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PATIENT GUIDE

Hooked? Heres help! 32% to 28%. The number of high school seniors A guide to who dropped from 29% in 1976 to 21% in 1983. cessation This article explores the options available to smokers and offers helpful tips. If you have attempted and failed to quit smoking Kathleen Kuk once before, try again. The benefits are almost Senior Staff Editor immediate. Within 2 years of quitting, an ex- smoker has half the risk of disease as a Smoking stinks. It is hard to ignore the message. person who continues to smoke. Within 10 years of Family, friends, physicians, the media, even a quitting, the risk of developing and dying from package of themselves carry the news— smoking-related cancer approaches that of some- "Warning: The Surgeon General has determined one who has never smoked. that smoking is dangerous to your health." Kicking the habit How dangerous? Smoking, the most preventable More than 56 million Americans are hooked on cause of in the U.S., is responsible for cigarettes. Nicotine, a natural component of the 320,000 deaths annually. It is a major cause of , is responsible for this dependency. emphysema, chronic bronchitis, heart disease, and The powerful is 6 to 8 times more addictive cancer of the , , mouth, and esophagus. than ! With every puff of a cigarette, a burst It contributes to cancer of the bladder, kidney, and of nicotine to the brain creates an immediate pancreas. It causes, in fact, far more cancer deaths feeling of satisfaction. The is short lived, than all other combined. The however, and the smoker must light up again to bottom line is that pack-a-day smokers shave 5 recreate the sensation. Nicotine also induces a years off their life expectancy, while people who wide range of physical changes. The heart rate smoke 2 or more packs a day cut their life speeds up, blood pressure rises, and blood vessels expectancy by 8 years. constrict. The major role of nicotine, however, is to Smoking also poses a health hazard to innocent strengthen and reinforce the desire to smoke. bystanders. Smoking during pregnancy increases Abruptly cutting off the supply of nicotine throws the risk of miscarriage, birth defects, prematurity, the body into a state of temporary disarray. This and lower birth weight. Young children with adjustment period is known as withdrawal. Phys- smoking parents are twice as likely to suffer from ical withdrawal symptoms include decreased bronchitis, , and other respiratory infec- heartbeat and blood pressure, light-headedness, tions. And nonsmoking wives of smoking husbands occasional , lack of energy, insomnia, have an increased risk of heart disease and lung sore throat, , and stomach upset. This cancer. physical disorientation usually disappears within But enough of the lecture. If you belong to the one week. majority of smokers, you are well aware of the The psychologic response to quitting take much health hazards. Ninety percent of smokers have longer to overcome—anywhere from a few weeks admitted that they want to quit. Recent statistics to years. Recent quitters experience an overpower- reflect this desire. From 1976 to 1985, adult male ing desire to smoke. Later, this craving manifests smoking dropped from 42% of the population to itself as a pleasant recollection of the joys of 33%, while adult female smoking decreased from smoking. Almost 90% of all smokers experience

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craving, and 50% of quitters who relapse cite this Going it alone as a major factor. Despite the proliferation of "stop smoking" clinics And what about that old bugaboo, weight gain? and seminars, most smokers who quit do so on This overrated side effect serves as a handy excuse their own. Often, the decision is made to quit for not giving up smoking. In one study, more than "cold turkey." Studies have shown that withdrawal half of all quitters gained less than 5 lbs., stayed symptoms subside more quickly this way. The body the same, or actually lost weight! Even if someone rids itself of nicotine within 48 hours, and the does gain weight, he or she would have to put on smoker needs only to ride out the discomfort, more than 75 pounds to offset the health benefits rather than prolonging the agony with renewed, of not smoking. albeit small and less frequent, bursts of nicotine. Weight gain, unlike other mental and physical Still, a slow and steady approach to smoking side effects of , is entirely cessation does have its advantages. Gradual re- preventable. Some quitters nurse their symptoms of ducers have time to mentally prepare themselves withdrawal by snacking; if you wish to do so, for the challenge ahead. Many smokers "step nibble on low-calorie foods, such as fruit, raw down" to brands of cigarettes with lower tar and vegetables, sunflower seeds, pickles, crackers, or nicotine content, so that the final absence of pretzels. Other folks "reward" themselves with rich nicotine is less traumatic. Other smokers increase desserts; instead, select a nonfattening treat such as the time interval between smoked cigarettes until a new outfit, record album, or trip to the movies. the point is reached that they can stop smoking Some ex-smokers need oral stimulation; substitute altogether. Another trick is to stub out the cigarette a cigarette with a carrot or celery stick, sugar-free after taking fewer and fewer puffs. gum, toothpick, or drinking straw. A final guaran- Whichever method is chosen—gradual or sud- tee against weight gain is to incorporate an den—there are numerous aids to help you toward exercise program into your new, nonsmoking your goal. Many nonprofit organizations offer self- lifestyle. An ideal time for a brisk walk is right after help booklets chock full of advice. The American dinner—at the time when you would usually settle Lung Association, for example, offers a do-it- down for an after-dinner smoke. yourself program called Freedom from smoking in 20 days. (See page 273/122 for where to write for Picking a program these and other brochures.) A sampling of stop- There comes a day when a smoker declares, smoking tips culled from the American Heart "Today is the day I am going to quit!" Fortunately, Association, American Cancer Society, American there are several paths he or she may follow to Lung Association, and National Cancer Institute achieve the goal of quitting. The important thing to appears on page 272/121. remember is that no one method is right for everyone. If you dont succeed with one approach, Over-the-counter aids try another. Aficionados of late-night television or readers who Most smoking programs have end-of-treatment peruse mail-order ads in the backs of magazines success rates of 40% to 90%. However, many may be familiar with those "amazing" cures for the quitters relapse into their old, bad habit before the smoking habit. If some of these products sound too span of a year. What distinguishes a wistful smoker good to be true, they probably are. from a successful ex-smoker? The key to success is Progressive cigarette filters are marketed as a motivation. If you do not truly want to quit, you successful smoking deterrent. The idea is to filter probably wont. out ever-increasing amounts of tar and nicotine

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until the smoker kicks the habit. The filters do at greater risk than people who abstain from all indeed eliminate tar and nicotine, but studies show forms of tobacco. few smokers the ultimate goal. Various tablets and remedies are heralded as safe Group sessions substitutes for tobacco and nicotine. Most have Commiserating with fellow quitters under the been repudiated by the Food and Drug Administra- guidance of a professional counselor is a popular tion. One formulation is still available over the approach to smoking cessation. A quick peek counter. These tablets contain a traditional Indian under "Smokers information and treatment cen- herb, lobeline. However, 10 of 11 studies con- ters" in the Yellow Pages will reveal a multitude of ducted have shown that lobeline is no more local sources. Some clinics are sponsored by effective at stopping smoking than placebo pills. nonprofit organizations, such as the American An is designed to leave a Lung Association, The Seventh-Day Adventist sweetish, metallic taste that can last up to 4 hours. Church, or local hospitals; other treatment centers After swishing with the silver acetate concoction, are run by for-profit corporations (SmokEnders and smokers supposedly lose the desire for another Smoke Watchers, for example). The fee require- cigarette. Three studies on the product have been ment to join some of these clinics may serve as that inconclusive; the Food and Drug Administration is extra incentive to stick with the program and conducting further tests. succeed. is the most successful drugstore Each program tackles an identical problem in a deterrent. Surprisingly, nicotine that is chewed and slightly different fashion. As mentioned earlier, no absorbed through the blood-rich tissues of the one program can be deemed better than the others. cheek carries few of the hazards of nicotine that is Shop around and select the program that best smoked. Therefore, chomping on the gum allows your personality and needs. See page the smoker to break the habitual and psychologic 273/122 for where to write for more information. addiction to smoking, without having to suffer A common thread in most of these programs is physical withdrawal. It also satisfies the smokers behavior modification. The first step is coming to need for oral gratification. After about 6 weeks, the grips with why someone in the first place. ex-smoker can slowly wean himself or herself off To cope with pressure? As a way to relax after a the gum and break the nicotine habit altogether. tough day? Pleasure? Or pure habit? Coping Scientific studies (and the manufacturer) concur strategies are adopted to satisfy these needs without that the gum increases the likelihood of cessation smoking (for example, taking up a hobby to relieve when used "as a temporary aid to the cigarette stress.) Smokers then learn to recognize and cope smoker seeking to give up his or her smoking habit with the triggers that initiate smoking. Is it finishing while participating in a behavior modification a meal, driving a car, being on a work break, or program under medical supervision." The gum, drinking alcohol that consciously or unconsciously which is sold under the brand name Nicorette, is propels you to strike that ? Hopefully, available only by prescription. Nicorette may cause smokers can change their lifestyles (that is, modify minor side effects, including dizziness, sore throat, their behavior) to reach their goal and quit smoking hiccups, nausea, sore , or flatulence. It for good. should not be used by pregnant women, nursing Remember the first cigarette you ever smoked mothers, or persons with recent heart attack, and how nauseated you were? Aversion therapy severe , or jaw malalignment. tries to recapture that essence. Some smoking Note that , pipes, and are clinics use this technique to get you so sick of not recommended as safe substitutes for cigarettes. cigarettes that you will never want to smoke again. The risk of cancer is not eliminated, it is merely Smokers are asked to smoke two to three times the relocated. Chewing tobacco carries the threat of normal quota of cigarettes in half the usual amount , while pipe and smoking causes of time. As unpleasant as it may seem, it often cancer of the mouth, larynx, throat, and works. This approach is most successful when esophagus. And while users of these tobacco combined with conventional educational and products have less a risk of other smoking-related counseling sessions. However, there are some diseases than cigarette smokers, they are certainly dangers involved. A rise in heart rate and blood

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pressure and an increased exposure to and nicotine may be hazardous for Tips for smoking cessation people with heart and lung conditions. The rapid puffing technique should only be attempted under Chew on something with a strong taste and few calories, a doctors supervision. such as a stick of cinnamon, clove, or ginger.

Hypnosis Place cigarette butts into a glass jar, add water, and stir. Hypnosis is no mere hocus-pocus. It is used by Take a whiff now and again to remind you of what an many doctors, dentists, and Ph.D. psychologists as awful habit smoking is. a legitimate tool in medical treatment. Still, reports of its usefulness as a smoking cessation aid are Brush and floss teeth after meals. Use mouthwash to keep a fresh taste in mouth. contradictory. In various studies, success rates ranged from a low of 4% to a high of 88%. Success Do not try to quit during times of family stress or may depend on how susceptible a person is to business upheaval. hypnosis; only 15 to 20 percent of the population is considered "highly hypnotizable." If tapering off the habit rather than quitting cold turkey, Hypnosis allows the subconscious mind to ac- buy cigarettes by the pack and not the carton. With each cept helpful suggestions made by the hypnotist. new purchase, "step down" to a brand of cigarettes that The suggestions may reinforce the reasons and has a lower tar and nicotine content. benefits you gave yourself for quitting smoking. Or, the hypnotic suggestions could link the urge to Wrap a sheet of paper around the and jot smoke with unpleasant images and feelings. But down the reason for and time of each cigarette smoked. you cannot fool your subconscious. If you do not really want to quit smoking, hypnosis will fail. Get it in writing! Draw up a contract with yourself stating When choosing a hypnotist, beware of quacks. the goals and reasons for quitting. Keep it in a handy There are no accredited institutions that hand out a spot and refer to it when tempted. Doctor of Hypnology degree. However, practi- tioners will receive professional accreditation if Spend time at places where smoking is forbidden— museums, movies, and libraries, for example. they meet the strict criteria and training require- ments of the International Society for Professional Start up hobbies that occupy the hands and make it Hypnosis. (Contact the ISPH, 218 Monroe Street, difficult to smoke at the same time. Try knitting, Boonton, NJ 07005 or the American Society of woodworking, puzzles. Clinical Hypnosis, 2250 East Devon Avenue, Suite 336, Des Plaines, IL 60018 for a referral.) Make cigarettes harder to reach. Place them in a locked drawer or in a high cupboard. Acupuncture This ancient Oriental art is based on the premise Exercise. It keeps down weight, and it is hard to puff a that channeling the energy flow within the body cigarette while doing sit-ups or swimming laps. will lead to an inner strength and self healing. On a less esoteric level, acupuncture is supposed to Reward yourself. Place the money you would have spent on cigarettes into a savings account. After a year, make cigarettes taste dull or funny. Small needles splurge! are inserted into specific energy points in the , nose, or other points of the body. The needles are Stop carrying a or matches. Make lighting up a sometimes left in place between sessions, and the hassle. quitter is asked to wiggle the needles whenever he or she feels the urge to smoke. The treatments are Phone an ex-smoking friend during a moment of repeated for an average of 4 to 5 treatments, at a temptation. rate of 2 per week. Scientific literature contains scant data as to the Visit a dentist to have tobacco stains removed. Now, effectiveness of this technique. An element of faith resolve to keep that shining smile. is required, because acupuncture seems to work

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best for people who have high expectations. This car, or smelly clothes...set a better example for approach to smoking cessation is most effective their children...do not have to worry about burn when used in conjunction with other techniques. holes in carpeting, clothes, or furniture...enjoy better social acceptance from peers—and employ- The payoff ers...are no longer a prisoner to the habit, and can Wondering if all the effort to quit smoking is worth sit in any section of the plane, restaurant, or it? The following are just some of the benefits of theater...have an improved sense of smell, taste, leading a healthy, smokefree life. and mental concentration...and feel more vigorous Ex-smokers...add years to their life expectancy in sports due to increased lung capacity. by decreasing the risk of cancer and heart dis- ease...save $$$...rid themselves of stained teeth and fingers...earn reduced rates for auto and health (All material in the Patient Health Guide insurance...no longer have , a musty is reviewed by JAOA referees.)

For more information: References American Cancer Society Calling it quits. By the American Heart Association, Dallas, 1984 777 Third Avenue New York, NY 10017 Cleaning the air: A guide to quitting smoking. By the U.S. Department of Health and Human Services, NIH Publication American Heart Association No. 85-1647, Washington, D.C., 1985 7320 Greenville Avenue Dallas, TX 75231 Freedom from smoking in 20 days. By the American Lung Association, New York, 1986 American Health Foundation 320 East Forty-Third Street Kicking the nicotine habit: How to help patients stop smoking. By D.J. Fletcher. Postgraduate Medicine, vol. 77, pp. 123-33, 15 New York, NY 10017 Feb 1985 American Lung Association Methods for stopping cigarette smoking. By the Health and 1740 Broadway Public Policy Committee, American College of Physicians. New York, NY 10019 Annals of Internal Medicine, vol. 105, pp. 281-91, Aug 1986 Office of Cancer Communications 1986 Cancer facts and figures. By the American Cancer Society, National Cancer Institute New York, 1986 National Institutes of Health Quitters guide: 7 day plan to help you stop smoking cigarettes. Bethesda, MD 20205 By the American Cancer Society, New York, 1978 Office on Smoking and Health Searching for a way out: Smoking cessation techniques. By the U.S. Department of Health and Human Services American Council on Science and Health, Summit, New Jersey, 5600 Fishers Lane 1985 Park Building, Room 110 Smoking or health: Its your choice. By the American Council on Rockville, MD 20857 Science and Health, Summit, New Jersey, 1984 Seventh-day Adventist Community Health Services Smoking prevention, cessation, and maintenance: Review for 85 Long Island Expressway the primary care physician. By M.W. Ketterer, et al. Journal of New Hyde Park, NY 11040 the American Osteopathic Association, vol. 87, pp. 248-57, Mar 1987 SmokEnders Why do you smoke? By the U.S. Department of Health and National Offices Human Services, NIH Publication No. 86-1822, Washington, 3708 Diablo Boulevard D.C., 1986 Lafayette, CA 94549

Why people smoke cigarettes. By the U.S. Department of Health and Human Services, PHS Publication No. 83-50195, • Consult the telephone directory for local chapters. Washington, D.C., 1982

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