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(59) Quit Smoking

What is the Single Best Thing You Can Do to Quit Smoking?

How to Quit Smoking - A Guide to Kicking the Habit for Good

Guide to Quitting Smoking - American Cancer Society


What are the success rates of the non-NRT therapies?

The success rates of the various non-NRT Therapies

Non-nrt medication - success rates

Bupropion SR - 24.2%

Varenicline 1 mg/d - 25.4%

Varenicline 2 mg/d - 33.2%

Nortriptyline - 22.5%

Clonidine - 25.0%

SSRIs - 13.7%

Naltrexone - 7.3%

Placebo -13.8%

What is cognitive behavioral therapy and how is it helpful?

Cognitive behavioral therapy (CBT) involves talking interventions that focus on both thoughts and behaviors. CBT has been shown to be effective with or without the use of medication in smoking cessation. It is a goal-oriented problem-solving approach to overcome distortions resulting from ingrained or automatic thinking that lead to maladaptive behaviors.

Cognitive behavioral therapy is helpful because all smokers develop not only physiological dependency to cigarettes but also psychological and behavioral addictions. The physiological dependency can be dealt with by taking one of the medications for smoking cessation. However, medication cannot take care of the psychological or behavioral addiction. Thoughts and behaviors or addictive habits that people have developed over time are difficult to change. Many people have integrated cigarette smoking into their daily lives (wake up in the morning, smoke; drink coffee, smoke; read the paper, smoke; feed the dog, smoke). Smokers view cigarettes as a friend and a support. There is the “good morning” cigarette, the “pat myself on the back” cigarette, the “stress relief” cigarette, and my “after dinner” cigarette. Consequently, some people need more than just medication. Cognitive behavioral therapy is a great adjunct to pharmacological therapies to ensure a person’s success at quitting.

Sykes and Marks from the United Kingdom developed a world-renowned CBT program called Quit for Life. It is a two-stage program of reduction and relapse-prevention. The reduction phase aims at a gradual reduction over a 7 to 10 day period. The relapse-prevention phase occurs the week after “D-Day” (that is, the quit day). The goal is to empower a smoker to quit and maintain abstinence.

Smokers may choose the quit methods that are most comfortable for them. A textbook includes a cassette tape, which summarizes the various behavioral and cognitive strategies that participants can select. Handouts for participants include a combination of 30 CBT methods and other materials. A self-help package is provided, which includes:

  • A handbook
  • Reduction cards
  • Behavioral strategies include:
  • Identifying triggers (that is, cues to smoke) and risky situations
  • Keeping a smoking diary
  • Delaying tactics
  • Fading techniques (tapering the nicotine content in NRT medications)
  • Behavior substitutes (chewing gum or eating carrot sticks versus smoking cigarettes)
  • Positive reinforcements (setting goals and self rewards)
  • Self-esteem enhancement
  • Coping skills training
  • The cognitive techniques include:
  • Personal responsibility for one’s own thoughts
  • Learning to change beliefs that prove to be barriers to Success
  • Disputing irrational thoughts and then replacing them with more positive thoughts
  • Homework assignments
  • Learning mastery and control
  • Cognitive rehearsal (that is, practicing how to deal with risky relapse situations)
  • Identifying barriers to successful quitting and how to cope with them

Styles and Marks’ studies have shown that Quit for Life has quit rates that are five to six times higher than quitting using willpower alone. CBT is another effective method to add to the smoking cessation repertoire of quit programs.

 Cognitive behavioral therapy is helpful because all smokers develop not only physiological dependency to cigarettes but also psychological and behavioral addictions.

 Are there 12-step programs for cigarette smokers, like Alcoholics Anonymous (AA)?

Nicotine Anonymous is a form of group therapy. It began in California in 1982, and is similar to Alcoholics Anonymous, the original 12-step, self-help group program. It is based on the assumption that people who share a common problem can collectively support each other to eliminate a destructive behavior and its consequences. The only requirement for belonging to the group is the desire to quit smoking. The emphasis is not only on quitting an addiction but also personal and spiritual growth. The goal is for each member to be completely free of addiction to nicotine. Mutuality, trust, honest sharing, acceptance of self, and other goals are the building blocks for a supportive self-help group. Like other 12-step programs, there is no professional group leader. The 12-step approach develops strong social support networks among participants. Role models who have successfully quit smoking become the leaders and sponsor (mentor) new members.

Believing in oneself and in a higher power is strongly encouraged.

The concept of a higher power is not faith-based but rather an acceptance of one’s own limitations regarding one’s ability to change on one’s own, thus allowing group members to interpret a stronger outside force that helps to guide them and give them the strength to change according to their own personal beliefs. That outside strength can be the group itself or the extended community. It does not necessarily have to be an abstract being such as God. During the recovery process, group members are encouraged to believe in the power of healing within the group. The 12 steps and 12 traditions for Nicotine Anonymous are similar to Alcoholics Anonymous.

They are as follows:

The Twelve Steps of Nicotine Anonymous

 1. We admitted we were powerless over nicotine-that our lives had become unmanageable.

2. We came to believe that a Power greater than ourselves could restore us to sanity.

3. We made a decision to turn our will and our lives over to the care of God as we understand Him.

4. We made a searching and fearless moral inventory of ourselves.

5. We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. We were entirely ready to have God remove all of these defects of character.

7. We humbly asked Him to remove our shortcomings.

8. We made a list of all persons we had harmed, and became willing to make amends to them all.

9. We made direct amends to these people wherever possible, except when to do so would injure them or others.

10. We continued to take a personal inventory and when we were wrong promptly admitted it.

11. We sought through prayer and meditation to improve our conscious contact with God, as we understand Him, praying only for the knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to nicotine users and to practice these principles in all our affairs.

The Twelve Traditions

1. Our common welfare should come first; personal recovery depends upon Nicotine Anonymous unity.

2. For our group purpose, there is but one ultimate authority-a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.

3. The only requirement of Nicotine Anonymous membership is the desire to stop using nicotine.

4. Each group should be autonomous except in matters affecting other groups or Nicotine Anonymous as a whole.

5. Each group has but one primary purpose-to carry its message to the nicotine addict who still suffers.

6. A Nicotine Anonymous group ought never endorse, finance, or lend the Nicotine Anonymous name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.

7. Every Nicotine Anonymous group ought to be self-supporting, declining outside contributions.

8. Nicotine Anonymous should remain forever non-professional, but our service centers may employ special workers.

9. Nicotine Anonymous, as such, ought never to be organized; but we may create service boards or committees, directly responsible to those they serve.

10. Nicotine Anonymous has no opinion on outside issues; hence the Nicotine Anonymous name ought never to be drawn into public controversy.

11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of the press, radio, TV, and films.

12. Anonymity is the spiritual foundation of all of our traditions, ever reminding us to place principles before personalities.

Self-help groups and psychosocial aftercare groups are highly recommended long-term for people who are at risk for a relapse. Belonging to a group may prevent this common phenomenon.

The success rate of Nicotine Anonymous has not been well documented because Nicotine Anonymous is a self-help group, which is not run by professionals. Some of the data collected to evaluate the effectiveness of a 12-step approach to smoking cessation was conducted at an inpatient program run by the Palo Alto Veterans Administration Hospital in California. The smoking cessation program, which was run by professionals, used a 12-step approach. A study compared the hospital-based 12-step program with another inpatient program, which used cognitive behavioral therapy as the approach to smoking cessation. The results showed that over 45% of the men enrolled in the 12-step program were abstinent one year after discharge, compared to 36% of the men who received cognitive behavioral therapy.



(60) Quit Smoking

How to Quit Smoking Naturally Using Herbs, Hypnotherapy & Exercise! (Video)

Quit Smoking Using Natural Remedies Like Herbs, Fruits and Vegetables


Why is group therapy as important as anti-tobacco drug therapy?

Group therapy is a frequent intervention used in smoking cessation programs. Group intervention is not necessarily the most effective method of quitting when it is the only method used; however, it is effective in combination with other smoking cessation tools, including medications. Group programs teach people to recognize problems that occur while quitting. Group members offer emotional support and encourage each other to reach for success, which many people find helpful. Studies have demonstrated differences in abstinence success rates depending upon the type of therapy utilized as well as whether or not it is used in combination with medication therapy. Table bellow illustrates those differences. (It is important to note that the medication and counseling statistic is from a different set of studies, and therefore one cannot compare that number against any of the other numbers as denoted by the asterisk [*].)

Successful abstinence rates by type of therapy

Format -estimated abstinence rate

No format - 10.8%

Self-help - 12.3%

Telephone counseling - 13.1%

Group counseling - 13.9%

Individual counseling - 16.8%

Two formats - 18.5%

Three or more formats - 23.2%

0–1 Counseling sessions - 21.8%

2–3 Counseling sessions - 28.0%

4–8 Counseling sessions - 26.9%

More than 8 counseling sessions - 32.5%

Counseling without medication* - 14.6%

Counseling with medication* - 22.1%

* Data cannot be compared as they are from a different set of research.

Are there herbal remedies for smoking cessation?

Thousands of people are looking for alternative approaches to smoking cessation. As a result, non-traditional quit smoking methods look attractive to many who do not want to take medications or to participate in traditional programs used to stop smoking. These alternatives are known as Complementary and Alternative Medicine (CAM). The U.S. Department of Health and Human Services (DHHS) conducted a metaanalysis that determined alternative therapies such as hypnosis, acupuncture, electro stimulation, and laser treatments were not effective in tobacco cessation. If you decide on herbal medicines, discuss your plan with your doctor, pharmacist, or a holistic health practitioner.

Herbal Remedies

All of the following herbs that will be discussed have been used as aids for smoking cessation. Herbs have been used traditionally in Eastern medicine for years but have been introduced to Americans only recently. There are herbal teas as well as pills that are available over-the-counter (OTC) at health food stores.


Ginseng is a root that has been made into a medication, which has been used historically in Chinese medicine for 7000 years.  It is grown in the Far East as well as the United States. Ginseng can be eaten raw or prepared using various methods. The best way to prepare it is to brew it into a tea. Ginseng is purported to reduce stress, improve cognitive performance, boost energy, enhance memory, and stimulate the immune system. Many of these effects are similar to the effects of nicotine. Studies conducted in China reported that ginseng increased the activity of the brain’s neurotransmitters.


Kava is a sacred drink to many Pacific Islanders. Kava is purported to relieve anxiety that is associated with the withdrawal symptoms of a variety of addictive drugs including nicotine and alcohol. Kava is non-addictive and is also an appetite suppressant. One of the chemicals found in kava inhibits the enzyme monoamine oxidase-B (MAO-B), which is also inhibited by the antidepressants Nardil and Parnate. Inhibiting MAO increases the neurotransmitters dopamine and norepinephrine in the brain, which may explain why kavais thought to have smoking cessation properties. However, neither Nardil nor Parnate are believed to be safe or effective in treating tobacco dependence, and they are far more potent MAO inhibitors than kava. Kava is contraindicated in all patients taking antidepressant medications.

The therapeutic uses of kava are as follows:

• Relieves anxiety and stress and the ensuing depression

• Is a muscle relaxant

• Is a diuretic and anti-inflammatory medication

• Is an anti-convulsant

• Protects against strokes

• Is a mild analgesic

• Is a mild anesthetic

• Is a topical antifungal medication


Lobelia also has been called the Indian tobacco or the pukeweed. It is a purgative used in small doses as an expectorant to treat respiratory problems; in large doses it is used as an emetic (it makes you vomit) to treat food poisoning. It grows all over North America. It has nicotine-like properties in that it is both a stimulant and a relaxant. In small doses, lobelia can have a soothing, sedative effect. It can calm the jittery nerves of someone who is withdrawing from nicotine. Thus, if lobelia is taken during smoking withdrawal, the cravings will be reduced. If one smokes a cigarette while taking lobelia, however, the smoker may become nauseated and may vomit.

It also may have mild antidepressant effects, which helps with the initial sadness during nicotine withdrawal. Precautions: It is contraindicated to take lobelia during pregnancy, if you have low blood pressure, if you get easily nauseated, if you are taking blood pressure medications, if you are a diabetic, or if you are already on potassium replacement therapy, diuretics, or corticosteroids. If you are taking aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), the combination can increase the risk of a toxic reaction.

How many times does a typical smoker quit throughout his or her life?

Many attempts at quitting are often the norm. Occasionally you will find someone who threw the cigarettes out and never went back. That is atypical for most smokers. Research shows that 70% of smokers want to quit, 81% of smokers have tried to quit at least once, 35% try to quit each year, and quitting may require more than 10 attempts before becoming successful. Only about 7% of smokers attempting to quit remain smoke-free at the end of one year. This is exactly why tobacco dependence should be thought of as a chronic relapsing condition, and adding the various medications and support groups available can increase the success rates for quitting.

Only about 7% of smokers attempting to quit remain smoke-free at the end of one year.

What can I do to avoid “triggers”?

Triggers are the environmental stimuli that are associated with smoking and serve to support the ongoing habit. A trigger prompts you to reach for a cigarette. Some of the most common triggers for smoking are things such as stress, coffee, and alcohol. Other triggers include:

• The morning routine

• Certain people, often smoking buddies or a spouse

• Driving

• Finishing a meal

• Watching TV

• Talking on the phone

• Post coitus

• Boredom

• Finishing something

• Breaks at work or after work

• Feeling anxious, tense, angry, or lonely.

Whatever the triggers may be, it’s important to make note of them. If you prepare for your triggers, you can handle them better. Avoiding triggers, at least until you are more secure as a nonsmoker, will help in the process. Triggers can overwhelm the unprepared quitter.

Try the “4 Ds”:

• Drink plenty of water, between six and eight glasses per day.

• Delay the impulse to smoke for three to seven minutes. The urge should pass.

• Do something else that will take your mind elsewhere.

• Deep breathe.

It is important to drink lots of fluids, eat right, and get enough sleep. A poor diet and the lack of a good night’s sleep can decrease your resistance to triggers. Cognitive behavioral therapy and support groups also help to both identify the triggers and assist in developing coping strategies when one is confronted with a trigger.

Lisa’s comment:

During the first days after quitting, I experienced a mysterious and disturbing phenomenon whereby I received repetitive images of my right arm (I am right-handed) that kept swinging up to my face holding a lit cigarette. I did not want a cigarette; however, I told my therapist that I could not imagine going through the rest of my life with this image “assaulting” me. She told me to vocalize my determination to quit and that my subconscious would listen. Every time the image jumped up, I loudly spoke out “I do not want a cigarette. I have a higher goal in mind, and that is to live my life as a nonsmoker; smoking a cigarette is an obstacle to reaching my goal.” It’s truly amazing how quickly this worked and how the appearance of the image began to decrease in frequency, until it disappeared altogether. The images stopped in a few days after this method.




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