Tobacco cessation

Tobacco is one of the single most addictive substances in the world. Although it's legal, tobacco is more addictive than many illicit drugs. And often, it can be just as harmful. Tobacco has been linked to various cancers, as well as premature aging, facial wrinkles and much more.

According to the Substance Abuse and Mental Health Services Administration, 25 to 29 percent of American adults smoke or use a tobacco product. More than 70 percent of smokers want to quit -- an estimated 30 percent of those will try to quit each year. Most smokers make several attempts before they successfully quit.


Secondhand smoke
Secondhand smoke, also known as environmental tobacco smoke or passive smoke, is made of:
sidestream smoke -- smoke produced at the burning ends of cigarettes, cigars and pipes
mainstream smoke -- smoke exhaled by a smoker
Secondhand smoke has been classified as a carcinogen by the Environmental Protection Agency. Secondhand smoke is especially risky for children because it can complicate asthma and cause ear infections and serious respiratory problems.


Smokeless tobacco
Smokeless tobacco delivers just as much, if not more, nicotine than cigarettes -- and it's just as addictive. Smokeless tobacco takes two forms:
Chewing is placing a golf ball-sized wad (or "quid") of tobacco between the cheek and teeth and sucking on it.
Dipping is placing a pinch of tobacco between the lower cheek and the teeth, where it mixes with saliva.
Either way, the "buzz" happens quickly because the nicotine is absorbed directly through the mucous membranes of the mouth.

Like cigarettes, smokeless tobacco contains carcinogens, or known cancer-causing chemicals. Some smokeless tobaccos are sweetened with sugar to mask the unpleasant tobacco taste. The sugar may lead to tooth decay. Abrasives, gritty materials that wear down the surface of the teeth, and salt are also used to flavor smokeless tobacco. Too much salt contributes to high blood pressure and kidney disease.


Tobacco and adolescents
Of all addictive behaviors, tobacco use is the most likely to start and become an addiction during adolescence. One-third to one-half of all children and adolescents who smoke one cigarette become habitual smokers.
For teens, the most consistent influence on tobacco use is having friends who use tobacco. Smoking is also associated with alcohol and drug problems in adolescents.

Often, teens don't follow the same pattern of tobacco use as adults. For example, teens who use tobacco may quit during a particular sports season, then start up again once the season is over.

Most teen smokers say they regret the decision to start smoking.


Tobacco and elderly adults
Elderly adults are less likely to perceive the risks of tobacco use or the benefits of quitting than younger smokers. They're also less likely to believe in the relationship between tobacco use and other illnesses. For older adults, tobacco use may interfere with many prescription or over-the-counter medications.

The gender connection
In the United States, men are slightly more likely than women to smoke cigarettes. For both sexes, the most common reasons for smoking include:
enjoyment
to calm down or distract themselves
to feel less restrained or more in control
to reduce anxiety
In addition, many men smoke to maintain alertness and take their minds off eating. Women often smoke to relax, help control weight and increase concentration.

The rate of tobacco use among men is dropping much faster than among women. In fact, lung cancer now surpasses breast cancer as the leading cause of cancer deaths for women. Depression, lack of emotional support and fear of weight gain appear to undermine the quitting process for many women.


Predictors of successful quitting
People who successfully quit smoking often share various characteristics. For example:
They tend to have a network of friends and loved ones supporting the decision to quit.
They're more likely to have identified the risks of tobacco use -- particularly if they're diagnosed with a tobacco-related disease.
Many quitters want to set a good example for their children.
The number or intensity of withdrawal symptoms generally doesn't predict a return to tobacco use.


Potential interfering factors
Young tobacco users appear to develop nicotine dependence more quickly and experience more withdrawal symptoms than older users. As a result, they may find it more difficult to quit.
Women are less likely to maintain long-term abstinence from tobacco, especially if they lack social support or gain weight.

Elderly adults are less likely to perceive the risks of tobacco or the benefits of quitting.

At any age, tobacco use may interfere with medications and contribute to or impact existing medical conditions.

Tobacco users who struggle with alcohol or drug abuse problems are unlikely to stop using tobacco unless they can resolve the other addiction because use of one substance often serves as a cue for the other. For example, lighting up a cigarette may trigger a desire for alcohol and vice versa. By avoiding both smoking and drugs or alcohol at the same time, both cues are eliminated and a person has a greater chance of successfully quitting both substances.

For anyone, exposure to high-risk situations (being around others who smoke or having easy access to tobacco or alcohol, for example) increases the possibility of relapse.

Mental health can also help predict your ability to quit. People who are coping with depression are more likely to be tobacco dependent, for example, because the tobacco becomes a way to cope with their feelings. People who are currently depressed or have a history of depression are more likely to experience intense withdrawal symptoms and relapses. Smokers who have a history of anxiety, depression or schizophrenia are also less likely to stop smoking.


Symptoms
Various symptoms may develop in response to tobacco dependence. Physically, you may notice:
an increase in resting heart rate and blood pressure
chronic health concerns
a decreased sense of smell and taste
shortness of breath
headaches
increased nicotine tolerance
Continued tobacco use may lead to conditions such as:

emphysema
chronic bronchitis
chronic obstructive pulmonary disease
heart disease
various types of cancer
Smokeless tobacco may lead to additional problems, including:

leukoplakia, a precancerous growth in the mouth that appears as a white, wrinkled, leathery patch
cancer of the cheek, lip, tongue, throat area, esophagus, urinary tract or bladder
dental problems, including brown-stained teeth, ground-down teeth, gingivitis or decayed teeth
"black hairy tongue," a stain on the tongue formed by a combination of food, tobacco and germs
stomach ulcers
For women, tobacco use may lead to reduced fertility. Combined with oral contraceptives, tobacco may increase the risk of heart disease and stroke -- particularly for women age 35 and older. For pregnant women, tobacco use increases the risk of miscarriage, stillbirth and premature birth, as well as the possibility of slowed fetal growth. Maternal smoking has also been linked to sudden infant death syndrome (SIDS).

Psychologically, tobacco dependence may lead to:

low self-esteem
lack of control over tobacco use
self-doubt
shame
anger
irritability
Sometimes dealing with tobacco dependence can be more than you're able to handle. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation.

As with all physical symptoms, consult a doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help from a mental health professional.


Coping strategies
First, consult your doctor for a physical exam. Discuss your readiness to quit and the most appropriate treatment options.
Medication
Medications such as bupropion (Zyban, for example) are available by prescription to help control cravings that may accompany quitting. These products don't contain nicotine. Possible side effects include insomnia and dry mouth. You can stop taking these products abruptly if you choose.

Nicotine replacement therapy
With nicotine replacement therapy, controlled amounts of nicotine are used to decrease withdrawal symptoms and control cravings. Eventually, the dosage can be tapered off. Nicotine replacement therapy is most effective when used along with a program that addresses psychological dependence and offers support for changing behaviors.

Nicotine replacement therapy is available in various forms:

The nicotine patch is a small, self-adhesive patch that delivers a consistent amount of nicotine into your bloodstream through the skin. It's available without a prescription and in different doses to allow for gradual tapering. Common side effects include skin irritation at the patch's application site, skin rashes, insomnia and nervousness.

Nicotine gum, also available without a prescription, can be chewed when you have the urge to smoke. It's designed to release nicotine slowly into your system when placed between your cheek and gum. Possible side effects include mouth or jaw soreness, an unpleasant taste and hiccups.

Nicotine lozenges are available without a prescription and come in varying doses. The lozenge is quick-acting and designed for a 12-week weaning period. Possible side effects include indigestion and throat irritation.

Nicotine nasal spray, which is only available by prescription, is misted into your nasal cavity. Possible side effects of this fast-acting medication include throat, sinus or nasal irritation, as well as sneezing, coughing and watery eyes.

A nicotine inhaler, also only available by prescription, is designed to mimic the hand-to-mouth motion of smoking. Side effects may include respiratory problems.
It's important to remember that nicotine replacement therapy can cause a nicotine overdose if used along with smoking or chewing tobacco. It may also interact with or affect certain medications. Discuss any possible drug interactions with your doctor or pharmacist.

Counseling
Counseling can be helpful in successfully quitting, as well as preventing a relapse. A counselor can help you:

identify and change thoughts and behavioral patterns linked to tobacco use
learn stress-management techniques and new coping skills
recognize danger situations and triggers
Support groups
Self-help support groups such as Nicotine Anonymous can increase your motivation to quit. You'll learn about:

the health benefits of quitting
the skills needed to quit
the importance of diet and exercise
ways to manage cravings
Tobacco cessation programs
Another option is a formal tobacco cessation program. To learn more, contact your local hospital or clinic.

No one needs to remind you that quitting smoking is a challenge. The goal is well worth the struggle, however. Along the way, think positively, encourage yourself and remember the multiple benefits of quitting.