Smoking Cessation
Choices and Challenges
Updated by Peggy McMahon, RN, MSN, MPS
Workbook
Smoking Cessation, 1/2004, Revised 1/2009,
Updated 7/2009, T238-16-C24
Reproduction of material for use other than intended purpose
requires the written consent of OptumHealth.
Training Programs
© 2008 OptumHealth
Agenda
Introduction
Review Agenda and Learning Points
Opening Exercise
Explore Behaviors Associated With Tobacco Use
Personal Positives and Negatives
Reasons to Stop Smoking
Physiology
Effect of Nicotine on Body
Smokeless Tobacco
Health Benefits of Quitting
Process of Quitting
Stages of Quitting
Awareness
Visualization
Decision
Action
Methods
Medications
Maintenance
Ongoing Recovery
Symptoms of Withdrawal
Alternatives to Triggers
Closing
Personal Plan
Three Vital Steps
2
Learning Points
Learning Points
• Explore the behaviors associated with personal
tobacco use.
Breathing Free
An Introduction to Effective Smoking
Cessation Techniques
• Describe the physiology of quitting.
• Identify the process of quitting, including
methods and medications.
• Discuss recovery and maintenance.
• Make a personal plan for quitting.
Breathing Free Version 1
Reproduction of material for use other than intended purpose requires the written
consent of UBH.
Presented by Working Solutions
2
Live and work well.
©Working Solutions 2004
Participants will:
•
Explore the behaviors associated with personal tobacco use
•
Describe the physiology of quitting
•
Identify the process of quitting, including methods and medications
•
Discuss recovery and maintenance
•
Make a personal plan for quitting
It’s easy to quit smoking.
I’ve done it a thousand times.—Mark Twain
Consult your physician before beginning any smoking cessation program
or adopting any suggestions made in this handbook or by the trainer.
3
Explore Your Habit
Quadrant 1
Reasons I like to smoke
Quadrant 3
Reasons I want to quit
Quadrant 2
Reasons I hate to smoke
Quadrant 4
Reasons I want to keep smoking
4
Explore Your Habit (Continued)
Use Your Strengths; Plan for Your Weaknesses
Quadrant 1
Reasons I like to smoke
Weakness
Quadrant 3
Reasons I want to quit
Strength
Quadrant 2
Reasons I hate to smoke
Strength
Quadrant 4
Reasons I want to keep smoking
Weakness
My main strength:
I will use it by:
My main weakness:
My plan to get around it is:
5
Some Good Reasons
to Stop Smoking
From the following list, check your top five reasons for quitting tobacco. Of those
five items, put a * next to the one that is most significant to you.
_____
You will live longer.
_____
You will reduce your risk of stroke and heart attack.
_____
You will reduce your risk of getting a wide variety of cancers.
_____
You can save money.
_____
You will sleep better.
_____
You may become a calmer person.
_____
You will become less likely to have an accident.
_____
You will heal faster.
_____
Your children will be healthier.
_____
Your bones will be stronger.
_____
The environment will be cleaner.
_____
Your teeth will be cleaner and your breath, clothes, hair, home and
car will smell better.
_____
You will increase your sense of smell and taste, and decrease the
risk of gum disease.
_____
You will reduce the risk of an accidental fire in your home.
_____
You will have more energy and vitality.
_____
You will look and feel younger and slow down the development of
wrinkles.
_____
You will feel happy knowing you are doing something good for
yourself.
_____
You will have a powerful sense of accomplishment!
6
Smokeless Tobacco
Smokeless Tobacco
Smokeless tobacco is not harmless!
3
Not a safe choice
Plug, leaf and snuff are three smokeless tobaccos that have become more popular as
the number of adults smoking cigarettes has decreased. This doesn’t mean that
smokeless tobaccos are safe. Smokeless tobaccos are not safe alternatives to
cigarettes; they can lead to many health problems.
The effects of smokeless tobacco
The Surgeon General’s Advisory Committee has found that smokeless tobacco is
dangerous to one’s health.
Research has found that smokeless tobacco, as well as cigarettes, has many cancercausing substances. A recent study found that people who use smokeless tobacco are
almost four times more likely to get cancer of the mouth, lips and gums. (Third
National Cancer Survey.) The risks also add up the longer one uses smokeless
tobacco.
Other problems caused by using smokeless tobacco include gingivitis (gum disease),
tooth loss, and damage to the mucous membranes in the mouth, throat and nose. It
also has a number of fairly immediate and harmful effects as well; after only a few
years of using smokeless tobacco, open sores and scars may develop in the mouth.
Smokeless tobacco and pregnancy
Studies have found high levels of heavy metals, i.e. lead and cadmium, in the blood of
users; using smokeless tobacco while pregnant may harm the baby.
Smokeless tobacco and cigarettes
Smokeless tobacco also has some of the same effects as cigarettes. For example,
studies have found that, just like cigarette smokers, smokeless tobacco users will have
high levels of nicotine in the blood, a higher heart rate and high blood pressure.
Lastly, it is important to note that, just like cigarettes, the nicotine in smokeless
tobacco is addictive — causing a chemical dependence that’s very hard to break.
7
Health Benefits of
Quitting Smoking*
*Assuming no other illnesses and assuming individual is in otherwise 100 percent normal health
Health Benefits of Quitting
11 12
1
10
11 12
2
9
4
8
7
6
9
3
4
7
Blood pressure drops
6
1
10
2
8
5
11 12
1
10
3
5
2
9
3
4
8
7
6
5
CO level in blood drops to normal
2010
2009
Coronary heart disease
risk drops to half
2019
2026
Lung cancer
death rate
drops to half
Disease risks
same as
nonsmoker’s
4
Within 20 Minutes
Blood pressure drops to a level close to that
before the last cigarette; temperature of hands
and feet increases to normal
8 Hours
Carbon monoxide level in the blood drops to
normal
24 Hours
Chance of heart attack decreases
2 Weeks-3 Months
Circulation improves and lung function
increases up to 30 percent
Coughing, sinus congestion, fatigue and
shortness of breath decrease; cilia regain
normal function in the lungs, increasing the
ability to handle mucus, clear lungs and
reduce infection
1 Month-9 Months
1 Year
Risk of coronary heart disease is reduced to
half that of a smoker
5 Years
Risk of a stroke is reduced to that of a
nonsmoker 5-15 years after quitting
8
Health Benefits of
Quitting Smoking*
*Assuming no other illnesses and assuming individual is in otherwise 100 percent normal health
Health Benefits of Quitting
11 12
1
10
11 12
2
9
4
8
7
6
9
3
4
7
Blood pressure drops
6
1
10
2
8
5
11 12
1
10
3
5
2
9
3
4
8
7
6
5
CO level in blood drops to normal
2010
2009
Coronary heart disease
risk drops to half
2019
2026
Lung cancer
death rate
drops to half
Disease risks
same as
nonsmoker’s
4
10 Years
Lung cancer death rate decreases to about half
that of a continuing smoker’s; risk of cancer
of the mouth, throat, esophagus, bladder,
kidney and pancreas decrease
15 Years
Risk of coronary heart disease is that of a
nonsmoker’s
9
Stages of Quitting Tobacco Use
Stages of Quitting
Awareness
Toy with
quitting
Decision
Make plan;
engage
Visualization
support
Serious
intentions
Action
Involved in
activities of
quitting; select
method
Maintenance
Remain
smoke-free
5
I.
Awareness
Toying with the idea of quitting (70 percent of smokers)
» Keep thinking about quitting.
II. Visualization
Serious intentions to quit
» Mentally prepare; list reasons for quitting.
» Anticipate potential difficulties (withdrawal symptoms, lack
of support).
III. Decision
Making decision to quit; making plan; visualization
» Set a target quit date (to begin within next two weeks).
» Develop a plan for triggers, unexpected events, living with a
current user, possible relapse (note that relapse often occurs
within first three months).
» Review previous attempts to quit—what worked, what
didn’t.
10
Stages of Quitting
Tobacco Use (Continued)
Stages of Quitting
Awareness
Toy with
quitting
Decision
Make plan;
engage
Visualization
support
Serious
intentions
Action
Involved in
activities of
quitting; select
method
Maintenance
Remain
smoke-free
5
IV. Action
Actively involved in quitting tobacco use (Continuum of
activities)
Get support:
»
Inform family, friends, co-workers and ask for their
support. Note: not everyone may be supportive as they
may feel resentful of the change and their loss of a
“smoking buddy.”
Control your environment:
»
Toss out all tobacco paraphernalia—cigarettes, lighter,
matches, ashtrays, pouches, etc.
»
Clean clothes, car, carpet, furniture and draperies to get
rid of stale smoke smell.
»
Spend as much time as possible in nonsmoking
environments i.e. movie theatres, library—especially
during the first few difficult days and weeks.
»
Stay busy; change routine.
»
Gather resources—pamphlets, booklets, manuals,
videos, audiotapes, support groups, community
programs, hotline numbers, computer programs, etc.
11
Stages of Quitting
Tobacco Use (Continued)
Stages of Quitting
Awareness
Toy with
quitting
Decision
Make plan;
engage
Visualization
support
Serious
intentions
Action
Involved in
activities of
quitting; select
method
Maintenance
Remain
smoke-free
5
If cutting back to cut out tobacco
»
Switch to a brand you don’t like.
»
Determine the amount of tobacco you will allow
yourself each day.
»
Smoke half of the cigarette; draw a line on the cigarette
with a pen to mark the stop point.
»
Use your other hand to smoke with.
»
Buy one pack at a time (rather than carton) to make
smoking inconvenient.
»
Make tobacco and accompanying paraphernalia —
matches/lighters — difficult to find or out of reach.
»
Make using unpleasant, e.g. don’t empty ashtrays.
Wellness
»
Experience withdrawal—it is a normal process usually
lasting one to two weeks and is an important signal
your body is healing itself.
»
“Nothing bad lasts forever”—make it a point to get
through withdrawal so that you won’t need to
experience it all over again with another attempt to quit.
»
Become aware of the difference between
“overwhelming desire” to use vs. “effects of
withdrawal.”
»
Have teeth cleaned, buy a new toothbrush.
»
Eat healthy food and exercise moderately.
12
»
Have healthy oral substitutes available—hard candy,
gum, nuts, sunflower seeds, straws, stir sticks,
toothpicks, pencils, popcorn, etc.
Stages of Quitting
Tobacco Use (Continued)
Stages of Quitting
Awareness
Toy with
quitting
Decision
Make plan;
engage
Visualization
support
Serious
intentions
Action
Involved in
activities of
quitting; select
method
Maintenance
Remain
smoke-free
5
V.
Maintenance
Sustaining your role as a nonuser; avoiding relapse
»
Mark your progress and congratulate yourself on
successes—daily, weekly, monthly.
»
Recognize when you are in dangerous situations, for
example: arguing, bad moods, drinking alcohol, being
around other users, under pressure, stressed, etc.
The only reason we fail is that our desire
to succeed is not strong enough.
13
Methods of Quitting
Methods of Quitting
Self-help materials
Group
support/counseling
Behavior
modification
Alternative
therapies
Nicotine
replacement
Medication
Conditioning
Cold turkey
6
See Appendices A and B for a full discussion of a variety of methods for quitting tobacco.
•
Nicotine replacement
•
Cold turkey
•
Self-help materials
•
Group support/counseling
•
Alternative therapies such as hypnosis or acupuncture
•
Behavior Modification
14
Methods of Quitting (Continued)
Methods of Quitting
Self-help materials
Group
support/counseling
Behavior
modification
Alternative
therapies
Nicotine
replacement
Medication
Conditioning
Cold turkey
6
Medication
A vital step in quitting is to manage nicotine cravings. Many people have used
various medications to help them stop using tobacco. There are benefits and risk
factors associated with these medications. The Appendices will give you an overview
of the most widely used medications for tobacco cessation.
Methods I’ve tried before:
Methods I plan to use now:
A habit cannot be tossed out the window. It must be
coaxed down the stairs a step at a time .—Mark Twain
15
Symptoms of Recovery
Symptoms of Recovery
“Recovery is a journey. The goal is not
simply to quit, but to stay quit.”
~Terry A. Rustin, M.D.
7
Symptoms of recovery, also known as withdrawal symptoms, may vary in length depending
on the individual and may begin within a few hours after the last use of tobacco. Symptoms
peak within the first few days and may subside within a few weeks. For some people,
however, symptoms may persist for months or longer.
Some symptoms you may experience include:
___ Irritability and tension
___ Cognitive and attention deficits
___ Feelings of frustration and anger
___ Fatigue
___ Headaches
___ Increased appetite
___ Tightness in chest
___ Nervousness
___ Difficulty sleeping
___ Dry throat/mouth
___ Cough
___ Dizziness
___ Increased thirst
___ Hoarseness
___ Stiffness
___ Tingly fingers
___ Feelings of depression
16
Symptoms of Recovery (Continued)
Symptoms of Recovery
“Recovery is a journey. The goal is not
simply to quit, but to stay quit.”
~Terry A. Rustin, M.D.
7
Which of these are your biggest concerns? Place a check by the top five symptoms you are
most concerned about experiencing upon quitting.
Even though these possible symptoms may seem overwhelming, keep in mind that there are
many methods and tips that can help you deal with these symptoms. The following
segments will explain some of the stages that you might encounter and some recommended
steps/tips to help you quit using.
“Recovery is a journey. The goal is not simply to quit,
but to stay quit.” —Terry A. Rustin, M.D.
17
My Triggers
My Triggers
8
Become aware of your triggers, then prepare a tool box of alternatives. Refer to the
list you made at the beginning of the session. Other triggers may include:
 Anxiety

Having a drink
 Being around smokers

Insomnia
 Cravings

Irritability, anger and frustration
 Depression

Relaxing
 Difficulty concentrating

Restlessness
 Drinking coffee or tea

Remembering the good times
 Enjoying meals

Rewarding yourself
 Facing boredom

Talking on the telephone
 Facing the morning

Traveling by car
 Handling stress

Watching TV
My personal triggers:





18
Alternatives to Triggers
My Triggers
8
The following exercise can help you through the quitting process by developing
alternatives to tobacco triggers which you have identified. List 5-15 minute and 3060 minute alternatives that you think would work best for you in overcoming or
postponing the urge to use tobacco.
5-15 Minute Alternatives
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Color code pens on desk
Straighten desk drawers/locker
Clean purse/wallet
Weed small section of the garden
Organize tool box/tackle box, tapes, CDs
Brush teeth
Water the plants
Wash the leaves on the plants
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
19
Adapted from Rustin, Terry A., M.D. ©1994, Quit and Stay Quit, Center City, MN: Hazelden.
Used with permission.
Alternatives to
Triggers (Continued)
Three Vital Steps*
*Roberta Lee, MD. Beth Israel Medical Center for Health and Healing, More, June 2009.
Reprinted with permission
Become an exerciser
Fill the tobacco vacuum
Conquer Nicotine Cravings
9
30-60 Minute Alternatives
•
Exercise!!
•
Yoga
•
Walk around building/to car and back
•
Reorganize files
•
Learn a new job technique from co-worker/boss
•
Touch up paint on walls
•
Change oil in car
•
Needlepoint/knit
•
Read
•
Take dog for a walk
•
Take kids to the park
•
____________________________________
•
____________________________________
•
____________________________________
•
____________________________________
•
____________________________________
•
____________________________________
20
Alternatives to
Triggers (Continued)
My Triggers and
Possible Alternatives
Triggers
Alternatives
Argument
Go for a walk…
Driving
Sing, have car detailed…
After a meal
Brush/floss teeth…
Something to hold
Knit, doodle…
Need a “lift”
Mild exercise; chew gum;
read…
9
My Triggers and Possible Alternatives
Use your list of triggers from the opening exercise, choose the top five triggers that
cause you to want to use tobacco and list possible alternatives you can try instead.
Triggers
Argument with co-worker
Driving
After eating
Need something to hold
Need energy
Alternatives
Go for a walk; clean; take deep breaths;
journal
Sing; keep car smoke-free — have it detailed,
put potpourri in the ash tray
Brush and floss teeth; leave table
Hold pen/pencil, carrot, straw; knit; doodle;
call a friend
Mild exercise; chew gum; get enough rest;
read
1. ____________________________
________________________________
2. ____________________________
________________________________
3. ____________________________
________________________________
4. ____________________________
________________________________
5. ____________________________
________________________________
Adapted from Rustin, Terry A., M.D. ©1994, Quit and Stay Quit, Center City, MN: Hazelden.
Used with permission.
21
Personal Action Plan
Making A Plan
Determine current stage
Set goal quit date
Make list of three things you will
do within the next week to
prepare
Choose a method(s) to use
Identify your resources;
contact each one
10
Remember the three Vital Steps as you make your plan:
1. Conquer nicotine cravings.
2. Fill the tobacco vacuum.
3. Become an exerciser!*
I am currently in the ________________________ stage of quitting and within the next
two weeks plan to be in the ____________________stage.
My goal quit date is ___________________________.
The three things I will do within the next week to prepare for quitting are:
1._________________________________________________
2._________________________________________________
3._________________________________________________
The method(s) I will choose to help me quit is/are ______________________________.
What/who are my resources?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
22
*Lee, M.D., Roberta. Beth Israel Medical Center for Health and Healing, More, June, 2009. Reprinted with permission
Further Reading &
Additional Resources
The Journey…
“A journey of a thousand
miles begins with a single
step.” ~Lao Tzu
What one step will you take
today to get started?
Congratulations for moving toward being a non-smoker!
11
Books
American Lung Association. How to Quit Smoking Without Gaining Weight. Pocket, 2004.
Brizer, M.D., David. Quitting Smoking for Dummies. For Dummies, 1 Edition, 2003.
Dodds, Bill. 1440 Reasons to Quit Smoking: 1 For Every minute of the Day. Meadowbrook,
2000.
Ehrman, Jane Pernotto. Positive Affirmations for Being Smoke-Free: Guided Imagery for
Smoking Cessation. Playaway, 2009.
Ferguson, Tom. The No-Nag, No-Guilt, Do-It-Your-Own Way Guide to Quitting Smoking.
Ballantine Books, 1988.
Fisher, Edwin B. American Lung Association 7 Steps to a Smoke-Free Life. John Wiley &
Sons, 1998.
Herrick, M.D., Charles and Charlotte Herrick, RN, PhD and Marianne Mitchell, APRN. 100
Questions and Answers About How to Quit Smoking. Jones and Bartlett Publishers, 2009.
Holmes, Peter & Peggy Holmes. Out of the Ashes: Help for People Who Have Quit
Smoking. Fairview Pr., 1992.
Jones, David C. Yes! You Can Stop Smoking: Even if Your Don’t Want To. E and E
Publishing, 2007.
Kleinman, Lowell, M.D.; Deborah Messina-Kleinman, M.P.H.; Mitchell Nides. Complete
Idiot’s Guide to Quitting Smoking. Alpha Books, 2000.
Klesges, Robert C. & Margaret Debon. How Women Can Finally Stop Smoking. Hunter
House, 1994.
Mayer, Gerald S. When It Hurts Too Much to Quit: Smoking and Depression. Desert City
Pr., 1997.
23
Further Reading &
Additional Resources (Continued)
The Journey…
“A journey of a thousand
miles begins with a single
step.” ~Lao Tzu
What one step will you take
today to get started?
Congratulations for moving toward being a non-smoker!
11
McCall, Steve. How to Quit Smoking: The Cold Eagle Method. Eagle Reef Publishing, 2002.
Parkinson, D.C., Anthony. The Layman’s Guide to Smoking Cessation. Lulu.com, 2007.
Riley, Gillian. How to Stop Smoking and Stay Stopped for Good. Edbury Press, 2007.
Reilly, Thomas J. You’ve Got the Power: A Smoking Cessation Program. Booksurge
Publishing, 2006.
Stevic-Rust, Lori & Anita Maximin. The Stop Smoking Workbook. New Harbinger Pubns.,
1996.
West, Robert and SDaul Shiffman. Smoking Cessation (Fast Facts). Health Press, 2007.
Whelan, Elizabeth M.; American Council on Science and Health; American Council on
Science. Cigarettes: What the Warning Label Doesn’t Tell You: The First Comprehensive
Guide to the Health Consequences of Smoking. Prometheus Books, 1997.
Additional Resources
Due to rapid changes occurring on the Internet, we cannot guarantee the availability of these Websites.
www.cancer.org
www.nci.nih.gov
www.amhrt.org
www.nicotine-anonymous.org
www.lungusa.org
www.cdc.gov/tobacco
American Cancer Society
404-320-3333
National Cancer Institute
800-4-CANCER (800-422-6237
American Heart Association
800-AHA-USA1 (242-8721)
Nicotine Anonymous
415-750-0328
American Lung Association
212-315-8700
Office on Smoking & Health
800-311-3435
Centers for Disease Control and Prevention
www.quitnet.com
www.mayoclinic.com/print/chewing-tobacco/CA000019/METHOD=print
24
Appendices
A
Methods of Quitting
B
Further Information About Nicotine Replacement
C
Twelve Reasons to Kick the Habit
D
Tips for Immediately After Quitting
E
Weight Gain
F
Coping With Stress
G
Facts About Smoking
H
Secondhand Smoke
I
Smoking and Children
25
Appendix A: Methods of Quitting
Nicotine Replacement
•
Nicotine Patch
– Positives:
•
•
•
Doubles rate of success
Available over-the-counter
Steady, unchanging dose
No surge of nicotine levels
Only need to apply once daily
Minimal side effects
– Negatives:
No “rush” as with cigarettes
Side effects (depending on dose) include:
Dizziness/headache
Racing heartbeat
Stiffness and muscle aches
Nausea, vomiting
Skin irritations (redness/rash)
16-Hour Patch (Usually recommended for light to average smokers)
– Positives:
Less likely to cause side effects
– Negatives:
Does not deliver nicotine at night so is not helpful for early
morning withdrawals
24-Hour Patch
– Positives:
Steady dose of nicotine
Helps with early morning withdrawal
– Negatives:
More side effects such as disrupted sleep patterns and skin
irritation
Nicotine Gum
– Positives:
Available over-the-counter
Minimal side effects (good for people with sensitive skin)
You control nicotine dosage
Convenient
– Negatives:
Surges in nicotine levels
Have to use several times daily (limited to no more than 20
times/day)
Long-term dependence (not recommended for longer than six
months)
Side effects may include:
Hiccups
Mouth ulcers
Nausea
Jaw discomfort
26
Racing heartbeat
Throat irritation
Methods of Quitting (Continued)
•
•
Nicotine Nasal Spray
– Positives:
Easy to use
Delivers nicotine quickly to bloodstream through nose
Immediate relief of withdrawal symptoms
– Negatives:
Prescription only
Not recommended for people with asthma, allergies, nasal
polyps or sinus problems
Danger of using more than needed
Side effects which may last one to two weeks include:
Nasal irritation
Runny nose and watery eyes
Sneezing and coughing
Nicotine Inhalers (plastic rod with a nicotine plug)
– Positives:
Delivers nicotine vapor to mouth instead of lungs
Smoker may feel he or she is substituting some of behavioral
aspects of smoking
– Negatives:
Prescription only
Throat irritation
Coughing
Cold Turkey
– Positives:
– Negatives:
Self-help Materials
– Positives:
– Negatives:
Immediate health benefits with nicotine elimination
Low quit rates
Much information available and easily attainable
Low quit rates
Amount of information can be overwhelming for some
Group Behavior Therapy plus Nicotine Replacement
– Positives:
Support group
– Negatives:
Requires self-disclosure which may be uncomfortable for
some people
Physician Counseling
– Positives:
Support system
Can provide information and supplemental prescriptions if 27
appropriate
– Negatives:
Immediate access to physician can be limited
Some individuals intimidated by doctors
Methods of Quitting (Continued)
Acupuncture
– Positives:
–
Negatives:
Hypnosis
– Positives:
–
Negatives:
May decrease or eliminate cravings
May calm the nervous system which helps maintain willpower
Low quit rates
Uses suggestions to the unconscious mind to make smoking
unappealing
Low quit rates
Conditioning (Aversion therapy, i.e. rapid smoking, rapid puffing, additional smoke exposure)
– Positives:
Can reduce automatic or mindless smoking
– Negatives:
Can become physically ill
Low quit rates
Zyban (An antidepressant)
– Positives:
–
Negatives:
Controls cravings
Reduces withdrawal symptoms
Very effective with nicotine replacement
Prescription only
May be adverse side effects
Chantix (Latest prescription medication)
– Positives:
Blocks nicotine receptors in the brain which may make quitting
easier
Reduced withdrawal symptoms; reduced pleasure from smoking
More effective than the nicotine patch; more people were able to
remain smoke-free
28
Methods of Quitting (Continued)
–
Negatives:
May cause recurrence of old psychiatric illnesses or worsen
current psychiatric illnesses, even if under control
Side effects include nausea, headache, vomiting, gas, insomnia,
vivid/abnormal dreams, changes in the way food tastes
Those taking this medication may experience anxiety,
nervousness, tension, depression, unusual behaviors; thinking
about or attempting suicide
Should not be taken with other quit smoking medications
May affect ability to drive
Should not be taken if pregnant or breast-feeding
May alter effects of other medications or supplements
Behavior Modification:
This includes using filters, watching self in mirror while smoking, avoiding automatic
smoking, making smoking inconvenient, making smoking unpleasant (don’t empty
ashtrays, hold ashes in hand rather than use ashtray, smoke a brand you don’t like),
keeping a smoking record (number, time, place, reasons), cutting down on number smoked
per day, postponing smoking, smoking odd/even hours, finding new habits
– Positives:
Can help you quit (not a substitute for smoking)
Helps you become aware of habituate nature of smoking
– Negatives:
Requires regular monitoring and tracking
Requires you to participate in activities you may find unpleasant
29
Appendix B: Further Information
About Nicotine Replacement
— Nicotine Gum
How Do I Use Nicotine Gum?
• You must stop using tobacco all together when you start using the gum.
• Do not use more than 30 pieces of nicotine gum or 20 pieces of a different size dosage
of nicotine
• As your need to use smokeless tobacco goes away—usually within 2-3months—use
fewer pieces of gum.
• Stop when you are using 1 or 2 pieces a day—unless your doctor tells you otherwise.
• Carry the gum with you at all times in case you feel the need to smoke again.
Possible Side Effects
• More common side effects may include: bleeding gums, too much saliva, hiccups,
indigestion, slight swelling of the mouth, injury to teeth or cheeks, nausea, upset
stomach and sore throat.
• Less common or rare side effects may include: diarrhea, dry mouth, swollen gums,
tongue, throat, or mouth sores, muscle pain, rashes and sweating.
• If these or other symptoms develop or get stronger, inform your doctor at once.
Special Warnings About Nicotine Gum
• Nicotine gum has nicotine in it and is strong, potentially addicting medication. Follow
instructions to avoid side effects and addiction.
• Do not use the gum for more than six months: it can be harmful and addicting.
• Chew the nicotine gum slowly and follow your doctor’s instructions to avoid side
effects and addiction.
• Do not eat or drink 15 minutes before or while chewing the gum.
• If you develop an allergic reaction (hives or rash), stop using the gum and contact your
doctor.
• Before using nicotine gum, talk with your doctor about your medical history.
• The gum may be harmful if taken with other drugs/medications. Even mild drugs such
as caffeine or non-aspirin pain reliever can be harmful when taken with nicotine gum.
• Do not use the gum if you are pregnant, planning to become pregnant, or
breastfeeding.
30
Nicotine Gum (Continued)
Overdose
• Too much of any medication can have a serious outcome. Overdose may occur if you
chew too many pieces of gum or if you smoke while you are using the gum.
• Symptoms of nicotine gum overdose may include: stomach pain, fuzzy vision, cold
sweat, diarrhea, trouble breathing, trouble hearing, dizziness, exhaustion, fainting,
headache, low blood pressure, mental confusion, nausea, paleness, fast and irregular
pulse, too much saliva, “the shakes” and vomiting.
© 2006 State of Arizona. Funded by the Arizona Department of Health Services Office of Tobacco Education &
Prevention Program in partnership with the Mel & Enid Zuckerman College of Public Health at the University of
Arizona.
31
Appendix B: Nicotine Inhaler
What is a Nicotine Inhaler?
•
A Nicotine Inhaler is the only stop smoking aid that helps with both the physical and
psychological aspects of smoking.
•
A Nicotine inhaler, or the nicotine inhalation system, is a mouthpiece and a
cartridge, that looks much like a plastic, hollow cigarette, into which a nicotinefilled cartridge, is placed. A person breathes in nicotine-filled air through the
mouthpiece and refills the nicotine cartridge as needed.
Does the Nicotine Inhaler Work?
•
In two studies of more than 400 heavy smokers, those who used the Nicotine inhaler
were more likely to be smoke free six and 12 weeks after quitting than those using a
placebo inhaler.
•
After one year, when inhalers had not been used for six months, those who had used
nicotine inhalers were two times more likely to be smoke free. In one of the studies,
45 percent of those using the Nicotine Inhaler were smoke free after six weeks,
compared with 14 percent of those using the placebo. Nicotine Inhaler users were 11
percent smoke-free after a year compared with five percent in the placebo group.
How the Nicotine Inhaler Works
•
The person inhales about 30 percent of the nicotine found in a cigarette without the
tar and carbon monoxide and this helps to lessen the need or craving for cigarettes.
Craving is the most important withdrawal symptom, since it is the symptom that
keeps most smokers from being able to quit.
•
Since the Nicotine Inhaler is similar in shape to a cigarette, it helps to fulfill the need
to hold something in their hands while trying to quit.
•
Little nicotine is carried to the lungs, showing that most is absorbed in the
membranes of the mouth, very much like nicotine gum.
Possible Side Effects
•
Side effects were mouth and throat irritation from the nicotine, but this usually goes
away or lessens as people adjust their use of the product.
© 2006 State of Arizona. Funded by the Arizona Department of Health Services Office of Tobacco Education
& Prevention Program in partnership with the Mel & Enid Zuckerman College of Public Health at the
University of Arizona.
32
Appendix B: Nicotine Patch
What Do Patches Do?
•
Nicotine, the habit-forming drug in tobacco, is a stimulant, or mood lifter. When you
give up smoking, you give up nicotine. You want cigarettes and may also have such
feelings as being worried, angry, irritated, frustrated, restless or have concentration
problems. When you wear a nicotine patch, nicotine steadily goes out of the patch,
through your skin, and into your bloodstream, keeping an even, low amount of
nicotine in your body. This amount of nicotine is less than you would get from
smoking, but it may be enough to keep you from wanting cigarettes or having other
withdrawal symptoms.
Important Facts About Nicotine Patches
•
You should only use patches as part of a stop-smoking program that also offers ways
to change your smoking behavior through counseling.
•
If you have not stopped smoking after four weeks of using nicotine patches, it is likely
that the patch treatment will not work for you.
Possible Side Effects
•
The most common side effects that you may have are: itching and burning, a rash, or
redness of the skin in the place where the patch has been placed.
•
Less common side effects that you may have are: abnormal dreaming, allergic
reactions, back or chest pain, constipation, cough, diarrhea, dizziness, drowsiness, dry
mouth, headache, high blood pressure, impaired concentration, indigestion,
inflammation of sinuses, menstrual irregularities, nausea, nervousness, numbness,
pain, pins and needles sensation, sleeplessness, sore throat, stomach pain, sweating,
taste changes, tingling, vomiting, weakness.
•
It is important to see a doctor if you have any strong symptoms.
Special Warnings About Nicotine Patches
•
Do not use any form of tobacco while wearing a patch! You could overdose! Also,
know that nicotine stays in your body many hours after taking off the patch.
•
Do not use a patch if you have had an allergic reaction to other patches or adhesive
tape.
33
Nicotine Patch (Continued)
•
•
•
Before you use any brand of nicotine patch, make sure your doctor knows if you have,
or have ever had, any of the following: chest pain from a heart condition (angina),
diabetes requiring insulin injections, heart attack, high blood pressure (severe),
irregular heartbeat (arrhythmia), kidney disease, liver disease, overactive thyroid, skin
disease, ulcers or any other serious illness.
The effects of nicotine patches can change if you are using other medications, so
check with your doctor before using patches along with: Tylenol, No Doz, Dristan,
blood pressure medication, Insulin, Lithium, and many other drugs.
Used patches can poison a child or pet. Throw away your used patch by placing it in
its own wrapper or aluminum foil and throwing it out of the reach of children and
animals.
© 2006 State of Arizona. Funded by the Arizona Department of Health Services Office of Tobacco Education &
Prevention Program in partnership with the Mel & Enid Zuckerman College of Public Health at the University of
Arizona.
34
Appendix B: Chantix
What is Chantix (varinicline)?
•
Chantix is a prescription medicine to help adults stop smoking. It works best when
used as part of a stop-smoking program that helps you change your smoking behavior.
How does it work?
•
Chantix binds to nicotine receptors in the brain and thereby, blocks the ability of
nicotine to activate these receptors. The smoker does not feel the pleasure from
nicotine.
Who should NOT take Chantix?
•
Chantix has not been studied in children under 18 years of age and is therefore, not
recommended for this age group.
Tell your doctor before starting Chantix if you:
•
Have kidney problems or get kidney dialysis.
•
Are pregnant or plan to become pregnant. Chantix has not been studied in pregnant
women. It is not known if Chantix will harm your unborn baby. It is best to stop
smoking before you become pregnant.
•
Are breastfeeding. Although it was not studied, Chantix may pass into breast milk.
•
Tell your doctor about all your other medicines including prescription and
nonprescription medicines, vitamins and herbal supplements. Especially tell your
doctor if you take insulin, asthma medicines or blood thinners.
What are the common side effects?
•
Nausea
•
Sleep disturbance
•
Constipation
•
Gas
•
Vomiting
How effective is Chantix?
•
In studies comparing Chantix to a placebo (sugar pill), persons who took Chantix were
about 3.5 times more successful at not smoking after 12 weeks than persons who took
a placebo.
© 2006 State of Arizona. Funded by the Arizona Department of Health Services Office of Tobacco Education &
Prevention Program in partnership with the Mel & Enid Zuckerman College of Public Health at the University of
Arizona.
35
Appendix B: Zyban
What is Zyban?
•
Zyban (bupropion hydrochloride) is a prescription medicine that does not contain
nicotine and helps people quit smoking. For many people, it cuts down on cravings
and withdrawal symptoms such as: irritability, frustration or anger, anxiety, trouble
concentrating, restlessness and depression.
•
Zyban should be used with a personalized support program such as phone counseling
or cessation classes.
Does Zyban Work?
•
One study found that smokers using Zyban quit smoking more than smokers using a
nicotine patch; using both Zyban and a nicotine patch helped even more. Everyone in
the study was also given brief individual counseling to stop smoking.
How Does Zyban Work?
•
Zyban works with the chemicals in the brain — dopamine and norepinephrine — that
are associated with nicotine addiction, cravings and withdrawal symptoms.
•
You do not have to stop smoking when you begin using Zyban. It is recommended
that after two weeks of using Zyban, you should stop smoking and follow the rest of
the treatment plan.
You Should Not Take Zyban if You:
•
Have a seizure disorder, for example, epilepsy.
•
Are taking Wellbutrin, or any other medicines that have bupropion hydrochloride.
•
Have or had an eating disorder, for example, bulimia or anorexia nervosa.
•
Are currently taking or have recently taken a monoamine oxidase inhibitor (MAOI).
•
If you drink alcohol. It is best not to drink alcohol while taking Zyban. If you drink
alcohol and suddenly stop, you may increase your chance of having a seizure. It is
very important to talk about this with your doctor.
•
Are pregnant or breast-feeding.
Possible Side Effects
•
You may get dry mouth and have trouble sleeping. These effects should be mild and
often disappear after a few weeks. If you have trouble sleeping, avoid Zyban too close
to bedtime. A few people get skin rashes and shakiness and have had to stop using
Zyban. If you get a rash or a more serious side effect, contact your doctor or health
care professional.
36
© 2006 State of Arizona. Funded by the Arizona Department of Health Services Office of Tobacco Education &
Prevention Program in partnership with the Mel & Enid Zuckerman College of Public Health at the University of
Arizona.
Appendix C:
Twelve Reasons to Kick the Habit
1. You will live longer.
According to the Centers for Disease Control and Prevention (CDC), men who quit
smoking between ages 35 and 39 add about five years to their lives. Women in this
age category who quit, live about three years longer. If you quit between ages 65 and
69, you'll probably live about a year longer.
2. You will reduce your risk of stroke and heart attack.
Research at Harvard Medical School shows that smoking doubles your risk of stroke.
Smoking also adds the equivalent of 10 years of aging to your arteries, say researchers
at the Bowman Gray School of Medicine in Winston-Salem, N.C.
3. You can save money.
If you're a pack-a-day smoker who spends about $3.50 per pack, that's about $1275 a
year you could save or spend on something else.
4. You will sleep better.
Smokers often have trouble falling asleep and report more nightmares than
nonsmokers, say researchers at the University of Wisconsin at Madison. The
stimulating effects of nicotine, nightly nicotine withdrawal and breathing difficulties
are all factors that may make it difficult for smokers to sleep soundly.
5. You may become a calmer person.
Your need for nicotine can make you irritable, anxious and tense.
6. You will become less likely to have an accident.
According to the CDC, smokers are 1.5 times more likely to have an automobile
accident than nonsmokers.
37
Twelve Reasons to Kick
the Habit (Continued)
7. You will heal faster.
University of Texas Southwestern Medical School researchers found, on average, a
smoker's broken bone will take almost twice as long as a nonsmoker's to heal. And
researchers at the Baylor College of Medicine found quitting smoking speeds recovery
from wounds and surgery.
8. Your children will be healthier.
Children of smokers are more likely to be sick with coughs and colds and have weaker
lungs than children of nonsmokers, according to the American Academy of Pediatrics.
These children also have a higher risk for ear infections and hearing problems,
bronchitis, pneumonia and asthma.
9. Your bones will be stronger.
Australian researchers found that women who smoke a pack a day begin menopause
with five to 10 percent less bone than nonsmokers.
10. The environment will be cleaner.
The U.S. Environmental Protection Agency (EPA) classified secondhand smoke as a
Group A carcinogen, meaning it is one of the most toxic substances released in the air
known to cause cancer. Other Group A carcinogens include benzene (also found in
cigarettes), radon and asbestos.
11. Your breath will smell better and your teeth will be cleaner.
Smoking not only causes bad breath, it marks your teeth with a yellowish stain.
12. It's never too late.
According to the American Cancer Society, within five years after quitting, your risk of
lung cancer is cut in half. Within 15 years, you are no more likely to develop lung
cancer than someone who has never smoked.
©1999 Optum. All rights reserved.
Reprinted from the Taking Care program, "I'm Going to Kick Those Butts."
38
Appendix D:
Tips: Immediately After Quitting
1. For the first few days after you quit, spend as much free time as possible in places where
smoking is prohibited—libraries, museums, theaters, churches.
2. Drink large quantities of water and fruit juice.
3. Avoid alcohol, coffee and other beverages that you associate with smoking.
4. Strike up a conversation instead of a match for a cigarette.
5. If you miss the sensation of having a cigarette in your hand, play with something else such
as a pencil, a paper-clip, a marble.
6. If you miss having something in your mouth, try toothpicks, cinnamon sticks or celery.
7. Avoid temptation by staying away from situations you associate with pleasurable smoking.
8. Find new habits and develop a nonsmoking environment around you.
9. Stress constructive, not destructive, thinking to lessen discomfort.
10. Avoid resuming the habit by anticipating future situations or crises that might lead to
smoking, and assert your reasons for not giving in.
11. Take deep rhythmic breaths similar to smoking to relax.
12. Remember your goal and the fact that the urge will eventually pass.
13. Think positive thoughts and avoid negative ones.
14. Brush your teeth.
15. Do brief exercise—isometrics, pushups, deep knee bends, walk up a flight of stairs or touch
your toes.
16. Call a supportive friend.
17. Compile a list of "Urge Activities" and start at the top when it hits.
18. Eat several small meals. This maintains constant blood sugar levels and helps prevent the
urge to smoke. Avoid sugary or spicy foods that trigger a desire for cigarettes.
19. Above all, reward yourself. Plan to do something fun for doing your best.
39
Appendix E:
Weight Gain
•
•
•
•
Not everyone gains weight during the quitting process.
Average weight gain is 5-10 pounds.
Less than four percent of those quitting gain more than 20 pounds.
Nicotine increases metabolism so there may be weight gain even if there is no change in
calorie intake; it may be necessary to cut up to 200 calories a day.
•
There is a physiological basis to increased appetite and cravings for sweets.
•
Fat from diet may be converted to body fat.
However:
•
Health benefits of not smoking far outweigh the effects of adding a few pounds.
•
Individuals are more likely to be successful with quitting smoking if they deal with
smoking first and later take steps to reduce their weight.
How to Reduce Weight Gain and Stress
•
Eat plenty of fruits and vegetables; limit fat intake.
•
Drink plenty of water.
•
Eat a good breakfast and don’t skip meals. You may want to eat four smaller meals
each day rather than two to three larger meals.
•
If you need a snack, make sure its low calorie/low fat/low sugar snacks.
•
Limit caffeine, alcohol, sugar and chocolate, especially if these trigger a desire to
smoke.
•
Take multivitamins.
•
Get plenty of rest.
•
Exercise regularly:
– Set a goal of 30 minutes of physical activity three or four times a week.
– Walking is great exercise and routinely will increase the chances of successfully
staying quit.
– Regular exercise helps:
• Reduce stress
• Burn calories and tone muscles
• Keep your mind off smoking
• Alleviate or reduce the temporary sense of depression some individuals
experience
It’s not whether you get knocked down.
It’s whether you get up again. —Vince Lombardi
40
Appendix F:
Coping With Stress
The Relationship Between Thinking, Feeling and Behaving
Stress-Reducing Thoughts
Stressful Thoughts
“I cannot do this.”
“I don’t know how to do this, but I have
learned new tasks before. I am sure I can get
on top of this, too.”
“This is awful! I cannot believe it!”
“Okay, this is not good. However, it is not the
end of the world.”
“Oh my gosh, what a mistake I’ve
made.”
“Well, at least this is fixable. I am human and
I make mistakes.”
Relieving Stress
•
•
•
•
•
Take time out to breathe, stretch, nap, meditate or exercise.
Get it off your chest because bottling your feelings just increases stress.
Talk to a loving friend or relative.
Reward yourself.
Schedule more fun.
Relaxation: Breath Awareness
Sit in a balanced position. Settle into your chair so you feel as little strain as possible on your
lower back or abdominal muscles. Imagine a cord attached to the top of your head, pulling your
spine perfectly straight and aligned from the top of your head to the bottom of your spine.
Move your feet around until they are both comfortably placed on the floor, approximately one
and one-half feet apart and with your calves perpendicular to the floor. Lift your hands and
drop them to your thighs. Now visualize the cord being cut and allow your head to move very
slowly to a comfortable position.
Take a deep breath and gently and easily exhale.
Allow your next breath to be the one your body takes itself and watch your abdomen expand as
you breathe in and contract as you breathe out.
When you feel settled into your breathing, say to yourself on the in breath, “ I am...” and on
each breath out, “...relaxed.” Allow your body to slip into relaxation easily and comfortably.
Continue this practice and soon you will be able to relax simply by taking a deep breath.
41
Appendix G:
Did You Know…?
Smoking Increases Morbidity and Mortality
•
Smoking is the No. 1 preventable cause of death in the United States.
•
Each year smoking kills more people than AIDS, alcohol, drug abuse, car accidents,
murders, suicides and fires combined!
•
Statistically, smokers die 10 to 12 years younger than nonsmokers.
•
Smoking is the main cause of bronchitis, emphysema and lung cancer.
•
Over 10 million people in the United States have died from smoking-attributable causes
since the first Surgeon General’s report on smoking and health in 1964.
•
Dropped cigarettes are the leading cause of residential fire fatalities.
Women and Smoking
•
Smoking causes an increased risk for cervical cancer.
•
The lung cancer death rate among women has increased by more than 400 percent during
the past 30 years and is continuing to rise.
•
Since 1987, more women have died each year from lung cancer than breast cancer, which
was the major cause of cancer death in women for more than 40 years.
•
Smoking dramatically increases the risk of heart disease if oral contraceptives are used.
•
Tobacco use has a damaging effect on a women’s reproductive health; smoking
contributes to complications during pregnancy, early menopause and reduced fertility.
•
There is an increased risk of miscarriage, stillbirth, pre-term delivery and infant death. It
is also a cause of low birth weight in infants.
•
Infants are more likely to die from Sudden Infant Death Syndrome (SIDS) if their
mothers smoke during pregnancy or resume smoking after delivery.
42
Did You Know…? (Continued)
Nicotine
•
Nicotine can act as both a stimulant and a sedative. After exposure to nicotine,
adrenaline is released into the body which causes a sudden release of glucose as well
as an increase in blood pressure, respiration and heart rate.
•
Nicotine suppresses insulin output from the pancreas, which means that tobacco users
are always slightly hyperglycemic.
•
Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug
levels peaking within 10 seconds of inhalation; smokeless tobacco delivers higher
concentrations of nicotine than cigarettes do.
•
Nicotine is a poisonous alkaloid found in tobacco and used in insecticides. At higher
doses, such as that which can be found in some insecticide sprays, nicotine can be
extremely toxic, causing vomiting, tremors, convulsions and death.
•
Nicotine poisoning has been reported from accidental ingestion of insecticides by
adults from ingestion of tobacco products by children and pets. Death usually results
in a few minutes from respiratory failure caused by paralysis.
43
Appendix H:
Secondhand Smoke
•
•
•
Secondhand smoke is also known as Environmental Tobacco Smoke (ETS) or
passive smoke. ETS is a combination of:
Sidestream smoke:
a mixture of smoke produced at the burning ends of
cigarettes, cigars, pipes
Mainstream smoke:
exhaled by the smoker
ETS contains the same harmful chemicals as the smoke that smokers inhale. In
fact, because sidestream smoke is formed at lower temperatures, it gives off
even larger amounts of cancer-causing substances.
Secondhand smoke is now classified as a Class A Carcinogen (this class
includes only 15 other substances such as Asbestos, Radon and Benzene).
Secondhand Smoke Can Cause Lung Cancer in Nonsmokers
•
•
A nonsmoker who is married to a smoker has a 30 percent greater risk of
developing lung cancer than a nonsmoker living with a nonsmoker.
Secondhand smoke causes:
– 3,000 lung cancer deaths in nonsmokers annually
– Heart disease, lung cancer and other cancers resulting in over 60,000
deaths annually
44
Appendix I:
Smoking and Children
Secondhand Smoke Is a Serious Risk to Children
•
•
Causes ear infections; causes a build-up of fluid in the middle ear, a sign of chronic
middle ear disease
Causes and worsens asthma and other acute respiratory infections such as bronchitis
and pneumonia
Parents Are Important Role Models
•
Parental smoking influences attitudes toward smoking at a young age. Children of
parents who smoke:
– Are twice as likely to begin smoking
– Assume smoking is an acceptable way to handle stress and boredom
– Develop a positive attitude toward smoking
– Are more tolerant of the unpleasant effects such as odors and stale smoke
45