Health Library Quitting Tobacco UseFrom Healthwise

Are you ready to quit?

Thinking about giving up tobacco is the first step. How ready are you to stop? To find out, take this quiz:

Interactive Tool: Are You Ready to Quit Smoking?

It's okay if you are not ready now. But you may want to quit at some point. So keep learning and preparing yourself. Most smokers do quit. You can do it.

How can you stop using tobacco?

You don't have to quit alone. Ask your family, friends, and doctor to help you. Quitting is hard, but if you have help and a plan, it is much easier.

• Get ready. You don't have to stop right away, but set a date to quit. Pick a time when you won't have a lot of stress in your life. Get rid of ashtrays, lighters, or spit cups before you quit. Don't let people smoke in your house.
• Change your routine. For example, if you smoke after eating, take a walk instead.
• Use medicine. It can help with cravings and stress. You can buy nicotine gum, lozenges, or patches without a prescription. See a picture of how to use patches to help you quit smoking or stop using spit tobacco. Your doctor may also prescribe medicine, such as bupropion (Zyban) or varenicline (Chantix). Using nicotine replacement products and/or medicine doubles your chances of quitting tobacco for good.^{1, 2}
• Get support. Seek help from:
  • Stop-smoking programs, such as the American Lung Association's Freedom from Smoking program.
  • National tobacco quit line: 1-800-QUIT NOW (1-800-784-8669).
  • Counseling from doctors, nurses, or therapists.

As soon as you stop, stay committed. Don't use tobacco at all. One cigarette never helps. It only makes it harder.

Why is it so hard to quit?

Quitting is hard because your body craves the nicotine, or is addicted to tobacco. Giving it up is more than just kicking a bad habit. Your body has to stop craving the nicotine. Nicotine gum, lozenges, patches, and other medicines can help reduce the cravings without the harmful effects of tobacco.

You also have to change your habits. You may not even think about using tobacco. You just do it. You may chew tobacco when you are stressed. Or maybe you have a cigarette with coffee. Before you quit, think of new ways to handle these things. For example, call a friend or practice deep breathing when you feel stressed. Try chewing sugarless gum instead of lighting up.

What if you feel bad when you are trying to quit?

You may feel grouchy, restless, or sad when you first quit. Or you may have trouble sleeping and want to eat more. But you won't feel bad forever, and medicine can help. Using medicines and products like nicotine gum can help with cravings and make you feel more like yourself.

Will you gain weight?

You may worry about gaining weight when you stop using tobacco. Don't let this stop you. You have a lot more to gain by quitting than a few extra pounds. You will feel better and save money. You may also have fewer health problems.

You can take steps to lower your chance of gaining weight:

• Try to be active. Exercise can also improve your mood.
• Eat more fruits, vegetables, and whole grains and fewer high-fat foods.
• Try not to substitute food for tobacco. Instead, chew on a drinking straw or a coffee stirrer.

What if you start using tobacco again?

Most people quit and restart many times (more than 5 times) before they stop smoking for good. If you start smoking again after you quit, don't give up. Each time you quit, even if it is just for a short time, you get closer to your long-term goal.

Remind yourself that by quitting you may avoid serious health problems and live longer. Use these tools to find your risk of heart attack based on how much you smoke and to find out how smoking affects your life span:

Interactive Tool: How Does Smoking Increase Your Risk of Heart Attack?

Interactive Tool: How Does Smoking Affect Your Life Span?

Each time you quit, you learn more about what helps and what gets in the way. Think about why you started smoking again, and make plans to succeed next time. You can do it!

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I take medicine to quit smoking?
	Should I use nicotine replacement therapy to quit smoking?
	Actionsets are designed to help people take an active role in managing a health condition.
	Dealing with weight gain when you quit smoking
	Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
	Interactive Tool: Are You Ready to Quit Smoking?
	Interactive Tool: How Does Smoking Affect Your Lifespan?
	Interactive Tool: How Does Smoking Increase Your Risk of Heart Attack?
	Interactive Tool: How Much Is Smoking Costing You?

Most people don't think about when or why they use tobacco. They just do it. But knowing when and why you smoke or chew can help you choose the quitting strategy that is most likely to work. Perhaps you use tobacco:

• To relieve tension, especially after arguments or during stressful times, or when you feel angry or upset.
• To control your weight, either by keeping it down or because you're afraid of weight gain if you quit.
• For stimulation, to perk yourself up, improve your concentration, or boost your energy when you are feeling sluggish.
• To be part of the group, by joining your friends in having a cigarette or chew.

Use this form to find your reasons(What is a PDF document?) for using tobacco.

Reasons children and teens smoke

Many children and teens use cigarettes, cigars, and spit tobacco because their friends do. Movies and TV shows can make tobacco use seem glamorous and attractive. Teens, especially girls, often use smoking to try to control their weight.

Teens may think smoking is a way to look more mature, independent, and self-confident to their peers. They may smoke to rebel against their parents.

Children and teens are more likely to smoke if their parents smoke.

When you're craving tobacco, it's hard to focus on quitting. Preparing yourself before you quit can help. Before you toss the tobacco, get ready for a life without nicotine.

Motivation

What would motivate you to quit smoking? Think about it.

Use this self-test to help you discover what might motivate you to quit smoking(What is a PDF document?).

Staying healthy is one reason for teens to quit using tobacco. Perhaps you want to feel more in control of your life, instead of feeling controlled by tobacco.

Risks

What worries you about smoking? Make a list. Talk about it with your doctor. You may worry about:

• Health problems. Are you out of breath when you take the stairs? Are asthma symptoms getting worse? Are you coughing a lot?
• Long-term health risks. Are you afraid of having a heart attack or stroke? How about lung disease or cancer?
• Risks to others. Do you worry about family members getting lung cancer and heart disease? Are you afraid that your children might start smoking because you do? Are you concerned that your baby may die of sudden infant death syndrome (SIDS) if you smoke? Maybe your children have frequent ear infections or asthma.

Rewards

What do you gain by quitting? You can:

• Have a younger-looking and healthier body.
• Set a good example for others (especially children).
  • If you smoke, your child is more likely to smoke.
  • If your teen smokes, he or she is more likely to quit smoking if you quit.³
  • If your child never uses tobacco during the teen years, he or she is more likely to never start using tobacco in the future.
• Save money by getting rid of the cost of smoking. To find out how much you spend on cigarettes, see the Interactive Tool: How Much Is Smoking Costing You?
• Be in control of your habits.

Roadblocks

What could make you start smoking or chewing after you stop? Triggers could be events, places, or even people. You may always have a smoke after lunch or during happy hour on Fridays. Does your best friend chew? You can't always avoid these roadblocks. You can develop a strategy that helps.

Other roadblocks and possible solutions include:

• Nicotine withdrawal. People who smoke daily often have symptoms (such as irritability, trouble sleeping or concentrating) when they try to quit. Quitting the use of spit tobacco produces the same nicotine withdrawal symptoms that quitting smoking does. There are medicines that can help control these symptoms. Starting a new hobby and exercising can also help.
• Failure in the past. If you weren't able to quit in the past, don't be hard on yourself. Studies show that each time you try to quit, you will be stronger and will have learned more about what helps and what hinders. Most people try to quit many times before it finally sticks.
• Weight gain. You may gain some weight when you stop smoking. Don't try to avoid this by going on a strict diet at the same time. This will make it even harder to stop smoking. Instead, get active. This helps you burn calories.

  Dealing with weight gain when you quit smoking

• Depression. Medicines and counseling can help treat depression.
• Lack of support from family or friends. Finding people to support your efforts can improve your chances of quitting. Look for some people who have stopped smoking.
• Stress. Stress can lead to smoking. Learn new ways of coping with stress to get past this roadblock. For suggestions on coping with stress, see the topic Stress Management.
• Alcohol. Drinking alcohol can increase your desire to smoke. Try drinking less alcohol during the first 3 weeks after you quit.
• Living with someone who smokes or being around someone who smokes. If the person would quit with you, it would be easier for you to quit. If this isn't an option, talk to the person about not smoking around you.
• Missing your smoking habits and rituals or not being able to avoid smoking triggers that make you reach for a cigarette or pipe. Assess your tobacco use(What is a PDF document?) to discover your smoking triggers.

One strategy that does not work well is switching from your regular cigarettes to a "light" cigarette. These "light" cigarettes are no safer than regular cigarettes.

Teens, especially girls, are often afraid that they will gain weight, not fit in at social events, or not be able to handle stressful situations if they quit smoking. Fresher-smelling clothes and breath may actually improve chances of fitting in. Also, feeling good physically may help teens deal with stress in healthier ways than by smoking.

Repetition

Keep reminding yourself why you want to quit smoking. Make a list of your reasons to quit and the benefits you expect from quitting. Put your list of reasons on your bedroom dresser, in your wallet, or on the refrigerator. Review it whenever you are struggling with the quitting process. Add to your list whenever another reason or benefit occurs to you.

If you have tried to quit smoking before, remember that most people try to quit many times before they are successful. Don't give up.

It may help you to achieve a long-term goal like quitting tobacco by breaking it down into smaller goals. Every time you reach a goal, you feel a sense of pride along the path to becoming tobacco-free.

• Set your goals clearly. Write down your goals, or tell someone what you are trying to do. Goals should include "by when" or "how long" as well as "what." For example: "I will keep a smoking journal for 1 week starting tomorrow."
• Reward yourself for meeting your goals. Quitting smoking is a tough process, and each small success deserves credit. Don't punish yourself for failing to meet goals. Instead, hold back on a reward until you achieve your goal.
• Pace yourself. You may want or need to quit slowly, over the course of several months or a year. Set a comfortable pace. Certain activities won't be temptation-free for many months after you quit. As you set goals for yourself, decide when you are ready to challenge yourself.
• Be realistic. You may feel very excited and positive about your plan for change. Be careful not to set goals, including a timeline for quitting, that are higher than you can meet. Set realistic goals.

When you plan your strategy for quitting tobacco, use the U.S. Surgeon General's five keys to quitting: get ready, get support, learn new skills and behaviors, get and use medicine, and be prepared for relapse.

1. Get ready

Contact your doctor or local health department to find out the kinds of medicines and help available in your area for people who want to quit smoking. Telephone help lines operated by your state can also help you find information and support for quitting tobacco use.

Check with your insurance provider to find out if medicines or counseling are covered under your plan.

Prepare your body and mind for the stress that comes with quitting.

• Set a quit date and stick to it. This is an important step toward becoming tobacco-free. Choosing a good time to quit can greatly improve your chances of success. For example, avoid setting your quit date on high-stress days, such as holidays.
• Make some changes. Get rid of all ashtrays and lighters after your last cigarette. Throw away pipes or cans of snuff. Also, get rid of the smell of smoke and other reminders of smoking by cleaning your clothes and your house, including draperies, upholstery, and walls. Don't let people smoke in your home. Take the lighter out of your car. Try some methods to reduce smoking before your official quit date. Use a smoking journal to record what triggers urge you to use tobacco. This gives you important information on when it's toughest for you to resist.
• If you have tried to quit in the past, review those past attempts. Think of the things that helped in those attempts, and plan to use those strategies again this time. Think of things that hindered your success, and plan ways to deal with or avoid them.
• Once you quit, don't even take a puff. After your quit date, don't smoke at all—not even a puff.

2. Get help

You will have a better chance of quitting successfully if you have help and support from your doctor, family, friends, and coworkers.

• A doctor, nurse, or mental health professional can help you tailor an approach to quitting smoking that best suits your needs. These people are also good sources of motivation and support during the quitting process.
• Tell your friends that you are quitting, and talk to ex-smokers about their experiences during and after quitting. Have a friend or ex-smoker check in with you once in a while to ask how you are coping.
• If you live with someone who smokes, let that person know how he or she can support you. Be specific. Talk with him or her about not smoking in front of you. Better yet, ask that person to quit smoking with you. That way you can support each other through the quitting process. Also, family and friends can help support and encourage you while you are quitting.
• Join a support group for people quitting smoking. People who have quit smoking may be particularly helpful, because they know what you are going through.
• Get counseling (telephone, individual, or group). The more counseling you get, the better your chances of quitting. Counseling may help you learn to recognize and cope with situations that tempt you to smoke. Counseling sessions can also offer comfort if you have a relapse.
• You may want to attend a program to help you quit smoking. When choosing a smoking cessation program, look for one that has proven success. Ask your doctor for ideas. You can also check with your local health department or call the national quit line at 1-800-QUITNOW for help.
• Children and teens may respond well to community and school programs based on the social and self-image aspects of smoking.
• Use the Internet. The Internet allows round-the-clock access to information about quitting smoking and to chat rooms that can provide support. These programs are good for people who can't get to a stop-smoking meeting. They also work well for people who don't like group meetings.

3. Learn new skills and behaviors

Since you won't be using tobacco, decide what you are going to do instead. Make a plan to:

• Identify and think about ways you can avoid those things that make you reach for a cigarette (smoking triggers), or change your smoking habits and rituals. Think about situations in which you will be at greatest risk for smoking. Make a plan for how you will deal with each situation.
• Change your daily routine. Take a different route to work or eat a meal in a different place. Every day, do something that you enjoy.
• Cut down on stress. Calm yourself or release tension by reading a book, taking a hot bath, or digging in your garden. See the topic Stress Management for ways to reduce stress in your life.
• Hang around nonsmokers and people who have stopped smoking.

4. Get and use medication

The U.S. Food and Drug Administration (FDA) has approved several medications to help people quit smoking. You will double your chances of quitting even if medication is the only treatment you use to quit, but your odds get even better when you combine medication and other quit strategies, such as counseling.¹

These medications also may help you if you use spit tobacco (chewing tobacco and snuff), pipes, or cigars every day.

If you are trying to quit (unless you only use tobacco occasionally), try one or more of these medications. Using these medications along with learning new behaviors further increases your likelihood of success.

The first-choice medicines are:⁴

• Nicotine replacement therapy (NRT). Nicotine replacement products include nicotine gum, patches, lozenges, and inhalers. You can buy gum, patches, and lozenges without a prescription. See a picture of how to use patches to help you quit smoking or stop using spit tobacco.
• Bupropion SR (Zyban), a non-nicotine prescription medicine that you can use by itself or along with nicotine replacement products.
• Varenicline (Chantix), a prescription medicine that helps withdrawal and reduces the effects of pleasurable smoking.

Take this new medicine information form(What is a PDF document?) with you when you talk to your doctor.

Should I take medicine to quit smoking?

Should I use nicotine replacement therapy to quit smoking?

Other medicines you can try if the above medications do not work or you cannot take them are:

• Nortriptyline (Aventyl, Pamelor).
• Clonidine (Catapres).

Your doctor will prescribe these medicines and explain how to use them. It is very important to take the medicines for a long-enough time.

Remember, taking medicines and using counseling or a cessation program at the same time greatly increases your chances of success.

5. Be prepared for relapse

Most people are not successful the first few times they try to quit smoking. Don't beat yourself up. Make a list of things you learned, and think about when you want to try again, such as next week, next month, or next spring.

You might try something new next time, such as a new medicine or program. You might try combining tools, such as counseling and medicine. Keep trying, and don't be fooled by light cigarettes, or reducing your smoking. Neither one appears to make smoking safer.

Quitting tobacco use when you have other medical conditions

If you have depression, anxiety, or a similar problem, or if you have had an alcohol or drug use problem, try to care for that problem before you try to stop smoking.

Some people who have had one of these medical problems find that the problem returns when they try to quit smoking. If you have any of these problems, talk to your doctor before you quit. After you quit, seek help right away if you see signs that the problem is returning.

Smoking can also affect the level of several medicines in your blood. If you take medicines for a health problem, talk with your doctor before you quit smoking to see whether you should alter the dose.

Many of the changes you feel when you first quit tobacco are not positive. Nicotine withdrawal can make you feel short-tempered and nervous. You may have trouble sleeping, or concentrating. These symptoms can last for several weeks, but they do go away, especially if you take medicine. You may struggle with changing your smoking habits and rituals. This is a lot to deal with, but keep at it. You will feel better.

You may keep getting cravings for months. But most people who quit report that they eventually stop thinking about smoking.

The following tips may help you remain tobacco-free:

• Deal with temptations and cravings when you quit smoking.
• Make positive changes in your life.
• Prevent a slip (smoking one or two cigarettes), or deal with one if it occurs.
• Prevent relapse (returning to regular smoking).
• Deal with weight gain.

  Dealing with weight gain when you quit smoking

Tobacco use, especially smoking, is the number-one preventable cause of death and disease in the United States.⁴ One out of two people who continue to smoke will die early because of their smoking.

Everyone who uses tobacco would benefit from quitting. The earlier you quit using tobacco, the greater your chance of reversing the risk of tobacco-related diseases.

When you quit smoking—no matter how old you are—you will decrease your risk of:

• Heart attack and stroke. Smoking even a few cigarettes a day (1 to 4) increases your risk of coronary artery disease. If a person who smokes has a heart attack, his or her risk of sudden death is twice as great as the risk of a person who does not smoke.⁵
  • As soon as you quit smoking, your risk of heart attack and stroke begins to decrease. If you already have coronary artery disease, your risk of a second heart attack and possible sudden death decreases when you quit smoking. Use this tool to find out your risk of having a heart attack: Interactive Tool: How Does Smoking Increase Your Risk of Heart Attack?
  • People who quit smoking before age 50 reduce by half their risk of dying in the next 15 years compared with continuing smokers.⁶
• Lung cancer and other lung diseases. After 10 years of not smoking, your risk of lung cancer is reduced by 30% to 50%. If you have asthma, you may have fewer and less severe asthma attacks. You will also have fewer respiratory illnesses, such as colds, flu, and pneumonia.
• Other cancers. After you quit, your risk for developing cancers of the voice box (larynx), mouth, throat, esophagus, intestines, bladder, kidney, and pancreas gradually declines.
• Impotence and fertility problems. Men who quit smoking are less likely to develop problems achieving and maintaining an erection. Women who quit smoking are less likely to have problems becoming pregnant.
• Gum disease and other dental problems. Smoking can lead to gum (periodontal) disease. People who smoke are twice as likely to lose teeth as people who do not smoke.
• Early death. No matter how old you are or how long you've been smoking, quitting reduces your risk for developing life-threatening health problems. Use this tool to find out how much smoking decreases your life span: Interactive Tool: How Does Smoking Affect Your Life Span?

In addition to reducing your risk of diseases in the future, you will notice some immediate benefits after you stop using tobacco. Your shortness of breath and asthma symptoms will likely get better within the first 2 to 4 weeks after you quit. On the other hand, you may temporarily cough more in the first week after you quit because your lungs are trying to clear themselves.

• Health risks for your family members caused by secondhand smoke are reduced when you quit smoking.
• Underweight babies and problem pregnancies are less likely in women who quit smoking.

Natural, low-tar, and low-nicotine cigarettes are not any safer to smoke than regular cigarettes. Do not be misled into thinking these products are any better for you.

Why quit using cigars, pipes, or spit tobacco?

You can get lung cancer and cancers of the throat and mouth from using cigars, pipes, or spit tobacco.

• Health risks related to smoking cigars or pipes. Even if you think you do not inhale the smoke from a pipe or cigar, you are at greater risk for disease. Quitting reduces these risks in much the same way as in quitting cigarettes.
• Health risks related to spit tobacco. Chewing tobacco ("chew") and snuff ("dip" or "rub") give you a higher risk of mouth cancer, gum disease, and tooth loss when you use these products.

Why teens should quit

Avoiding diseases caused by tobacco and being in control of your life are good reasons for teens to quit.

If you are a teen and you smoke, chew tobacco, or use snuff, you probably already know that tobacco is bad for you. If you are like most teens, you intend to quit at some point, but you may not feel it's very important to quit now. But the longer you use tobacco, the greater your risk for becoming addicted to it. Once you're hooked, it's even harder to quit.

Online Resources

Organizations

• Chronic Obstructive Pulmonary Disease (COPD)
• Coronary Artery Disease
• Depression
• Dietary Guidelines for Americans—2005
• Fitness
• Healthy Eating
• Lung Cancer
• Oral Cancer
• Stress Management

Citations

1. Talwar A, et al. (2004). Pharmacotherapy of tobacco dependence. Medical Clinics of North America, 88(6): 1528–1529.

2. Maseeh A, Jwatra G (2005). A review of smoking cessation interventions. Medscape General Medicine, 7(1). Also available online: http://www.medscape.com/viewarticle/504516.

3. Sunday SR, Folan P (2004). Smoking in adolescence: What a clinician can do to help. In VC Reichert et al., eds, Medical Clinics of North America, 88(6): 1495–1515. Philadelphia: Saunders.

4. Fiore MC, et al. (2000). Clinical Practice Guideline: Treating Tobacco Use and Dependence. Rockville, MD: U.S. Department of Health and Human Services. Also available online: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf.

5. National Guideline Clearinghouse (2001, updated 2005). Guideline synthesis: Tobacco use cessation and prevention. Available online: http://www.guideline.gov/Compare/comparison.aspx?file=TOBACCO7.inc.

6. National Institutes of Health (accessed March 2007). Tobacco addiction: Fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic/Tobaccoaddiction.pdf.

Other Works Consulted

• West R (2004). ABC of smoking cessation: Assessment of dependence and motivation to stop smoking. BMJ, 328 (7435): 338–339.

• Fiore MC, et al. (2002). Effective tobacco dependence treatment. JAMA, 288(14): 1768–1771.

• Mohsen A, Norris S (2005). Changing behaviour, search date May 2005. Online version of Clinical Evidence (14): 1–20.

• Shiffman S, et al. (2002). Efficacy of a nicotine lozenge for smoking cessation. Archives of Internal Medicine, 162(11): 1267–1276.

• Siqueira LM, et al. (2001). Smoking cessation in adolescents. Archives of Pediatrics and Adolescent Medicine, 155(4): 489–495.

Author:	Debby Golonka, MPH Caroline Rea, RN, BS, MS	Last Updated: July 24, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine John Hughes, MD - Psychiatry
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