What is the Single Best Thing You Can Do to Quit Smoking?
Can smoking cessation be done “one-on one” with a counselor or health educator, or must it be in a group?
Many find that they are not “group” people and don’t enjoy belonging to a group nor participate in any group interactions. For these people, an option is a one-on-one counselor who has a background of a healthcare provider, healthcare educator, or someone who is skilled in conducting smoking cessation classes. The positive aspect of individual counseling is that individual concerns can be immediately addressed. The negative aspect of one-on-one counseling is that there is no added benefit from the support of a group, whose members is going through a similar ordeal and has many of the same thoughts and feelings. During group counseling sessions, people bounce their thoughts and feelings off each other. For many, the added knowledge of not thinking that he or she is “the only one in the world” going through the withdrawal symptoms is valuable.
Lisa’s comment:
The group setting was invaluable for me. I felt that nobody else but my fellow program members really knew what I was going through. Each session, I looked forward to seeing at least one other person still succeeding, as this built up my courage that I, too, could continue to cease smoking.
Joseph’s comment:
For me, I learned a tremendous amount from working with the group. I replaced, “I myself will” with “we will” work with others towards a common goal of quitting.
What are some of the medication aids, notably the nicotine replacement therapies (NRTs), to smoking cessation?
Nicotine replacement therapies (NRTs) are smoking cessation medicines that release small amounts of nicotine into the bloodstream to help counter cravings and reduce other physical withdrawal symptoms. NRTs are used to slowly wean the smoker off of nicotine. The NRT products contain nicotine, which is equally addictive, but the NRT medications deliver smaller amounts of nicotine than cigarettes and without many of the other harmful effects of tar and carbon monoxide found in cigarettes. Follow the package directions carefully. It is important to first check with your doctor or pharmacist about the interactions of NRT drugs with other drugs you may be taking. Also, check with them about any medical condition that one may have that may restrict the use of an NRT, such as severe cardiovascular disease.
There are currently five forms of nicotine replacement therapies available in the
1. Nicotine Gum
A physician’s prescription used to be required to obtain the gum, but in 1996 the gum became an over-the-counter (OTC) medication. Nicorette is the brand name but there are generic forms of the gum. The manufacturer states that Nicorette allows smokers to self-titrate (up to 24 pieces a day) and it is currently available in six different flavors. The gum allows the nicotine to be absorbed through the mucus membranes of the mouth between the cheek and the gums. It comes in a 4 milligram (mg) dose for those patients who smoke more than 25 cigarettes a day, and a 2 mg dose for those who smoke less than 25 cigarettes a day.
Directions: It is very important you follow the directions on your prescription label carefully and exactly as directed. One piece of nicotine gum is chewed every one to two hours at first, or it may be chewed when you have the urge to smoke. Chew slowly until you can taste the nicotine or feel a slight tingling in your mouth. Then stop chewing and place (park) the gum between your cheek and gum. When the tingling sensation is almost gone (about 1 minute), start chewing again. Repeat this procedure for about 30 minutes. Do not chew more than one piece of gum at a time, and do not chew one piece after another. Gradually reduce the amount of nicotine gum after two to three months. Reducing the use of nicotine gum over time will help prevent withdrawal symptoms.
Tips to help reduce the use of nicotine gum gradually include:
• Decrease the total number of pieces used per day by about one piece every four to seven days.
• Decrease the chewing time with each piece from the normal 30 minutes to 10 to 15 minutes for 4 to 7 days. Then gradually decrease the total number of pieces per day.
• Substitute pieces of nicotine gum with one or more pieces of sugarless gum for an equal number. Every four to seven days, increase the number of sugarless gum pieces as substitutes for nicotine gum.
• Replace the 4-mg gum with the 2-mg gum and apply the previous steps.
• Consider stopping use of nicotine gum when your craving for nicotine is satisfied by one or two pieces of gum per day.
2. The Nicotine Patch
The patch comes in four main brands: Nicotrol, Nicoderm, Prostep, and Habitrol. All four patches transmit low doses of nicotine to the body throughout the day. Other smoking cessation programs or materials should be used while using the patch.
Directions: It is very important you follow the directions on your prescription label carefully and exactly as directed The Nicoderm patch offers a three-step program that can be used for 16 to 24 hours each day. One patch contains 21 mg of nicotine and is recommended for patients who smoke more than 10 cigarettes per day. Another patch contains 14 mg of nicotine and is recommended for patients who smoke less than 10 cigarettes per day. Apply the patch directly to the skin once a day, usually at the same time of day. Apply the patch to a clean, dry, hairless area of skin on the upper chest, upper arm, or hip, as specified by the package directions. Remove the patch from the package, peel off the protected strip, and immediately apply the patch to your skin. The sticky side should touch the skin. Press the patch to the skin by placing the palm of your hand over it for about 10 seconds. Be sure the patch is held firmly in place, especially around the edges. Wash your hands with water only after applying the patch. If the patch falls off or loosens, replace it with a new one. Wear the patch continuously for 16 to 24 hours. The patch may be worn even while showering or bathing. Remove the patch carefully, and dispose of it by folding it in half with the sticky sides touching. After removing the patch, apply the next patch to a different skin area to prevent skin irritation.
Nicotine patches may be used from 6 to 20 weeks. A switch to a lower strength patch may be considered after the first two weeks. A gradual reduction to a lower dosage of the patch is recommended so that the amount of nicotine in the system is reduced and consequently, the nicotine withdrawal symptoms will be reduced.
3. Nicotine Nasal Spray
Nicotine nasal spray comes as a liquid to spray into the nose. It should be used along with a smoking cessation program, which may include a support group, counseling, or specific cognitive or behavioral techniques. It allows smokers to cut back on their intake of nicotine gradually. Nicotine is absorbed rapidly through the nasal membranes.
Directions: It is very important you follow the directions on your prescription label carefully and exactly as directed to use the nasal spray, follow these steps:
1. Wash your hands.
2. Gently blow your nose to clear your nasal passages.
3. Remove the cap of the nasal spray by pressing in the circles on the side of the bottle.
4. To prime the pump before the first use, hold the bottle in front of a tissue or paper towel.
5. Pump the spray bottle six to eight times until a fine spray appears. Throw away the tissue or towel.
6. Tilt your head back slightly.
7. Insert the tip of the bottle as far as you comfortably can into one nostril, pointing the tip toward the back of your nose. Breathe through your mouth.
8. Pump the spray firmly and quickly one time. Do not sniff, swallow, or inhale while spraying. If your nose runs, gently sniff to keep the nasal spray in your nose. Wait two or three minutes before blowing your nose.
9. Repeat steps six to eight for the second nostril. Replace the cover on the spray bottle.
If you have not stopped smoking at the end of four weeks, talk with your doctor. Your doctor can try to help you understand why you were not able to stop smoking and make plans to try again. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient. Stay in touch with your doctor. He or she may need to change the doses of your medications once you stop smoking completely. If you continue smoking while using the nicotine nasal spray, you may have some adverse effects. Remember a nicotine overdose can be lethal.
Other Instructions:
• Handle the bottle with care. If the bottle drops, it may break. If this happens, wear rubber gloves and clean up the spill immediately with a cloth or paper towel. Avoid touching the liquid. Throw away the used cloth or paper towel in the trash. Pick up the broken glass carefully using a broom. Wash the area of the spill a few times
• If even a small amount of nicotine solution comes in contact with the skin, lips, mouth, eyes, or ears, these areas should be immediately rinsed with water.
4. Nicotine Inhaler
The inhaler should be used with a smoking cessation program, which may include support groups, counseling, or specific cognitive and behavioral therapies. Nicotine oral inhalation comes as a cartridge to inhale by mouth using a special inhaler.
Directions: It is very important you follow the directions on your prescription label carefully and exactly as directed. Your doctor may increase or decrease your dose depending on your urge to smoke. The inhaler has a plastic mouthpiece with a nicotine plug to deliver the nicotine to the mucous membranes of the mouth. The nicotine in the cartridges is released by frequent puffing over 20 minutes. You may use up a cartridge all at once or puff on it for a few minutes at a time until the nicotine is finished. Try different schedules to see what works best for you.
Read the directions for how to use the inhaler and ask your doctor or pharmacist to show you the proper technique. Practice using the inhaler while in his or her presence. If you continue smoking while using nicotine inhalation, you may experience adverse side effects. Remember: an overdose of nicotine kills. You should know that even though you are using nicotine inhalation, you may have some withdrawal symptoms.
5. Nicotine Lozenge
This is a more recent addition to the growing number of tools to combat nicotine withdrawal symptoms. Slowly allow the lozenge to melt in your mouth.
Directions: For weeks one to six of treatment, you should use one lozenge every one to two hours. Use at least nine lozenges per day to increase your chances of quitting. During weeks seven to nine you should use one lozenge every two to four hours. Weeks 10 to 12, you should use one lozenge every four to eight hours. Do not use more than five lozenges in six hours or more than 20 lozenges per day. Do not use more than one lozenge at a time or use one lozenge right after another. Using too many lozenges at a time or one after another can cause side effects such as hiccups, heartburn, and nausea. Do not eat while the lozenge is in your mouth. Stop using the nicotine lozenges after 12 weeks. After 12 weeks if you still feel the need to use nicotine lozenges, talk to your doctor.
