Smoking Cessation Guide There are many means to help in tobacco cessation. There is no “magic cure” for everyone. The American Lung Association Call Center/Tobacco Quitline provides smoking cessation counseling, free of charge, over the telephone. The smoking cessation counselors take a look at your smoking pattern and develop a plan that's right for you. The counselors encourage you to call in weekly to review your progress, discuss any problems you may be having and revise your plan as needed - so that your plan works for you. In addition, a Smoking Cessation Packet is sent to your home to provide you with written information to refer to and help you stay on track. The Smoking Cessation Packet includes information on: y Common recovery experiences y Distracting techniques / tips y Exercise y Healthy eating habits / risk of weight gain y Stress Management tips y Changes to expect your body to go through when you quit y Support systems (family, friends, co-workers) The American Lung Association Call Center/Tobacco Quitline has been helping clients to quit smoking, through the use of telephone counseling, for many years. The Call Center/Tobacco Quitline staff of Registered Nurses, Respiratory Therapists and trained Smoking Cessation Counselors have found that a combination of methods to assist you in the smoking cessation process has been most helpful. The methods our staff has found to be most effective in helping our clients be successful are listed below. A table describing the types of medications, how they are used, pros and cons, dosage, side effects and approximate costs can be found on the last page of this packet. Method 1 PRESCRIPTION MEDICATION: There is a cost to you for prescription medication (check with your insurance carrier) and your physician must prescribe the medication for you. Zyban and Wellbutrin are brand names for bupropion hydrochloride, a medication that is used to treat depression. In treating this condition, researchers found that the chemical in bupropion hydrochloride had an additional benefit of curbing the urge to smoke - it has been proven to assist smokers to quit smoking. This is the only prescription medication to help quit smoking available in tablet form. There is a small risk of seizure associated with the use of this medication. You cannot take this medication if you have a seizure disorder, eating disorder or head trauma. It must be used with caution for those with renal or liver disease, heart disease or history of a heart attack. Your physician can tell you if this medication is right for you. Method 2 TAPERING: There is no cost to you, other than the number of cigarettes you purchase while you are tapering. Tapering slowly reduces the amount of nicotine your body is used to and has the added benefit of giving you experience in changing your smoking behaviors so you are prepared to get through the urges to smoke. To begin the tapering process you must know the exact number of cigarettes you smoke every day. Reduce the total number of cigarettes by one every 2 days. For example, if you smoke 30 cigarettes per day, start with 29 cigarettes a day for 2 days, then 28 cigarettes a day for 2 days and so on. Continue this process until you are at 15 to 20 cigarettes per day - then STOP SMOKING and begin to use nicotine replacement therapy (patch, gum, lozenge, etc.). At 15 to 20 cigarettes per day the amount of nicotine per day is more equal to the amount of nicotine in the nicotine patches (approximately 1 milligram per cigarette compared to 21 milligrams in the initial patch). It is beneficial to write the number of cigarettes you are allowed each day on a calendar so you can keep track. This is the maximum number of cigarettes you are allowed to smoke each day. You can smoke up to that amount, less than the amount, but NOT MORE THAN THE AMOUNT ALLOWED FOR THE DAY. Follow the instructions -- tapering too quickly will cause withdrawal symptoms. See the “Tapering Calendar” examples next page. While you are tapering, you get a chance to try out new techniques to break your smoking habit. For example, you wake in the morning and automatically smoke a AUTOMATIC cigarette with your morning coffee. That morning coffee triggers your CIGARETTES urge to smoke. Instead, change your routine - brush your teeth first smoke only thing in the morning, drink orange juice with your coffee to curb the those cigarettes appeal of smoking that cigarette -- think of an alternative to smoking you really want that first cigarette with your coffee. To break your smoking habit you have to develop new life strategies How can I be successful? BE PREPARED with your distracters! Do something else with your hands: - doodle while you are on the telephone Keep with you: - squeeze a stress ball in the hand you smoke with - knit or crochet Toothpicks - crossword and/or word find books Straws Keep a novel or short-story book with you Listen to books on tape in the car Sugarless gum & hard candy Take a walk Stretch Pretzels Try deep breathing or meditation Bottled water Change your routines Breath spray Stay busy Worry stone Get to know what triggers your urge to light up a cigarette so you can ? be one step ahead of those urges. TAPERING CALENDER EXAMPLES 2 packs of cigarettes per day equal 40 cigarettes per day. Start the tapering process with 39 cigarettes a day for 2 days. Reduce cigarettes per day by 1 cigarette every 2 days - stopping at 15 to 20 cigarettes per day. Week Sun Mon Tues Wed Thurs Fri Sat 1111111111111 Week Sun Mon Tues Wed Thurs Fri Sat 1 39 39 38 38 37 37 36 1 25 25 24 24 23 23 22 2 36 35 35 34 34 33 33 2 22 21 21 20 20 19 19 3 32 32 31 31 30 30 29 3 18 18 17 17 16 16 15 4 29 28 28 27 27 26 26 4 15 ∅ ∅ Start nicotine replacement therapy (i.e., patch, gum, etc.) and DO NOT SMOKE 1 ½ packs of cigarettes per day equals 30 cigarettes per day. Start the tapering process with 29 cigarettes a day for 2 days. Reduce cigarettes per day by 1 cigarette every 2 days - stopping at 15 to 20 cigarettes per day Week Sun Mon Tues Wed Thurs Fri Sat 1111111111111 Week Sun Mon Tues Wed Thurs Fri Sat 1 29 29 28 28 27 27 26 1 15 15 ∅ 2 26 25 25 24 24 23 23 2 3 22 22 21 21 20 20 19 3 4 19 18 18 17 17 16 16 4 ∅ Start nicotine replacement therapy (i.e., patch, gum, etc.) and DO NOT SMOKE 1 pack of cigarettes per day equals 20 cigarettes per day. Start the tapering process with 19 cigarettes a day for 2 days. Reduce cigarettes per day by 1 cigarette every 2 days - stopping at 15 cigarettes per day. 88888888888888888888888888 Week Sun Mon Tues Wed Thurs Fri Sat 1 19 19 18 18 17 17 16 2 16 15 15 ∅ ∅ Start nicotine replacement therapy (i.e., patch, gum, etc.) and DO NOT SMOKE Do you use cigarettes to reduce the stress in your life? Develop new methods to deal with the day to day stressors in life - smoking does NOT reduce stress. In fact, it makes the heart beat faster, increases the breathing rate and causes the body to use more oxygen. Stop negative self-talk Allow private time for Identify stressors yourself Avoid stressors you can Visualize success Talk out problems with a control friend Do unpleasant tasks first Focus on understanding Take breaks others Practice relaxation Delegate responsibility Learn to live one day at a techniques time Be positive Change your pace on the Be prepared to wait weekends Method 3 THE NICOTINE PATCH: Nicotine patches may be purchased over the counter in a variety of locations (local and chain pharmacies, discount stores, etc.). Prices may vary between brands, with generic patches being the least expensive. The patch gets to the nicotine addiction. The nicotine patch provides a safer source of nicotine - that enters the body slowly and in lower concentrations than in cigarettes. Patch therapy is generally safe and well tolerated. The most common adverse reactions are skin irritation and sleep disturbance. The nicotine patch helps take care of the nicotine addiction so you can work on breaking your smoking habit. The full course of nicotine patch treatment starts with a 21 mg patch for the first 4 - 6 weeks, a 14 mg patch for the next 2 weeks and a 7 mg patch for final 2 weeks. During the last week, taper off the 7 mg patch reducing the hours you wear the patch daily until you reach zero (if you experience sleep disturbances you can remove the patch at night): Last Week Number of hours wearing the patch on If you wear the patch If you remove the 7 mg patch 24 hours a day patch at night Day 1 24 hours 16 hours Day 2 24 hours 16 hours Day 3 20 hours 16 hours Day 4 16 hours 16 hours Day 5 12 hours 12 hours Day 6 8 hours 8 hours Day 7 4 hours 4 hours Day 8 0 hours 0 hours CAUTION: You cannot smoke while you are on the patch The safety of the nicotine patch for children and adolescents has not been studied If you are pregnant, check with your Doctor HOW ARE THESE METHODS COMBINED? The use of a combination of all 3 methods can increase your rate of success.