special subjects
Smoking Cessation
Treatment for Smoking Cessation
Counseling and support in changing behavior Usingnicotinereplacement products Using certain medications Quitting is most likely to be successful by combining counseling and support with medication therapy (except for unusual cases). Seven medications are effective for smoking cessation. Health care practitioners can recommend ways to change behavior, provide education on cessation medications, write prescriptions, and offer helpful referrals for additional support. All U.S. states have telephone quit lines that can provide additional support for people trying to quit. People can call the national 1-800-QUIT-NOW (1-800-784-8669) number to connect with counseling services for their state. Quit lines seem to be at least as effective as in-person counseling. The National Cancer Institute's web site (Smokefree.gov) is a comprehensive resource for quitting smoking with information, treatment planning, and personalized behavioral counseling via text and live chat. Hypnosis, lasers, herbal treatments, and acupuncture have not proved to be effective for smoking cessation. For people who use smokeless tobacco products, counseling and support in changing behavior appear to be effective, while the evidence fornicotinereplacement and other medications is weaker. Behavioral strategies are recommended for quitting smoking. Behavioral strategies are focused on Making the surroundings smoke-free (for example, throwing out all cigarettes, ashtrays, and lighters and avoiding places where people typically buy cigarettes and/or smoke) Recognizing cues to smoking that occur during normal daily activities (such as phone conversations, coffee breaks, meals, sexual activity, boredom, traffic problems and other frustrations, as well as on awakening) After recognizing a cue to smoke, changing the behavior triggering the cue (for example, taking a walk instead of a coffee break) or substituting another behavior for smoking (for example, sucking on candy, chewing on a toothpick, holding ice, doodling, chewing gum, or doing puzzles such as crosswords) Engaging in pleasant activities and rewarding efforts to stay smoke-free (for example, listening to music, talking with friends, putting saved money into a money jar) Other recommended strategies include engaging in physical activities, deep breathing, and relaxation techniques as well as drinking water and eating low-calorie snacks and fiber-rich foods. People may want to avoid drinking alcohol or using marijuana because both substances can temporarily lower a person's resolve to quit smoking. Selection of a quit date is very helpful. The quit date may be selected arbitrarily or set on a special occasion (such as a holiday or anniversary). A stressful time, such as when a deadline (for example, a tax deadline) needs to be met, is not a good time to try to quit. If others in the home also smoke, it is important to make the home smoke-free. Quitting cigarettes completely (cold turkey) is better than gradually decreasing the number of cigarettes smoked. People who smoke fewer cigarettes may unconsciously inhale more deeply or smoke down to the filter, and thus get as muchnicotineas they did before. Nicotinereplacement therapy (NRT),bupropion, andvareniclineare all medication-based therapies that help minimize the discomfort ofnicotinewithdrawal, thus allowing people to focus on the behavioral aspects of quitting smoking. Nicotinereplacement therapyis available in a variety of formulations, including patch, gum, lozenge, and nasal spray. All providenicotineto the brain but without the quick hit of a cigarette. The speed at which a medication reaches the brain increases its addiction potential. Hence, very few people become dependent on thenicotinereplacement products. The patch, gum, and lozenges are available for purchase over-the-counter; the nasal spray is available in the United States by prescription only. Previously available by prescription, thenicotineinhaler was discontinued in the United States in 2023. Thenicotinemouth spray is available in many countries outside of the United States, but is not approved in the United States. Combinationnicotinereplacement, which typically combines the long-actingnicotinepatch with a shorter-acting formulation (gum, lozenge, or nasal spray) is a particularly effective strategy, which more than doubles the chances of quitting smoking over the long term. Nicotinereplacement products have a few cautions: People with jaw (temporomandibular) disorders should not use the gum. People with severe skin sensitivity should not use the patch. These products may have harmful effects in pregnant women. People who have had heart attacks recently or certain blood vessel disorders should talk to their doctor before using one of these products. Bupropionis a prescription antidepressant that was found to help with smoking cessation in people with and without depression.Bupropioncan be used in combination with anicotinereplacement product. Together, they have a higher success rate than either alone. The results of both medications are best when used with a behavior modification program. People at risk for seizures should not usebupropion. Varenicline,another prescription medication, helps lessen cravings and withdrawal symptoms, makes smoking less rewarding, and increases success with quitting over the long term.Vareniclineworks in two ways: It partially blocks the receptors in the brain that are affected bynicotine, which eases withdrawal symptoms. It stopsnicotinefrom attaching to the receptors, so that a person who smokes a cigarette while takingvareniclinefinds the activity less rewarding. Some people takingbupropionSR orvareniclinehave developed serious nervous system or behavioral side effects, such as hostility, agitation, depressed mood, other behavioral abnormalities, suicidal thoughts, and attempted or completed suicide. Anyone who experiences any of these should immediately stop taking the medication and notify their health care provider. Therapies under investigation for smoking cessation include the medications cytisine,bromocriptine, andtopiramate. Vaccine therapy has been studied and found to be ineffective. Nicotinereplacement and other smoking cessation medications (bupropionandvarenicline) are typically taken for 8 to 12 weeks; some may be taken longer to help prevent relapse to smoking. At this time, cessation medications andnicotinereplacement products are not routinely recommended for people who are Pregnant Not smoking daily or smoke only a few cigarettes a day Adolescents (under age 18) Using smokeless tobacco In general, all people should talk with their health care provider about the different medications available to help them quit smoking, to determine which is best for them. People should also be sure to read the package inserts that come with all smoking cessation products. Vaping None Parents should maintain a smoke-free household and communicate the expectation to their children that the children will not smoke. The counseling approach is similar to that for adults, but children and adolescents typically are not given smoking cessation medications. 