, many fail several times. Many smokers find it impossible to quit, even in the face of serious smoking-related disease in themselves or close family members or friends.


Statistics
No smoking cessation methods have consistently achieved better than a 25% quit rate after six months. About 1.5%–3% of smokers manage to quit each year without support from health services. Enrollment into the placebo arm of medical trial and receiving a minimum level of counselling increases this rate to about 5%–10% after one year, partly reflecting participants' motivation.


Methods

Screening
Health professionals may follow the "five A's" in every person they come in contact with:

Ask about smoking
Advise quitting
Assess current willingness to quit
Assist in the quit attempt
Arrange timely follow-up

Modalities
Effective techniques to increase smokers chances of successfully quitting are:

"Five-Day Plan": Oldest and most effective way of quitting smoking through acceptance of addiction and realization of smoking's harmfulness
Going "Cold turkey": stopping by force of will
Nicotine replacement therapy (includes transdermal patches, gum and inhalers)
Specific support and counselling
Self-help books (Allen Carr etc.)
The antidepressant bupropion (Zyban®, contraindicated in epilepsy and diabetes)

Alternative techniques
Alternative techniques, from which many patients report benefit, include:

Hypnosis
Herbal preparations such as Kava Kava and Chamomile
Nutritional nicotine detoxification
Acupuncture
Laser Therapy based on acupuncture principles but without the needles

References
Peters MJ, Morgan LC. The pharmacotherapy of smoking cessation. Med J Aust 2002;176:486-490. Fulltext. PMID 12065013.
Retrieved from "http://en.wikipedia.org/wiki/Smoking_cessation"
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