The benefits of smoking cessation are clear: for instance, only 20 minutes after a smoker’s last cigarette, blood pressure and heart rate start to return to normal. Yet millions of smokers find it virtually impossible to quit.
Part of the problem is that nicotine addiction is highly underrated. To compound the difficulty in quitting, there are more factors (e.g. psychosocial factors) involved than straightforward nicotine addiction.
It's also a long-term process. Research from the Boston University’s School of Dental Medicine indicates that most committed ex-smokers stick to their resolution after they’ve managed to abstain for at least one year. According to the study, only two to four percent of ex-smokers pick up the habit again each year after the initial two-year period. The very best results, yet to be scientifically verified, indicate a maximum success rate of 50 percent after six months, an estimated 35 percent after one year, and an estimated 30 percent after two years.
Some of the options that may lead to a long-term solution include nicotine replacement therapy (gum, inhaler or patches), the drugs Zyban and Champix, combination therapy, the Smokenders programme, or quitting unassisted. Others swear by the E-cigarette and by Allen Carr's Easyway to Stop Smoking Programme.
Here is a brief overview of some of the options:
1. Nicotine replacement therapy (NRT)
Any form of NRT (gum, inhaler or patches) increases the success rate of a smoking cessation programme. All the different types of NRT have been shown to be effective, with little or no side-effects.
NRT can be regarded as a temporary solution that helps smokers get past the first hurdle on their journey to long-term smoking cessation.
A tip: always carry a batch of gum or another type of NRT with you while you travel. The urge could come at any time.
2. Zyban (bupropion)
The antidepressant Zyban (bupropion) seems to increase levels of dopamine and norepinephrine in the brain, leading to an enhanced feeling of pleasure. Buproprion seems also to prevent relapse, according to researchers from the Mayo Clinic Nicotine Dependence Center.
The relapse-free period did not, however, persist: at the end of the first year, 55% of the Zyban group in the Mayo Clinic study were still smoke-free, but two years later, similar numbers of the Zyban and non-Zyban groups had relapsed.
Longer-term treatment of bupropion may prevent relapse, but more research on the long-term benefits of Zyban is necessary before definite conclusions can be drawn.
Zyban should not be used by:
- people with seizure disorders such as epilepsy,
- those who have shown an allergic response to bupropion,
- people with a current or prior diagnosis of bulimia, anorexia nervosa or bipolar disorder,
- people with a liver disorder,
- kidney problems,
- heart problems,
- head injury,
- a brain or spinal column tumour,
- diabetes, or
- people using alcohol or benzodiazipine sleeping tablets.
Zyban is only available on prescription.
3. Champix (Varenicline)
Champix (varenicline tartrate) is a prescription medicine to help people stop smoking by reducing the urge to smoke.
Make sure your prescribing doctor knows your medical history and any other medications you’re taking. Also be sure to mention if you are using any other chemical smoking cessation methods, and whether you have experienced smoking withdrawal symptoms previously.
Depending on medical conditions you have had, it may not be advisable for you to take Champix, or you may need a reduced dose. For example, Champix may not be suitable if you have had mental health problems like depression, heart disease or kidney disorders. It is also not yet recommended for pregnant or breastfeeding women.
Champix has been associated with various side-effects, which have received a lot of attention in the media. The most controversial reported side-effects are those relating to mental disturbances: some people have had changes in behaviour and mood, including hostility, agitation, depression and suicidal thoughts or actions. If you or those close to you notice any marked changes in behaviour or mood, stop taking the drug and call your doctor immediately.
In fact (and this always applies to any new medication): report any changes to your doctor without delay. Champix has also been linked to various other physical side-effetcs, including allergic skin reactions.
All medications have potential side-effects, and it’s important to discuss with your doctor whether these outweigh the negative effects of smoking on your health, or whether you would do better on an alternative smoking cessation method.
4. Combination therapy
Combination therapy, which involves counselling and the simultaneous administration of NRT (patches and/or gum) and/or medication, seems to be an effective solution for many smokers.
While counselling in combination with other treatments can only be beneficial, it's important to discuss the combined use of NRT and medication (Zyban or Champix) with your doctor, as doing so may cause an increase in side effects. The interactions are also not well studied.
Counselling forms an integral part of the Stop Project, a smoking cessation programme that is run at the University of Stellenbosch Faculty of Health Sciences.
5. Smokenders’ behavioural changes
Some experts don't regard NRT alone as a long-term solution, but as a temporary replacement. This replacement method doesn't address the core psychosocial factors involved in smoking addiction.
According to Mercia Axon, managing director of Smokenders, the focus for long-term smoking cessation should be on behavioural changes - and not NRT. "Most smokers will recognise that the emotional bond with their cigarettes is the biggest issue. Our programme gives people a stress-management tool and helps them to reconstruct their emotional support system," says Axon.
The international Smokenders group specifically deals with the emotional and psychological aspects involved in smoking. These factors are addressed during seven group sessions. Long-term success is linked to appropriate ways of managing emotions and stress – without cigarettes. The first six months is the most difficult period for many smokers. Clients who feel the urge to light up during this period should contact their counsellors immediately.
6. Kicking the habit on your own
Quitting all by yourself is not easy, but not impossible.
The biggest reason for relapse, in general, is that the quitter feels anxious about being without his cigarettes. Other reasons include missing the pleasure of smoking, feeling pressurised by family members or friends who smoke, or feeling addicted. The Boston research found certain lifestyle habits to be an indicator of likelihood of relapse: more than five alcoholic drinks or more than six cups of coffee daily.
Research suggests that stress-management techniques, like exercise or meditation, can play an important role in long-term success, whether you want to stop by yourself or join a programme.
People who are committed to stop smoking should make it easier for themselves by monitoring their diets to prevent weight gain and cutting back on excess alcohol and caffeine intake to limit the risk of relapse.