Nicotine addiction is “highly underrated”. So bad is it for some that the addiction has been likened to the one of heroin, says Prof Chris Bolliger, pulmonary expert from the University of Stellenbosch's (US) Faculty of Health Sciences.

There are more factors involved in smoking addiction than mere nicotine addiction and these factors make smoking cessation a complex and challenging process.

Research has shown that most committed ex-smokers stick to their resolution after they’ve managed to abstain for at least one year.

According to a study conducted by Boston University’s School of Dental Medicine, only two to four percent of ex-smokers generally 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 available that may lead to a long-term solution, include nicotine replacement therapy (gum, inhaler or patches), the new drug Zyban, a combination of the above, the Smokenders programme, or quitting all by yourself. Choose the one that suits you best.

1. Nicotine replacement therapy (NRT)
According to Prof Bolliger, any form of NRT 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 for ex-smokers: Always carry a batch of gum or another type of NRT with you while you travel. "The urge could come at any time," says Bolliger.

2. Zyban alone
The antidepressant Zyban (bupropion) is the latest aid in smoking cessation. The medication seems to increase levels of dopamine and norepinephrine in the brain, leading to an enhanced feeling of pleasure.

Not only has buproprion been an effective tool in helping many smokers quit, but it seems to prevent relapse, according to researchers from the Mayo Clinic Nicotine Dependence Center. Unfortunately, the relapse-free period did not 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.

Some people should not use Zyban. People who should not take Zyban include:

• 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,
• hypertension,
• head injury,
• a brain or spinal column tumour,
• diabetes, or
• people using alcohol or benzodiazipine sleeping tablets.

Zyban is only available on prescription.

3. Combination therapy
Combination therapy, which involves counselling, the simultaneous administration of NRT (patches and/or gum) and/or the drug Zyban, seems to be an effective solution for many smokers. Preliminary research results indicate a 50 percent six-month success rate for combination therapy.

The dosage and usage of NRT and/or Zyban vary according to the individual. The usual recommendation is to take NRT and/or Zyban for three months – then you either make it or you don't. If you don't make it, it's not useful to try again immediately. Accept it and have another go in six months' time, is Bolliger’s advice.

Counselling forms an integral part of the Stop Project, a smoking cessation programme that is run at the US Faculty of Health Sciences.

4. Smokenders’ behavioural changes
Some experts do not regard NRT alone as a long-term solution, but as a temporary replacement. This replacement method doesn't address the core psychological factors involved in smoking addiction.

According to Mercia Axon, managing director of Smokenders, nicotine addiction is just one aspect of smoking addiction. This factor is being blown out of proportion, she says. The focus for long-term smoking cessation should be on behavioural changes.

"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 with clients. 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, Axon advises.

The group claims that they have a 92 percent success rate after a one-year period and a 70 percent to 75 percent success rate after a period of five years.

Bolliger, however, queries the high success rates of some smoking cessation programmes. He speculates that inaccurate feedback from clients may be boosting the figures.

5. 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. Men who drank more than five alcoholic drinks a day were more likely to relapse. Drinking more than six cups of coffee daily, also increases the risk for relapse.

These findings by the Boston researchers suggest that stress management techniques, like exercise or yoga, 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.

"Whatever works, is fine," Bolliger says. "In the end, most people stop by themselves."

- (Carine van Rooyen, Health24)