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Smoking cessation strategies

Nicotine patches
The most successful strategies for quitting are those that combine a behavior modification plan (changing the "habit" part), with a pharmacological aid (nicotine skin patch or nicotine gum) to alleviate the physical craving for nicotine.

You may question that if nicotine is so bad for your health, why would we suggest using the patch? The nicotine in the patch is absorbed without the combustion of a cigarette, so the bronchial airways are not aggravated. Also, using the patch instead of smoking eliminates over 4,000 chemicals, including many that cause cancer. It is easier to give up the nicotine patch than cigarettes.

Nicotine skin patches come in three different strengths:

    1. 21 mg (some of the patches are listed as 23 mg, but this is equivalent to 21 mg absorption)
    2. 14 mg
    3. 7 mg

If you smoke a pack of cigarettes per day or more, the usual recommended program is: four weeks of the 21 mg patch, followed by four weeks of the 14 mg patch, then two to four weeks of the 7 mg patch.

One patch should be placed each morning. Some people who have tried to place them at night have had difficulty sleeping. If the patch is too strong, you may also experience vivid Technicolor dreams. It is common to feel a little light-headed when the patch is first placed, similar to the "nicotine buzz" you may have experienced with your first cigarette. If, however, you experience prolonged dizziness, irritability, palpitations, headaches or nausea, contact your physician. The dose of the patch may need to be decreased. If the strength of the patch is decreased, increase the number of weeks you use it. The most successful cessation has occurred when the patches are used for a total of 10-12 weeks.

Choose a non-hairy, clean, dry area of your chest or upper arm for placement. Remove the old patch. Take off the protective liner of the new skin patch and press it firmly to a different area of your skin for 10 seconds. Wash your hands in case some of the nicotine has gotten on your hands.

The patch may be worn while bathing, showering or working out. The adhesive should be strong enough for the patch to stay in place.

REMEMBER: IT IS IMPORTANT NOT TO SMOKE WHEN WEARING THE SKIN PATCH. You may overdose on nicotine if you smoke with the skin patch in place. Even if you have decreased to only one to three cigarettes per day, with the skin patch in place you are actually getting more nicotine in a 24-hour period than smoking two packs of cigarettes per day. You must be ready to quit before you start using the patch. Nicotine patches help to curb some of the unpleasant withdrawal symptoms from nicotine. They are not magic. You have to convince yourself to quit.

DO NOT CUT SHORT THE USE OF THE PATCH! People who are most successful in using nicotine patches for smoking cessation are those who follow a 10-12 week program.

Nicotine gum
Some people prefer nicotine gum over the patch. The advantage of the gum is that you have something in your mouth to substitute the oral need from your cigarette. The disadvantage is that it is more difficult to obtain a steady nicotine level with the gum than the patch.

As with the patch, DO NOT COMBINE CIGARETTE SMOKING WITH USE OF NICOTINE GUM! The nicotine gum is available in 2 mg or 4 mg (double strength). When using the gum, chew it slowly until a tingling or peppery taste is in your mouth (usually about 15 chews). Then "park" the nicotine gum between your cheek and gum. This allows the nicotine to be absorbed through the lining of your mouth and into your bloodstream. Start to chew the gum again when the peppery taste or tingling returns, park the gum in a different spot between your cheek and gum. Repeat this until most of the nicotine is gone (usually about 30 minutes).

Most people find that nine to 12 pieces of gum per day will control their urge to smoke. DO NOT USE MORE THAN 20 PIECES OF THE 4 mg (double strength) GUM OR MORE THAN 30 PIECES OF THE 2 mg STRENGTH PER DAY.

As the urge to smoke decreases, gradually use fewer pieces of nicotine gum. Slowly decrease over two to three months. Every four to seven days, you can reduce the number of pieces of gum per day by one. For example, if you are using 12 pieces a day, begin using 11 pieces after four to seven days. Then four to seven days later, use 10 pieces per day. You may also begin to decrease the time you use the gum. Use some pieces for only 10-15 minutes instead of 30 minutes. Keep decreasing the number and length of time you use the gum over two to three months until you are completely free of nicotine.

Tips to help you quit

    1. Plan on smoking your last cigarette sometime before you go to bed. Then, when you wake up in the morning, you have an eight-hour head start at quitting.
    2. Be prepared to change your habits. If you normally have a cigarette with your morning coffee, skip the coffee and have juice instead. Or have your breakfast in the non-smoking section of a restaurant. If you smoke a cigarette during your mid-morning break, keep working through the break or use the time to take a brisk walk.
    3. Keep a pen in your hand to simulate the feeling of holding a cigarette. Go ahead and fidget. It's better than smoking.
    4. Chew gum, candy, carrot sticks, pencils or ice cubes.
    5. Exercise helps relieve tension and it gives you something to do. It also reinforces your commitment to good health.
    6. Drink plenty of liquids. Not only do they help satisfy your oral cravings, they also cleanse the body of those unhealthy chemicals.
    7. Cravings last only a few seconds. Each time you suppress one, they get further and further apart, until you can go days without even thinking about a cigarette.
    8. When you have a craving, take a deep breath, hold it for 10 seconds, then release it slowly. This simulates the act of smoking and helps provide some relief.
    9. Brush your teeth immediately after a meal. This signals that eating has stopped. Your mouth will feel fresh, and you'll have no desire to pollute it with a nasty cigarette.

Quit day checklist

Get rid of all smoking materials:

  • Destroy cigarettes by wetting them down or breaking them in half.
  • Discard or give away all matches, lighters, cigarette cases and containers
  • Clean and remove all ashtrays from your home, work and car

Vary your daily routine by:

  • Change the order in which you do things, especially in the morning
  • Don't sit in your favorite easy chair
  • Eat lunch in a new restaurant
  • Talk on the phone in a different room or hold the phone in the opposite hand
  • Spend more time in parts of your home or office that aren't associated with smoking
  • Avoid people who smoke, if possible
  • Listen to a different radio station; rent some new videos rather than watching your usual TV programs
  • If you associate smoking with driving, try taking the bus for awhile

After meals, instead of smoking, try:

  • Getting up from the table immediately after eating and washing your hands or doing the dishes
  • Brushing your teeth
  • Going for a walk
  • Using mouthwash

Make sure you get enough sleep every night.

Shower or bathe in the morning and the evening.

Begin an exercise program. Exercise a minimum of 10 minutes every day:

  • Walk, jog or run
  • Do calisthenics or aerobic dance
  • Swim
  • Ride a stationary bike or use a rowing machine