Smoking Cessation

I'm a 48-year old woman who has smoked for 20 years. I've tried to quit several times without success. Is there anything I can do?

You've taken an important first step--knowing that you want to quit smoking. There is nothing you can do that can reduce your risk of heart attack more than getting rid of the cigarettes.

I counsel patients that there are three main steps to smoking cessation. First, pick a time to quit when your life stresses are low-to-moderate, not high. Second, you'll need to change a lot of minor personal habits. Though nicotine dependence is the initial struggle, the psychological dependence continues to be a battle weeks and months out from your quit date. You'll have to avoid restaurants and bars where you used to smoke, drink your morning coffee in a different place (if you are used to smoking with your daily cup of joe), and generally not do the things you associate with smoking. Third, most people require medications to successfully quit. Though nicotine supplements (patches, lozenges, nasal sprays) can help, these have not been shown to be very effective in keeping smokers off cigarettes in the long-term.

here are now two effective medications that can increase your chances of success. One is called Zyban (also known as Wellbutrin). This can increase your chance of success from 5-10% to 40-50%. You start the medication for ten days prior to your quit date, then usually continue it for 3-4 months. Side effects include dry mouth, jitteriness, and insomnia--most improve with time. A more recently released medication is called Chantix--in limited head-to-head studies with Zyban, it appeared to be slightly more effective.

Finally, don't give up! Many ex-smokers had to try several times before they were ultimately successful. Ask your health care provider for more information.

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