Part 3: TECHNIQUES, TROUBLESHOOTING, AND TIPS

30. What is the best method for quitting?

The best method to use for quitting is the method that works for you. If one method doesn't help, try another! Don't let external images get in the way of your success (such as, it's weak to use the patch, or acupuncture is too New Age). Whatever works for you is a good method - with one big caution: be very wary of using unmedical miracle cures you may see advertised on the WWW or - gasp! - occasionally on AS3. They can be, at best, very overpriced, and at worst, dangerous. Please be cautioned that AS3 does not condone or encourage the practice of advertising on Usenet, and it does not recommend any product which may be advertised on the group.

Here is information on some conventional and not so conventional tools for smoking cessation, along with some feedback from AS3 members. And remember, being prepared is key, no matter which method you try.

a. Rational Emotive Therapy (RET)

I put this one first because it can be - and IMHO, should be, - used in conjunction with any of the other methods listed in this section. It also seems to me to be closely related to the advice of Allen Carr, whose method is described below.

Don't shy away from what may sound like a technical discussion; RET basically is no more than a way of changing your attitude.

Steve Polansky ("DD [Dare Devil] Steve") introduced RET to the group in a follow-up to a post by Shirley Shaw.

Shirley observed:

"The fear was the most uncomfortable thing about the day. Perhaps that is one of the reasons we smoked...the fear of being uncomfortable."

DDSteve responded:

"I had an opportunity several years back to be introduced to Rational Emotive Therapy [RET]. About all I remember is that: between the occurrence of an event and our reaction to it, there is a mental dialogue that probably determines what our reaction will be to that event. ... [T]he dialogue is usually one that we are unaware of on a conscious level. =46urther, that by altering the script of that dialogue, we will alter our reaction to the event.

"When I look back at why I smoked, what I remember is that I seldom smoked a cig because it tasted good or because it felt good. I usually, like any chemical addict, smoked so that I wouldn't be/feel uncomfortable. A sagging nicotine level brought on that awful feeling we called a nicotine fit. What were its characteristics? Nervousness, trembling, sweating, irritability? I remember these and there are probably others, all uncomfortable sensations.

"And how did we 'cure' the condition? We smoked a cigarette. Pretty simple solution, and effective. This is where I see the internal dialogue being established. As neophyte smokers we 'learned' to relieve discomfort by smoking a cigarette. I'm sure very few of us willingly waited till we were uncomfortable. The onset of the sensations associated with a sagging nic level triggered a response that, with practice, happened more automatically, [until] we were no longer consciously in the loop.

"Here is where I make a connection that may not be valid. Once we had established the dialogue that went "when I feel a sensation that feels like a nic fit, smoke a cig to cure it", then any event that produced feelings similar to a nic fit should/could be cured by smoking a cig. I very much doubt that we looked closely at why we lit a particular cig. With every cig smoked, with every repetition, the pattern became more ingrained.

"... I was talking to a friend who had quit cold turkey a few months earlier. He was telling me how much he wanted a cig. That sometimes he craved them so badly he felt like he was being turned inside out. Talking to him, it seemed that the only thing that had changed was that he was no longer putting a cig in his mouth. But the rest of his habit was somehow still intact. He really believed that a cig would relieve his discomfort. I wonder if his inner dialogue is telling him that 'a cig will make you feel better'. =2E.. "If we don't alter the script, we run the risk of relapse. If we do change the script, we can comfortably and confidently carry on with our lives with no risk of relapse."

b. Cold Turkey

This is certainly the cheapest, oldest, and simplest method: just stop smoking. Aside from its economic and operational advantages, going Cold Turkey means that the nicotine in your body will clear itself out as fast as possible - so your withdrawal period will be short, but it will also be intense.

c. The Patch

(Material for this FAQ was contributed from various sources, as credited.)

[Adapted from Brad Olin's contribution.]

The 'patch' is the common name for a nicotine replacement therapy (NRT) which delivers varying dosages of nicotine to the bloodstream via a plaster which adheres to the skin. There are several brands of the patch available, manufactured by different drug companies in different dosages and with slightly different properties, but all operate by weaning the nicotine addict off the drug over a period of weeks or months. (Nicotine gum is another form of NRT - see below.) Your body has become addicted to nicotine, and nicotine addiction is a medical problem that can be treated medically. However, NRT is not a sure-fire way to quit smoking.

Used properly, the patch can provide relative comfort from the physical symptoms of withdrawal (e.g., irritability, frustration, anger, anxiety, difficulty concentrating, restlessness), allowing those who feel overwhelmed by the physical addiction some relief while dealing with the behavioral habit. The discomfort felt when going from smoking to the patch, or when reducing dosages, is not as sharp as that felt when going cold turkey. But, some quitters contend that because the patch stretches withdrawal out over a longer period of time, it isn't any easier than quitting cold turkey.

Cravings may not be as intense when using the nicotine patch, but do not expect them to disappear magically. For most smokers, nicotine addiction is just one part of the habit. We develop behavioral and psychological addictions as well. Certain feelings, times of the day, or activities all become strong cues and make us crave a cigarette.

How many cigarettes does a patch equal? The nicotine released from the 21mg patch during a 24-hour period is roughly equivalent to that ingested from a pack of 20 cigarettes, whether they be high or low tar and nicotine. (Cigarettes are made 'light' by modifying the filter, not the tobacco; but it has been shown that smokers of 'Lights' and 'Ultra Lights' then modify the way they hold and inhale cigarettes, so that they get the same amount of nicotine as with the stronger brands.) You and your medical provider or pharmacist/chemist will determine, based upon factors such as your weight, general health, and smoking habits, the nicotine dosages you use and the length of time you will remain at each level.

Nicotine from the patch is not delivered to the bloodstream in the same way as it is when you smoke. When you inhale, the nicotine in cigarette smoke enters your bloodstream through your lungs. It is carried to your brain very quickly (faster than an injection into your veins) and it almost immediately satisfies your craving. At least for the moment. The amount of nicotine in your blood is known as 'blood nicotine level.' After a cigarette, the level of nicotine drops quickly. When it gets to a low level, your body signals that it needs more and you experience a craving. The desire is temporarily satisfied when you inhale your next cigarette. You may need a cigarette every 20 to 30 minutes. Throughout the day your blood nicotine level is raised and lowered like a roller coaster, and your system becomes a participant in a constant 'need-feed' cycle of addiction.

The nicotine patch, on the other hand, delivers the drug at a controlled rate into your bloodstream through your skin. The rate is intended to be steady, but it's not perfect. When the patch is first applied, the blood nicotine level quickly increases to its peak at about the two hour period; it remains at peak delivery through about the sixth hour; then it slowly tapers off through the remainder of the 24 hour cycle.

[Please note that nicotine remains in the blood for several hours even once the patch is removed; therefore, it is crucial that once you begin using the patch, you do not smoke. A nicotine overdose can result in illness, heart failure, even death. Also, a significant amount of drug remains in the patch itself even once it is discarded. See information provided by Michiko Walraven further on in this section.]

While nicotine is nicotine regardless of its delivery system, using the patch is not as harmful for you as continuing to smoke cigarettes. First, you receive no more nicotine, and usually far less, through the patch than you do from smoking. The patch does not contain tar or the poisonous gases that are found in cigarettes. The patch does not present health hazards, via second hand smoke, to those who share your living space. And most important, the patch is easier to stop using. It is not associated with qualities such as sexiness, rebelliousness, or creativity; nor will you look to it to see you through tough times or to join you in celebrations (though you may find yourself giving it a little pat now and again)! And, as explained above, the relatively constant nicotine level supplied by the patch, delivered passively and regardless of whether you think you need it or not, ends the need-feed cycle, allowing the body to disassociate itself from the expected reactions to nicotine intake.

It is unfortunate that the cost of the nicotine patch sometimes presents a barrier to its use, and although national governments and insurance companies agree that smoking is a highly significant source of senseless illness and premature death, few back up this belief by subsidizing the cost of this treatment. But even if your health insurance won't pay for the patch, remember that the cost of using the patch is usually no more than continuing to smoke a pack a day. And patch use will usually end within 10 to 16 weeks; cigarette buying never ends until the smoker stops, one way or another.

Not everyone can use the nicotine patch, so be aware of potential medical side effects associated with using the patch. It is possible, and not uncommon, to have some mild itching, burning, or tingling when the patch is first applied. This is normal and should go away after about an hour. After you remove a patch, the skin underneath might be somewhat red. Your skin should not stay red for more than a day. If you get a skin rash after using the patch, or the skin under the patch becomes swollen or very red, call your doctor. You might be allergic to one of the components of that particular company's patch. You can try switching brands, and see if you react more favourably. And, if you know you have problems with adhesives plasters/bandages, then consult your doctor before using the patch.

Most brands of the patch comes in different dosages, and using the wrong one could result in side effects including headaches, dizziness, upset stomach, diarrhea, blurred vision, weakness, and vivid dreams. Also, you must inform your doctor that you are using the patch if he/she prescribes other medication.

The happy side effect: Many people using the patch, especially one of the brands designed to be worn round-the-clock, experience unusually vivid dreams. One friend told me that the patch gave him extremely erotic dreams every night! It seems that the patch's steady nicotine delivery system keeps the brain relatively active even during sleep, which in turns produces lively dreams.

If the patch is causing insomnia, however, or if the excessive dreaming is disturbing, ask your doctor about switching to a 16 hour patch, or removing the one you're using during the night.

[From The Journal of the American Medical Association. Distributed by: JOIN TOGETHER: A National Resource for Communities Fighting Substance Abuse. Tel. 617/437-1500. Fax. 617/437-9394. 441 Stuart Street, Sixth Floor, Boston, MA 02116. info@jointogether.org]

_The Effectiveness of the Nicotine Patch for Smoking Cessation: A Meta-analysis_

- Michael C. Fiore, MD, MPH; Stevens S. Smith, Ph.D.; Douglas E. Jorenby, Ph.D.; Timothy B. Baker Ph.D.

"Our objective was to estimate the overall efficacy and optimal use of the nicotine patch for treating tobacco dependence. Our data sources were from nicotine patch efficacy studies published through September 1993, identified through MEDLINE, Psychological Abstracts, and Food and Drug Administration new drug applications. Our study selection was double-blind, placebo-controlled nicotine patch studies of 4 weeks or longer with random assignment of subjects, biochemical confirmation of abstinence, and subjects not selected on the basis of specific diseases (e.g., coronary artery disease). Pooled abstinence rates and combined odds ratios (ORs) at end of treatment and 6-month follow-up were examined overall and in terms of patch type (16-hour vs 24-hour), patch treatment duration, dosage reduction (weaning), counselling format (individual vs group), and intensity of adjuvant behavioral counselling. Across 17 studies (n=3D5098 patients) meeting inclusion criteria, overall abstinence rates for the active patch were 27% (vs 13% for placebo) at the end of treatment and 22% (vs 9% for placebo) at 6 months. The combined ORs for efficacy of active patch vs placebo patch were 2.6 at the end of treatment and 3.0 at 6 months. The active patch was superior to the placebo patch regardless of patch type (16-hours 24-hour), patch treatment duration, weaning, counselling format, or counselling intensity.

"The 16-hour and 24-hour patches appeared equally efficacious, and extending treatment beyond 8 weeks did not appear to increase efficacy. The pooled abstinence data showed that intensive behavioral counselling had a reliable but modest positive impact on quit rates. Our conclusions were that the nicotine patch is an effective aid to quitting smoking across different patch-use strategies. Active patch subjects were more than twice as likely to quit smoking as individuals wearing a placebo patch, and this effect was present at both high and low intensities of counselling. The nicotine patch is an effective smoking cessation aid and has the potential to improve public health significantly.

"Abstract Source: Fiore M.C., Smith S.S., Jorenby D.E., Baker, T.B., (1994) The Effectiveness of the Nicotine Patch for Smoking Cessation: A Meta-analysis. The Journal of the American Medical Association, JAMA 271 (24) 1940 Article Source: Fiore M.C., Smith S.S., Jorenby D.E., Baker, T.B., (1994) The Effectiveness of the Nicotine Patch for Smoking Cessation: A Meta-analysis. The Journal of the American Medical Association, JAMA 271 (24) 1940-1947. Date: 8/9/94"

[From Michiko Walraven, michiko@islandnet.com]

Warning to Patch Users

This is a summary of an article I found yesterday morning in our local newspaper. I hope this will help all the patch users who live with small animals/children:

Excerpts from Victoria Times-Colonist, Jan 12, 1995, page B3.

"A man in Duncan, BC has been on nicotine patch for the past 40 days trying to quit smoking. He noticed that the patch sometimes gets loose and falls off. So, he has been using duct tape on occasion. Last night his patch fell off during his sleep, and his pet kitten (11-month) accidentally swallowed it. The cat survived her nicotine blast and was recovering fine at the time of newsprint. BC Drug and Poison Information Centre representative says: 'With nicotine patches, when children get them stuck on them, we've had problems with nicotine toxicity where they get very shaky, stomach cramping and if untreated sometimes there's always the risk of seizures.' She recommends that users of patches consider returning the used patches to their pharmacies for proper disposal rather than just throwing them out with the normal trash. The spent patches could still contain traces of medicine."

d. Nicotine Gum

Another form of nicotine replacement therapy (NRT) is chewing gum laced with nicotine (sold under the brand name Nicorette in Canada, the U.S., and Europe. Like the patch, it provides nicotine to the person quitting smoking via a less psychologically- attractive delivery system, and allows for a more gradual (and theoretically more comfortable) departure of the drug from the bloodstream. Another factor which might appeal to some people is that the quitter has full control over gum use; unlike the patch, which is designed to deliver a steady and constant flow of nicotine, the gum is used in response to withdrawal cravings. You use it when you feel the need, and wean yourself off the drug by using fewer pieces of the gum per day. Even if you take months to go off the gum entirely, you will still be realizing many health benefits from not smoking.

That the nicotine gum requires the user to take an active role in nicotine dosing may make it an undesirable tool for some people. It may seem too much like smoking in that you are responding to the body's urges for nicotine by supplying it on an as-needed basis, only with gum rather than with a cigarette. OTOH, you may prefer to have control rather than use the patch, which sends nicotine to you whether you think you want it or not. If you find the gum upsets your stomach, you may be using it incorrectly. The package directions for Nicorette gum specify that you should chew a piece with small chews every minute or so, and "park" it between your cheek and gums when you're not chewing. The package also states most of the nicotine will be released within the first thirty minutes. If you chew Nicorette like regular gum before the nicotine is released, this could and probably will upset your stomach. Note that after the 30 minutes you can treat it as regular gum and chew as often or as vigorously as you want.

e. Nicotine Nasal Spray [Provided by Dixie, randixoe@digisys.net]

"The spray is called Nicotrol NS and is manufactured in the U.S. by McNeil Pharmaceutical. It was just approved by the FDA in July of 1996. It is a prescription medicine. It is sold in a spray bottle containing 10 mg/ml nicotine in an aqueous solution. Each time you spray the Nicotrol NS into each nostril you receive about the same amount of Nicotine as smoking 1 cigarette.

"One spray in each nostril is considered 1 dose. Instructions are not to use more than 5 doses per hour or more than 40 doses in 24 hours. The suggestion is to use the spray no longer than 3 months. The cost is $38.30 for 1 bottle that contains approximately 100 doses (200 sprays).

"Now for my experience with this nose spray. Although I had the prescription for Nicotrol NS, I wanted to see if I could quit 'cold turkey' first. Well the first day, towards afternoon I was turning into a miserable bawling mess. I decided to try the Nicotrol NS and to my amazement within 1 minute I was a new girl. I couldn't believe how well it worked, compared to the patches I had tried years ago.

"That day I used the spray 6 times. Since then I have used the spray about 15-16 times a day. I really don't want to use any more than I have to because in a couple of weeks I'll want to discontinue the use of the spray also.

"The nose spray really did sting some when I first used it but doesn't bother me much at all now. (They do give a warning for people who have sinus problems, etc. to check with their doctor before using.)

"From everything I've researched on this Nicotrol NS I think that someone who isn't careful could have problems being addicted to and continuing the spray longer than appropriate. My suggestion to anyone who decides to use it is to use as little as you can but don't let yourself get to the panic stage before you use it. I was smoking 2 1/2 packs a day when I quit and like I said I'm using about 15-16 doses a day. If I did that for a whole month it would end up costing me about $190-$200 per month."

f. Cutting down

Is there one among us who has not tried cutting down our tobacco intake at one time or another? Perhaps you weren't even thinking of quitting smoking as the ultimate goal, but of trying to reduce the damage or risk or save a little money. I have personally notched many a cardboard matchbook cover in my day. What I got for my trouble was an obsession. How much time has passed since my last smoke? Can I have another yet? How do I make this x number of cigarettes last me through y hours?

It would seem to be self-evident that gradually cutting down on smoking would be a viable means to quitting altogether. After all, the less you smoke, the less drug in your system, and this is the logic behind the nicotine patch and Nicorette gum, right? But in fact, whether your goal is to smoke less or to quit entirely, you're not doing yourself any favours by cutting down, because each cigarette that you light sets you right back down in the middle of your addiction cycle. The further apart you stretch the supply of drug, the longer you suffer the discomfort of withdrawal. The only way out of this cycle is to stop feeding the addiction altogether. That way, the body eventually gives up demanding the drug, and you're on the road to freedom.

Switching to a lighter brand might seem sensible, and theoretically it is. But keep in mind that what makes a cigarette's nicotine content less is manipulation of the filter, not the tobacco, and smokers in reality manage to compensate for that manipulation by holding the cigarette a certain way and/or inhaling more deeply.

Having said this, there are some people who have quit by cutting down, delaying smoking further and further into the day, limiting the places where they smoke, and/or switching brands. And if it works for you, great! If not, next time you can try another strategy. The important thing is that you keep trying to quit.

g. Acupuncture/Acupressure

i. Before quitting

[Contributed by Grant N. Mazmanian grantmaz@ix.netcom.com]

"QUOTE I went to an M.D. specializing in anesthesiology at a local hospital outside of Philadelphia at the recommendation of a friend. The doctor gave me references and claimed a 75% success rate. I called several doctors and nurses at the hospital and they all reported the same results: they stopped smoking after one or two treatments, minimal withdrawal symptoms, little or no weight gain and no apparent side effects. They all had tried to quit several times and failed and were very enthusiastic about the procedure.

"My visit lasted about an hour. Sterile, disposable acupuncture needles were inserted along my arms, hands, ears and head. There was little to no pain. A final needle was placed on the top of my head and an electrode was connected to a mild electric current. I rested in a chair during the procedure.

"At the end of treatment, I was given an herb to mix with hot water to make a tea. I was instructed not to smoke and if I had any cravings, to drink the tea. If the tea didn't work, the doctor gave me his beeper number.

"For the first few days I felt a craving but I didn't know what I wanted; it wasn't for a cigarette but I was at a loss to describe what the craving was for. I called the doctor about it and he told me that it was a normal response. I went for a second session because I wanted to reinforce the first treatment but I honestly didn't think I needed it. After a week, the craving subsided. The usual cigarette 'triggers were gone after two weeks."

[N.B. - Grant does not know the herb he was given - ed.]

ii. After quitting

[Contributed by Tina tivity@dti.net]

"I was getting discouraged that after sooooo many days without nicotine, I was still longing to smoke all the time. It didn't seem to make sense to reintroduce nicotine into my system via gum or patches (though if I'd planned my quit, I would have used one of them). I went to an acupuncturist instead, and thought I'd post a report. ...

"After swabbing my ears with alcohol, she used long tweezers to poke a little ring into the upper arch of my left ear, and another one at the nest-like hollow in the lower part of my right ear. These rings are less than 1/8 inch diameter, and though they seem to be laying flat on the skin, they must have a pointy part facing into the skin because a) I could feel them being placed as if they were poking my skin (although this might have been the tweezers) and b) I was instructed to tap the rings to activate the pressure points in question. Using small pieces of clear surgical tape, Dr. Lee secured the rings to my ears. She issued the following instructions: lightly tap the points 20 times each morning upon awakening; tap them 5-7 times any time I feel the urge for a cigarette. I could swim, shower, sleep, etc without fear of disturbing the rings, but I shouldn't scratch at them. They would help me be free of urges to smoke, and even if I did have a cigarette, it would taste bad and I wouldn't want to smoke it. (Junkie thinking ALERT: It did cross my mind to test this theory....) Because I had already quit for 2 weeks, she thought a week would do me, and I should drop by (no appointment needed, because it's so fast) to have the rings removed. The visit cost $50.

"So, how is it, you're asking. From the first, I noticed that tapping the rings did seem to help get over cravings. The first day, I did this many many many times. Fewer the second day, and, you guessed it, fewer each day than the last. Also, I could feel a little soreness, especially in the left, at the beginning, and this too diminished.

"The experience, especially noticeable with the 20 a.m.-taps, is sorta... Eastern. That is, the cravings don't feel like they're being wiped out, as if with a drug, but rather that you are becoming slightly better balanced, and therefore your need for something to fix you, like a cigarette, is less. I can't imagine that this subtle effect would be enough to have made me quit had I still been smoking. And I have not tried what it would taste like to smoke a cigarette."

h. Hypnosis

[Contributed by Michiko Walraven michiko@islandnet.com:

"I had decided to use hypnosis simply because: (1) I knew I did not have strong willpower; (2) I honestly believed that I would go under very easily. Also, the initial session was covered by our medical insurance, since it was a referral from my physician. My appointment with the doctor (a General Practitioner with a certificate for hypnotherapy) was 9 a.m. on my birthday (sheer coincidence, which turned out to be a great motivator later). I had my last smoke in the car in the parking lot at 8:59 a.m. The doctor asked me at the beginning of the session to describe to him why I was going to quit. It was, I told him, because I knew I had to quit eventually, and that it was as good as any other time (rather laid-back attitude). One thing I really emphasized was that I didn't want to turn into an ex-smoker who would become a strong anti-smoker, poking his/her nose into everybody else's (i.e. smoker's) business.

"My session began. He asked me to look back for the first happy moment I could remember as a non-smoker. That took a lot of going back... I had been a smoker since 16 or so. I was about 12 years old or so in that image. The doctor then told me that I no longer needed to smoke, and asked me if I could visualize myself being a non-smoker in that image, only at the current age. After some time I would see myself being a non-smoker. He then asked me if I could see myself being a non-smoker one week from that day, one month, 3 months, etc. etc. finally down to one year from that day. =46ortunately I could really see it.

"That was basically it. I did not become violently ill at the smell or sight of smoke, I did not turn into a radical anti smoker. I am just a happy and proud non-smoker for over two years now. Of course this newsgroup helped a LOT, particular at the beginning, and when I was going through some legal/family trauma. Sure, the thought comes to me 'Boy, a smoke would really hit the spot' once in awhile. But if necessary, I can always go back for a follow-up session. Actually I was told to have an follow-up after 2 weeks/months, but never bothered because (1) I did not need it all that much, and (2) it would cost me $80.00 CDN. (First session was covered by the medical insurance, lucky!)

"If you are interested, ask your family doctor. That is exactly what I did, and he recommended doctors who could do hypnotherapy (1 hr) for my purpose. It was strictly a private session. I don't know how a group session would have worked for me, since I wasn't interested."

Here is more on hypnotherapy, from a licensed practitioner.

Bob Christofferson asked a hypnotist who posted to AS3:

"Do you have any advice for how to select a hypnotherapist? Is one session enough, or are results better with more sessions? Are group sessions any good? Is there a way for a person to tell if he or she would be a good candidate for hypnotherapy? Is that enough questions for now? :) "

Edward Hutchison, a practicing hypnotist, responded:

"First, I don't know any sure guide to picking a lawyer, a good school, a wife ... or a hypnotherapist. There really aren't any good accrediting agencies with universal recognition for hypnotists or psychotherapists so about all I can suggest would be to ask friends or perhaps your family doctor. But, to be honest, although hypnosis is taught at some medical and dental schools it is not a part of the typical MD's training. Consequently, not enough of them are aware of its full potential and some patient might ask a question about it and, as you probably know, MD's are bred to never say 'I don't know.'

"As to the number of sessions: it depends. I prefer to see people once, and for about 70%, that one visit is enough to quit smoking. Crassilneck and Hall have published a study with an 82% success rate but it is predicated upon four sessions and the only subjects seen were males with a medical referral.

"I have conducted numerous group sessions - usually where some employer undertakes the expense of the program. The success rate is only about 50%. But in terms of cost-effectiveness these programs, especially in the absence of other options, can be very worthwhile. They last three hours (with two brief breaks) as opposed to about 70 minutes for the individual sessions.

"The last question is the easiest. Virtually everyone with the intelligence to ask the question is a good candidate for hypnosis. That is to say, about the only people who have any difficulty in obtaining the light trance necessary for stop-smoking suggestions are those who are very dull and those who are actively psychotic. In a long private practice I have only about one percent who were, in my opinion, refractory to hypnosis. Of course, the goal is not hypnosis, but change, and unfortunately no good way exists to measure the motivation so essential to all change."

i. Herbs

Herbal Teas. Excerpt from: Using Herbs To Quit Smoking by Elizabeth Phillips, "The Herb Quarterly"(ISSN 0163-9900), Winter 1993.

A regimen of teas to take for a few weeks:

* First thing in the morning to relax: 1/2 teaspoon valerian root; 1/2 teaspoon chamomile * 11 AM to aid in withdrawal: 1/2 teaspoon licorice root; 1/2 teaspoon comfrey * Noon to cleanse blood: 1/2 teaspoon black cohosh; 1/2 teaspoon burdock root * 2:30 PM to clear lungs: 1/2 teaspoon slippery elm; 1/2 teaspoon fenugreek. NOTE: if after two days you are not coughing or bringing up mucous, you can discontinue this tea) * 4:00 PM to aid in quitting: 1/2 teaspoon magnolia; 1/2 teaspoon pepperm= int * 6:00 PM to boost immune system: 1 teaspoon of Echinacea in a cup of boiling water

These teas are brewed for ten minutes in four ounce teacups. Of course there are always words of caution: check with your doctor before trying any herbal remedy. Do not mix herbal remedies with over-the-counter prescription medication. If you have allergies to ragweed or hay fever to not take chamomile. You can substitute skullcap. If you have heart problems do not take licorice root or goldenseal tabs. If you have high blood pressure do not take vitamin E capsules. I would further recommend that you get a copy of this article ... this tea regimen is for 3 WEEKS ONLY.

Thanks to the original poster, Barbara R.

j. Cream of Tartar

A few of us (myself included) saw this remedy presented on some breakfast television-type show, and one poster shared his experience:

Mark river1824@andorra-c.it.earthlink.net wrote:

"Well, I am getting ready to quit ... I have been using the cream of tarter for a few days now. What you do is take 1/2 teaspoon in a glass of orange juice, and it pulls the nicotine out of your system. You might sweat it out at night or urinate more. You can buy cream of tarter at the grocery store at the cooking spices. Cream of tarter is used to make meringues have more holding power and also is a component of baking powder (if I remember correctly). It is natural, as it is the dried powder of the remnants left in wine vats, from grapes. The idea is to smoke only when you actually crave ... not habit but craving. As you do this each day, you crave less and less as more and more nicotine has left your body. The eventual idea is to work your nicotine level to a tolerable and controllable level, that you can then quit completely. Without the terrible full strength withdrawal. I recommend it. It is an inexpensive way that might work for some. I would be interested in hearing from those that try it. My neighbors tried it with some success, however, they did not want to quit smoking at the time. They did, however, notice a difference."

k. Zyban a/k/a Wellbutrin and Other Antidepressants, w/ or w/o NRT

Wellbutrin (generic name, bupropion) was recently released under the name Zyban for marketing as a smoking cessation aid. They are the same drug, made by the same company, Glaxo-Wellcome.

During testing of the antidepressant Wellbutrin, it was realized that the test group experienced a reduced desire for nicotine. Studies have since been done using Wellbutrin as an aid in smoking cessation, both in conjunction with nicotine replacement therapy (in the form of the patch), and without. No conclusive results have yet been published. The following information was written and contributed by Scott Leischow leischow@ccit.arizona.edu.

"Greetings! Wellbutrin is one of several medications being tested for smoking cessation. Keep in mind that no medication has been found to be efficacious for a large percentage of people, and that different approaches work differently for each person. There are data to suggest that Wellbutrin (bupropion) increases the chances of quitting - see studies by Linda Ferry at Loma Linda Medical Center. Note that other medications being tested include Inversine (mecamylamine) in combination with nicotine, lobeline, cotinine (a metabolite of nicotine) - and new nicotine replacement options will eventually be available as well, such as nicotine nasal spray, nicotine inhaler, nicotine lozenge. Mint nicotine gum is now available in Canada, Mexico, and several European countries, and an even more flavorful gum is or will be available in the UK (made by Ciba-Geigy). Meds, of course, are not the answer - they can work to enhance personal motivation. All of these changes will definitely increase uncertainty about what to use (if anything), and whether we should be concerned about people using pure nicotine for long periods of time. There seems to be a growing consensus in the scientific community that we should not be too concerned about long term use of nicotine - if the alternative is returning to smoking. Just as with methadone versus heroin, the lesser 'evil' is the pure nicotine. I am not suggesting we should not be concerned about long term use, just that we put it in perspective. Note that I have no financial interest in any treatment approach - I do research on smoking cessation treatments at the University of Arizona (including on several of the methods I mentioned above). Send me a note if you have questions/comments/flames."

But before you run out and demand a prescription from your doctor, please consider this information, written and posted by Bob Christofferson rechris1@facstaff.wisc.edu:

"Prozac (generically, fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) and Wellbutrin (bupropion) is a heterocyclic antidepressant which affects reuptake of dopamine as well as serotonin. (Because of the affect on dopamine, by the way, Wellbutrin has been tried for alleviating symptoms of cocaine withdrawal, with inconclusive results.)

"Effexor (venlafaxine) affects reuptake of serotonin and norepinephrine and only very weakly affects dopamine.

"This will be on the exam, so take notes. :)

"Seriously, most of us have no reason to try to remember this stuff, but it's worth mentioning, I thought, partly as an example of the individuality of brain biochemistry. All of the drugs mentioned, and a lot more, are useful for some people who have symptoms of clinical depression. But the response to any particular drug by any individual patient is unpredictable -- it may have no effect, or even make the depression worse. But in someone else, with the same clinical symptoms, the drug will work a miracle.

"The same sort of individual difference applies, I think, with regard to smoking cessation -- how hard it is, how long it's hard, what helps -- these are widely different and unpredictable. So, it's worth keeping in mind that even with all the things we have in common, the experiences of any one of us may not be very predictive about anyone else. In other words, I need to keep in mind that even if you do exactly what I did, you may not have the same results.

"It's also worth comparing to smoking cessation, I think, because in cases where one antidepressant doesn't work, another one very well might -- just like one method of smoking cessation may not do it for an individual, but there are a lot of other choices to try. And (to tie this into a bow) one method that may be the key to smoking cessation for some people is to take antidepressant medication. It certainly wouldn't be the first suggestion I'd make for anyone, but for those who have not succeeded with other methods, and especially for anyone who thinks they may be using nicotine to self-medicate depressive symptoms, I would recommend talking to a medical professional about the possibilities."

l. Mecamylamine and the Patch

Another drug being tested in conjunction with the nicotine replacement patch for use in smoking cessation is mecamylamine, a prescription drug frequently prescribed for high blood pressure. A detailed summary of the original controlled study, see Clin. Pharmacol. Ther. Vol. 56 no. 1 pp. 86-99; also available on the Internet from the Medline page. Here's the short, layman's version: Source: The Mirkin Report #6455 (online)

"Jed Rose of Duke University has discovered that 6 weeks of taking a nicotine skin patch with mecamylamine pills, a drug that blocks the effects of nicotine, helped more than one third of smokers to stop smoking one year later. In high doses, both nicotine and mecamylamine have horrible side effects. High doses of nicotine cause high blood pressure, a fast thumping heart beat and shakiness. High doses of mecamylamine cause shakiness, dizziness, fainting, constipation and even convulsions. However, when the two drugs are combined in low doses, people trying to stop smoking seldom suffered side effects and many were not smoking one year later. The recommended doses were standard nicotine skin patches daily and 2.5 mg of mecamylamine twice a day."

m. Allen Carr

Discussion of Allen Carr's books (Allen Carr's Easy Way To Stop Smoking (Penguin; ISBN 0-14-013378-X), later revised and reissued as The Only Way to Stop Smoking Permanently (Penguin; ISBN 0-14 024475-1)) is the closest AS3 comes to making a commercial endorsement. So many of us have been helped by Carr's work that it is a frequent topic of discussion. Even if one part of the method doesn't seem right for you, something else may be just the thing that rings your personal bell. Unfortunately, Carr's books are very difficult to get in North America. See below, a couple of avenues interested parties might try. But many might be helped even by this summary of the Carr method, written and contributed by David Moss moss@irch.kfk.de and originally posted to AS3.

"First, Allen Carr's qualifications: he's not a doctor or a psychologist, he's a guy who smoked five packs per day (I didn't even know that was possible!) and who quit one day with no difficulty whatsoever. He was so astounded by this that he subsequently devoted his time to finding out why quitting had been so easy for him, and then wrote a book about it.

"He understands how smokers' minds work, so he doesn't fill his book with a load of horror stories on why you shouldn't smoke. We all know that already, and it doesn't help. Allen Carr turns it around and asks, why smoke? Our bodies tell us 'have a cigarette' and we give way, or we fight it with huge amounts of willpower. Instead, we should ask our bodies 'what for?'. He takes all the stock answers - it tastes good, it helps me relax, it helps me concentrate, it relieves stress, it relieves boredom - and disproves them one by one. In fact, we smoke to relieve the withdrawal symptoms that we all suffer between cigarettes, because nicotine is a fast acting, fast decaying drug. All the other justifications are rationalizations which don't stand up to scrutiny. The logical conclusion is that you shouldn't even think in terms of 'giving up' cigarettes, because you're not giving up anything - you're just stopping smoking because you simply don't need cigarettes.

"His next point is that quitting is actually very easy. Most smokers make the mistake of confusing the physical withdrawal symptoms with the psychological "crawling up the walls" cravings and panic that you get when you want to smoke and can't. The actual physical withdrawal symptoms are a mild, empty, hunger-like feeling, which doesn't hurt and which is easy to ignore. The psychological cravings, because they're psychological, will simply cease to exist if you can develop the right mental attitude. For this reason, Carr is very insistent that the reader continue to smoke until he's got his attitude right (i.e. until he's finished the book), so as to avoid the negative experience of a failed attempt to quit. Think about the question given above - what positive benefits do you get from smoking - until you're completely convinced that smoking gives you nothing. You don't need huge feats of willpower, because you're not giving up anything. Making quitting into a test of willpower only makes it harder. You don't need replacements like sweets or gum, because you're not giving up anything that needs replacing. You don't need nicotine patches or nicotine gum, because you don't need nicotine. Enjoy the withdrawal symptoms, because that's how it feels when you defeat your addiction.

"We all know that it takes about three weeks for the body to be cleared of nicotine. But don't think in terms of 'making it' three weeks without a cigarette, which would lead you to expect something wonderful to happen after three weeks. Nothing happens, because the physical withdrawal symptoms are so mild that you don't even notice they've gone. That wonderful thing happens in the moment you stub out your last cigarette and become a non smoker. Don't get melancholy and depressed about life without cigarettes, because you're not giving up anything. Enjoy life as a non-smoker, it's better in every way. Don't even try to avoid thinking about cigarettes - every time you think of them, think about how wonderful it is that you don't need them.

"Allen Carr gives five point that need to be internalized before you begin:

"1. Be quite clear in your mind, you're going to quit. Not hoping to quit or trying to quit, just going to quit. It's easy. "2. You're not giving up anything, but you're gaining a hell of a lot. "3. There's no such thing as 'just one cigarette'. Your choices are to quit, or to smoke for the rest of your life. "4. Don't think of smoking as an unpleasant habit. It's an addiction, and it's getting worse every day. The right time to quit is now. "5. Understand the difference between the chemical addiction and the 'junkie' mentality. As soon as you stub out your last cigarette, you're a non-smoker. Non-smokers are people who don't use cigarettes.

"If you've really taken these points on board, quitting will be simple and absolutely painless. You don't believe it? That's not surprising, we've all been brainwashed by advertising, by films, by society's generally tolerant attitude to smoking, and by our own addiction. You need to open your mind and think about what Carr is saying in order to ditch this conditioning and realize that Carr is right.

"Finally, a disclaimer - the above is my personal summary of Allen Carr's book, and I may have left out or misunderstood something important. If in doubt, read the book. The title is Allen Carr's Easy Way To Stop Smoking, and it was published by Penguin Books, London, in 1991. The ISBN number of my copy is 3-442-13664-4, but be careful because I have the German translation (Endlich Nichtraucher, Goldmann G1290).

"I very much hope that this information will make quitting as easy for someone out there as it was for me, and I'd be happy to deal with any follow-up questions. David moss@irch.kfk.de"

How to get Carr's book in North America:

I've recently heard that an American publisher is being sought for The Easy Way To Stop Smoking. In the meantime, for the convenience of those in North America, here are some options:

1. Order from one of the established Internet booksellers. I've used the Internet Bookshop, originating in the U.K., without problem, but there are several others you can check for comparison 'net shopping.

2. Try contacting one of the directors of an Allen Carr clinic. You can find a listing of the clinics at this URL: http://www.qwerty.co.uk/allencarr/

3. A company called Videocom sells a package of the book and audiotape for US$ 29.95 plus US$ 3.50 shipping and handling (U.S. cheques or money orders in U.S. funds only. They do not offer the book alone. The company's address is: Videocom Inc., 502 Sprague Street, Dedham, Massachusetts 02026 USA, Attention: Quit Smoking. If anyone tries the Carr package, I'd appreciate a report for the FAQ.

n. Programs

This information was supplied by Carolina Johnson. It is of use mostly to those in the U.S. and Canada; I would welcome receiving information on similar organizations from our members in other parts of the world.

American Lung Association, 1740 Broadway New York, NY 10019. (212) 315-8700

The American Lung Assoc. sponsors stop-smoking groups in most cities. It also publishes an excellent guide to quitting, Freedom from Smoking for You and Your Family. This book guides readers through a step-by-step 20 day program that leads to quitting and provides guidelines for remaining a non-smoker. The book is available from your local chapter of the American Lung Assoc. (consult your telephone directory for the address and phone number) or from their national headquarters at the address above.

American Cancer Society, 4 West 35th Street New York NY 10001. (212) 736-303= 0.

Local affiliates of the ACS sponsor a four-session stop smoking program called "Fresh-Start." Sessions last one hour each and extend over a two-week period. Sessions focus on behavior modification, goal setting, mastering obstacles, and social support. The ACS also publishes a free handbook for potential quitters, the "I QUIT KIT", which is available from your local chapter (consult your telephone directory for the address and phone number) or from their national headquarters at the address listed above.

The Breathe-Free Plan to Stop Smoking Narcotics Education Inc., 6830 Laurel Street, N.W., Washington DC 20012. Many local affiliates of the Seventh-Day Adventist Church run a highly recommended program that is usually led by a pastor physician team. The Breathe-Free Plan to Stop Smoking is based on motivation, lifestyle, modification, values clarification, modelling, visualization, affirmation, positive thinking, and self-rewards. There is also an optional nondenominational spiritual component. The plan consists of 8 sessions that take place over three weeks, with periodic phone contacts for one year thereafter. Prospective group members are invited to attend the first two sessions before making a decision as to whether to register for the remainder of the course. During the 3rd week a graduation ceremony is held. Successful quitters receive a BNS (Bachelor of Nonsmoking degree) during the 3rd week. MNS (Master of Non-Smoking) degrees are awarded at six months, and DNS (Doctor of Nonsmoking) degrees at 12 months.

Smokers Anonymous, PO Box 25335, West Los Angeles CA 90025. This group provides information on starting your own support group. They will also let you know if there is a Smokers Anon group in your area. Write to them at the above address enclosing a self-addressed stamped envelope. [N.B.: This is not the same organization as Nicotine Anonymous, a 12-step recovery program. - ed.]

o. Alternative Healing

Here are summaries of tools and techniques described in New Choices in Natural Healing (a Prevention magazine book), ed. by Bill Gottlieb (Pennsylvania: Rodale Press, 1995), pp. 505-507. I haven't tried any of them except imagery, and make no recommendations or endorsements. They could help, or they could be a colossal waste of time and money. As one of my univ. profs used to say, Yer pays yer money and ya takes yer choice.

Aromatherapy To ride out cravings, mix essential oils as follows: 3 parts lemon, 2 parts geranium, 1 part everlast (aka 'immortelle' 'helichrysum') in a small bottle. Inhale from bottle whenever a craving hits. "'Lemon is a detoxifying agent, and geranium helps balance the adrenal system,' explains [aromatherapist Victoria] Edwards. 'Everlast is a powerful cellular rejuvenator and will help your body heal the damage smoking has done.' This blend is also good when used in a diffuser, says Edwards.

Ayurveda To help you quit smoking or cut down on your habit, try chewing on small pieces of dried pineapple (about 1/2 teaspoon's worth) mixed with 1/2 teaspoon of honey, suggests Vasant Lad ... director of the Ayurvedic Institute in Albuquerque, New Mexico. He says to use this remedy whenever you desire a cigarette.

=46ood Therapy No, not eating everything in sight! :) According to Dr. John Pinto of Cornell University Medical College and a nutrition researcher at Sloan-Kettering Cancer Center, load up on Vitamin C well beyond the Recommended Dietary Allowance; its antioxidant qualities will help repair damage done by smoking. Thomas Cooper, D.D.S. concurs but note, he says to avoid orange juice if you're using the patch: "By making your urine more acidic, the juice will clear your body of nicotine faster. But the purpose of the patch is to keep some nicotine in your body as you try to wean yourself off the weed.

Hydrotherapy The body wrap, or wet sheet pack, can help detoxify your system if you're trying to quit, according to Charles Thomas, Ph.D. ... This treatment can be done at home but will probably require help from a partner. After warming up with a hot shower, lie down on a bed with your entire body wrapped in a sheet wrung out in cold water. Then wrap yourself in one or more wool blankets. While the pack feels cool at first, your body heat will gradually dry the sheet, and you will begin to sweat. Leave the wrap in place to two hours after you start perspiring. Dr. Thomas suggests using this treatment once a day until you no longer feel as intense a craving for cigarettes.

Imagery See yourself smoking. While you're doing it, do you perceive yourself as a smoker? In your mind, continue to see yourself smoking, but say to yourself 'At this time, I have the habit of smoking, but I am not a smoker,' says Dennis Gersten, M.D., a San Diego psychiatrist .... Now picture something that is good for you that you desire tremendously. It could be health, better looks or more control of your life. Focus on your desire. See yourself as an incredibly healthy, beautiful or self-reliant nonsmoker. Let that image overpower any desire that you have to smoke. Dr. Gersten recommends using this imagery for 10 to 20 minutes twice a day.

Relaxation and Meditation 'Studies have shown that many smokers use tobacco to help them reduce anxiety and tension. If you meditate, your mind learns another way to counteract that anxiety, so you may become less reliant on cigarettes,' says Dr. [Sundar] Ramaswami [a clinical psychologist]. ... Meditate for 20 minutes twice a day or for a few minutes whenever you feel the urge to smoke, suggests Dr. Ramaswami.

Thoughts to close the Alt.Support.Stop-Smoking FAQ, Part 3:

"The Willpower Method is based on giving up something you want to do and thus have to resist the desire to continue doing it. The Easy Way is to change your thinking so that you are not giving up anything, but becoming free of something that you don't want to do. That way you can enjoy it. - gecko@ibm.net"

"Once you get to the point where your mind is made up once and for all, it is very difficult to fail. - Cindi Smith"

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

FREQUENTLY ASKED QUESTIONS (FAQ)

FOR

ALT.SUPPORT.STOP-SMOKING (AS3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Part 4: TECHNIQUES, TROUBLESHOOTING, AND TIPS

"I am definitely gaining weight. The added money in my wallet is really weighing me down! Let the weight gain continue!" - Rick Weaver

"I'd rather be chunky than a nicotine junkie!" - MaryJane Patterson

31. How do I avoid relapsing during stressful times?

You can avoid a lot of the things that trigger the urge to smoke until you feel ready to handle them. But stress, bad news, and sad events come on their own terms, and when they do, they make many of us return to the comfort of that false friend, smoking.

There isn't any technique to guarantee that you won't smoke when the going gets really tough, and you'd only be human if you did. But if you can try to remember that smoking is only temporary relief and can't really solve your problem, you might get through. Here's how Nat nacjr@iglou.com put it:

"My dad died in March of lung cancer. I had quit a couple of months prior to that and started back during the days leading up to the funeral. What I'm going to say may sound hard, but I feel more compassion than you know.

My daddy died. I smoked just one. My daddy was still dead. I smoked some more. He was still dead. The estate pressures were still there. My momma still needed me. My family still needed me. I was once again a fully involved addict with a lot of grief and pressures. I have had to go through the quit all over again.

"We learn to deal with our emotions through smoking. A crisis arises after 2-3 years and we want to smoke. The quit process never ends. Every day we must make a conscious decision to either win or lose. If you look at it right, it's an opportunity that the never-smoker doesn't have: victory over the most addictive substance in our culture!"

Another way to deal with a strong urge is to beat it senseless. :) Here, Susan sharpie5@aol.com describes her battle with what we like to call the Nicobeast:

"... in a drunken stupor, I did the only thing I could do. I got in a barfight with him. I would have slammed him onto the pool table but it's a British Pub, no table. I would have hit him with a beer bottle but I was drinking mixed drinks. So I hit him. Hard. Then I kicked him right where it hurts. Rest assured my friends, there will be no little nicobeasts running around ... if you know what I mean. I was trying not to be too obvious about beating him up as I didn't want my friends to notice. Fortunately, we were outside. So I pretended to be stomping my feet to keep warm. Really I was stomping the nicobeast into so much hamburger helper. I had to sing Ave Maria to cover those awful squeals that he made. I can't carry a tune in a bucket. It was a little embarrassing, but worth it. I walked away unscathed."

32. I dreamt I smoked!

The 'smoking dream' is a bizarre yet very common phenomenon among ex-smokers. It might hit at different phases of your quitting experience; it might hit when you think you don't even think about smoking anymore. These dreams tend to be very vivid and so realistic that you will probably believe you actually smoked; you may even wake feeling raw in your throat. But, no matter how real the guilt feels, dreaming about smoking is not equivalent to actually smoking! So when the dreams come, try not to be bothered by them, just amused at the power of the subconscious.

33. What about weight gain?

By Michael D. Myers, M.D. myersmd@weight.com, as published on his homepage. Reused with kind permission.

Smoking and Obesity.

"When people stop smoking, they commonly gain weight. Most people think that they are substituting food for cigarettes. This is partially correct. Smoking is usually a different form of oral gratification that obviously does not involve the consumption of calories. However, smoking does have another effect - it actually increases caloric requirements. A person who smokes requires approximately 10% more calories to maintain their body weight than when they are not smoking. Therefore, if a person maintains constant food intake and exercise and stops smoking, their body weight is expected to increase between 5% and 10%.

"An excellent way to help counter this is to exercise consistently. For example, start walking 30 minutes a day three to four times a week - a very feasible goal. Another approach is recording your food intake. If you write down everything you eat before you eat it, you will become much more aware of what you are eating. This helps you make better food choices, thereby helping you maintain your weight.

"It is much more important to stop smoking than to worry about weight gain. The deleterious effects of smoking far outweigh the effects of putting on a few extra pounds. Some people think that when they stop smoking it is also a good time to go on a strict diet. This is not recommended because both are very stressful and it is extremely difficult to do both effectively. Usually, people do not succeed at either and feel like failures. Remember that it is important to stop smoking first. Then you can deal with your weight more effectively.

"Disclaimer Statement: The above information is for general purposes only, and should not be construed as definitive or binding medical advice. Because each person is medically different, individuals should see their personal physicians for specific information and/or treatment. For comments, please send E-mail to: myersmd@weight.com. I do respond to E-mail. Office Address: MICHAEL D. MYERS, M.D. Inc. 4216 Katella Av. Los Alamitos, CA (US) 90720 phone: 1-310-493 2266."

34. But I don't *want* to gain weight!

Contributed by Susan skcroutw@fuse.net

"Another person in the ng who wanted this information thought others would be interested, so I am passing it along. Walking has helped me a lot, both on the stress side and to avoid gaining weight.

Smoking fact: A smoker who smokes 20 cigarettes per day burns approximately 200 calories more each day than if he/she were a non-smoker.

To eliminate that 200 calorie gain, use the calculation below:

A person weighing 140 pounds who walks 3 miles [roughly 5km] per hour (a 20 minute mile) will burn about 95 calories per mile. 45 minutes at this pace will result in about 2 miles being walked, or 215 calories burned. This alone will prevent weight gain after quitting. Just walk a little longer or a little faster to lose weight. Also remember that 3,500 calories need to be expended or eliminated from the diet per pound of weight. I personally much prefer working out to giving up calories!

At 120 lbs, a person walking at 3 mph will burn 80 calories. For every 10 lbs you weigh over 120, add 5 calories burned."

35. Just how does smoking harm my health?

[This was posted to AS3 so long ago that the source has been lost. If anyone knows where this is from, please e-mail liorah@interport.net.]

* Lung Cancer risk increases roughly 50 to 100 percent for each cigarette you smoke per day;

* Heart Disease risk increases roughly 100 percent for each pack of cigarettes you smoke per day;

* Switching to filter-tip cigarettes reduces the risk of Lung Cancer roughly 20 percent, but does not affect the risk of Heart Disease;

* Smokers spend 27 percent more time in the hospital and more than twice as much time in intensive care units as nonsmokers;

* Each cigarette costs the smoker 5 to 20 minutes of life;

* A smoker is at twice the risk of dying before age 65 as a non-smoker!!

36. What are some of the less publicized health risks of smoking?

We all know that smoking greatly increases the risk of developing emphysema, stroke, heart attack, lung cancer, etc. In addition, there are several less publicized health conditions which are linked to smoking:

a. Blindness

In October 1996, results of separate long-term studies linking smoking to an incurable form of blindness called age-related macular degeneration were published in the Journal of the American Medical Association (JAMA). In this form of blindness, a person's field of vision becomes increasingly limited. The research found that smoking more than doubled the risk of macular degeneration in women over 50, with similar findings in men over 40. While researchers couldn't pinpoint the exact reason for the increased risk, they theorized that smoking either affects the blood flow to the eye, or causes retinal damage through oxidation.

(source: JAMA. 1996; 276:1141-1146 [study of women]; 1147-1151 [study of men]) Thanks to Evan Herberg for calling this study to AS3's attention.

b. COPD

From The Lung Association Home Page:

"COPD (Chronic Obstructive Pulmonary Disease) is a term that refers to a variety of chronic lung disorders, the most common being a mixture of chronic bronchitis and emphysema.

"COPD is the result of damage that has been done to lungs over many years. The diagnosis is made when the symptoms become apparent to you and your physician.

"COPD results in chronic airflow obstruction, the main symptom of which is dyspnea, or shortness of breath, often occurring with cough and wheeze. COPD affects both men and women. The average Canadian with COPD is 65 years of age and has a long history of smoking. However, COPD can first be diagnosed in patients as young as 40.

"COPD progresses slowly and worsens over time. Symptoms can range from being barely noticeable to incapacitating. The rate of progression and extent of disability vary from person to person.

"While there is no cure for COPD, the progression of the disease can be controlled first and foremost by quitting smoking. Appropriate medication, exercise rehabilitation and prevention of infection are also important factors in the rate of deterioration and symptom control."

c. Depression

This is a biggie, and comes up for discussion frequently. The excellent discussion below was posted to AS3 on 30 Sept. 1996:

Darcy Binder DBinder@ifc.org wrote:

"Does anyone know the connection between smoking (or quitting smoking) and depression? I have quit three times in my life, and each time I have been getting seriously depressed. Is there a chemical connection? Is it the lack of stimulant? I don't want to start again -- its been SIX weeks -- but I also would like to stop crying!"

Bob Christofferson rechris1@facstaff.wisc.edu followed-up:

"Hi! There definitely *is* a chemical connection between nicotine and depression, but as with most matters of brain chemistry, it's less than perfectly understood. What is quite certain is that people who are depressive find nicotine an especially effective drug, and consequently find it especially hard to quit.

"That doesn't mean that *you* are depressive, however. It's a normal response to nicotine withdrawal to have some feelings of depression. If you read the posts to this group, you'll notice that many people go through periods of depression while completing the process of smoking cessation. Different people have the experience at different times after they quit, and some people don't seem to have it at all. But, for most people, it's a withdrawal symptom which isn't too severe and doesn't last too long, and they recover from it and feel 'like themselves' again.

"In some people, though, smoking cessation does trigger serious episodes of clinical depression which require medical treatment, and which, in the extreme, can be life threatening. In recent years, new medication and therapies have been developed which can help most people with depression, and which often produce dramatic improvement quickly. Many people who could benefit from these treatments, though, are reluctant to get help because they feel embarrassed or ashamed, because they think they should be able to 'snap out of it' or somehow make their illness go away by themselves. Of course, there's no reason for anyone to think that, but symptoms of depression typically include feelings of guilt and hopelessness, which make it hard for the person to see the situation objectively.

"So, how does anyone decide if their symptoms are more than the normal consequence of smoking cessation? My advice is that anyone who has any doubt should be evaluated *really soon* by a medical professional qualified to determine whether medical attention is needed. I say that in part because I'm convinced people hardly ever exaggerate the seriousness of their own situation but often will *understate* it, even to themselves -- for perfectly sensible reasons, really. No one I know has ever been eager to get mental health treatment (but quite a few people I know have benefited by getting it).

"So, my point of view is that if someone feels they may be more depressed than 'normal' nicotine withdrawal would explain, then there's a good chance that they are -- at least, a good enough chance that they should talk it over with someone who can tell."

d. Gastro-Esophageal Reflux Disorder (GERD)

Again, I'll let the information come from our impressively well informed members. This was posted 22 Oct. 1996:

Luci wrote:

"Hi! I need an info buddy... After years of smoking and sinus problems, etc., I've been diagnosed with a new disorder - gastro esophageal reflux disorder. Does anybody out there share my problems??? Any advice???"

Ed replied:

"I've had GERD for years ...

"GERD, according to my doctor, is often caused by cigarette smoke irritating the valve that separates the esophagus from the stomach. It seems that the smoke also goes down the esophagus when we inhale. For some not completely understood reason, the smoke irritation causes a loose closure of this valve and at times stomach acid can rise into the esophagus. The tissue of the esophagus, unlike the stomach, reacts with pain when in contact with stomach acid. A prescription drug - PRILOSEC, has really helped me. It is time-released and I take one each day. On rare occasions, usually at night, I also use liquid GAVISCON and within 20 minutes the discomfort is gone. PRILOSEC is prescription. GAVISCON is over-the-counter. Both are not cheap but they work for me.

"Hope this helps you. GERD is not uncommon. Just another reason for me to stop the cigs."

e. "Smoker's Face" and Other Dermatological Ailments

This phrase seems to have been coined in 1985 by Dr. Douglas Model of Eastbourne, England, who found, in empirical evidence, that nearly half of the smokers he studied looked far older than they were. Similar research was conducted by Dr. Jeffrey Smith, a senior resident in dermatology at the University of South Florida in Tampa. He found these conditions to be directly related to smoking:

(From The St. Paul (Minnesota) Pioneer Press, 23 June 96. Originally posted to AS3 by selmar@concentric.net)

"Wrinkles: 'For some patients the threat of wrinkles may be a more powerful motivator to help them stop smoking than the more deadly consequences of smoking,' Smith wrote. He explained that, as with skin that is overexposed to sunlight, smoking causes thickening and fragmentation of elastin, the elastic fibers that are long and smooth in healthy skin. Smoking also depletes the skin's oxygen supply by reducing circulation. It decreases the formation of collagen, the skin's main structural component, and may reduce the water content of the skin, all of which increase wrinkling.

"Smoking also interferes with the skin's ability to protect itself against damage by free radicals, highly reactive substances that are omnipresent in tobacco smoke. In women, smoking diminishes the level of circulating estrogen, which in turn fosters dryness and disintegration of skin tissues.

"Skin Cancers: Two kinds of skin cancers, the more curable squamous cell carcinomas and the often lethal melanomas, are influenced by smoking. Smith said that although smoking did not cause melanoma, smokers with melanoma were more likely to die of their disease. They are twice as likely to have advanced disease at the time of diagnosis and are more likely to have their cancers spread within two years of diagnosis, probably because smoking impairs the immune system. As for squamous cell carcinoma, even when exposure to sunlight was taken into account, smokers were found to be at greater risk of developing this cancer. In a study of more than 107,000 nurses, for example, the risk of developing squamous cell carcinoma was 50 per cent greater in smokers than in those who had never smoked. Smokers also tend to get particularly 'large, bad' skin cancers, Smith said.

"Other Cancers: Cancers of the lip, mouth, penis, anus and vulva are also more common in smokers than nonsmokers. For example, in one study of 903 female cancer patients, 60 percent of those with vulvar and anal cancers and 42 percent of those with cervical and vaginal cancers were smokers as against only 27 percent of comparable women without cancer. Smoking more than 10 cigarettes a day more than doubles a man's risk of developing penile cancer.

"Delayed Wound Healing: The problem of slow or incomplete healing of wounds associated with exposure to cigarette smoke was clearly demonstrated in laboratory animals in the 1970s. Then surgeons began reporting on similar problems in patients who smoked: larger scars in women undergoing exploratory abdominal surgery, more complications and skin sloughing after facelifts and a much higher failure rate of skin grafts, for example. The more and the longer patients had smoked, the greater the likelihood of impaired wound healing. Even resuming smoking during an uneventful recovery could lead to adverse effects. Smith linked the slow healing of wounds to known effects of cigarette smoking, which constricts surface blood vessels, reduces the oxygen level in the blood, thickens the blood and impedes the laying down of collagen needed for healing.

"Psoriasis and related disease: Studies of both men and women with this unsightly and discomforting skin condition have shown that smokers are about two to three times as likely to develop it as nonsmokers. And the more cigarettes smoked, the greater the risk. Palmoplantar pustulosis, a difficult-to-treat skin condition that resembles psoriasis, occurs only on the palms of the hands and soles of the feet. The skin blisters, then forms a scaly rash. It occurs almost exclusively in smokers and it does not necessarily go away when the patient quits smoking.

"Oral lesions: In addition to smoker's face, there is also smoker's palate and smoker's tongue. The tars and heat of tobacco smoke can cause tiny red pimples in the mouth that result from an inflammation of the openings of salivary glands. Smokers also often develop depressions on the surface of the tongue. Potentially more serious, however, are lesions called leucoplakia, which are about six times more common in smokers than in nonsmokers. Although benign, these white patches in the mouth can become cancerous.

"Buerger's disease: This blood vessel disease results in poor circulation in the lower legs, causing skin problems like burning, tingling and ulcerations. 'It usually occurs in young men who smoke, men in their 30s,' Smith said. 'But now that women are smoking a lot more, we're seeing it in women too.'

"Other Skin conditions: Many skin diseases are associated with diabetes, which impairs circulation to the outer reaches of the body. A study of more than 112,000 female nurses followed for 12 years showed that current smokers faced an increased risk of developing noninsulin-dependent diabetes, and that the risk rose with the number of cigarettes smoked each day. Another study of nearly 43,000 male health professionals showed that smoking 25 or more cigarettes a day doubled a man's risk of developing diabetes.

"People who smoke are much more likely to develop the bowel disorder Crohn's disease, which can cause 'big, ugly-looking ulcerations, most often on the legs, and painful red nodules, usually on the lower legs,' Smith said. Another condition more common in smokers is systemic lupus erythematosus, an autoimmune disease that can cause rashes on the face, scalp, hands and elsewhere, ulcerations in the mouth and hair loss."

37. How do the numbers from smoking-related deaths compare to other causes of death?

The statistics which follow were obtained from an American Cancer Society pamphlet and are for 1993.

Cause of Death : Number per Year (excluding smoking) (U.S.A. only)

Alcohol-related: 105,000 Car accidents: 49,000 Suicide: 31,000 AIDS: 31,000 Murder: 22,000 Fire: 4,000 Cocaine: 3,300 Heroin/Morphine: 2,400

~~~~~~~~~~~~~~~~~~~~

Total (of above): 247,700

Cause of Death: Number per Year (Tobacco only) (U.S.A. only)

Total tobacco related: 434,000

38. What is metastasis?

By Barry Pekilis:

"'Metastasis' is defined as the transfer of a disease-producing agency from the site of the disease to another part of the body. One of the mortal threats of cancer is metastasis. Early detection of cancer can be the difference between life and death. Most cancers can be detected at an early stage mainly because of physical symptoms such as lumps, bleeding, or some other clue.

"Unfortunately there are two types of cancer in which early detection is highly unlikely: lung cancer and pancreatic cancer. By a dint of bad luck, if an individual has one of these two cancers, they will probably not know it until the disease has invaded other vital organs and parts of their body. By this time is may be too late for any meaningful treatment or cure.

"The five-year survival rate for pancreatic cancer is 5% and for lung cancer, 10 percent. This compares to a survival rate of 50 80% for most other cancers.

"This information is being supplied in this FAQ to help provide motivation for those of you who have either quit or are trying to quit. Cigarette smoking appears to be a major cause of both of these two malignant cancers."

[For more on lung cancer in particular, including a GIF of a diseased lung, try http://ourworld.compuserve.com/homepages/LungCancer/

39. What if I quit ... will I ever get better?

Smoking cessation has major and immediate health benefits for men and women of all ages. These benefits apply to people with and without smoking-related diseases. The following information is from a booklet produced by the American Cancer Society:

Within 20 minutes of your last cigarette:

* blood pressure drops to normal * pulse drops to its normal rate * body temperature of your hands and feet increases to normal

Within 8 hours:

* carbon monoxide level in your blood drops to normal * oxygen level in your blood increases to normal

Within 24 hours:

* chance of heart attack decreases

Within 48 hours:

* nerve endings start regrowing * your abilities to smell and taste things are enhanced

Within seventy-two hours:

* bronchial tubes relax, making breathing easier * lung capacity increases

Within two weeks to three months:

* circulation improves and walking becomes easier * lung function increases by up to 30 percent

Within one to nine months: * coughing, sinus congestion, fatigue, shortness of breath decreases * cilia regrow in lungs, increasing ability to handle mucus, clean the lungs, and reduce infection * the body's overall energy level increases

Five years:

* lung cancer death rate for average ex-smoker decreases from 137 per 100,000 people to 72 per 100,000 (... almost half!)

Ten years:

* lung cancer death rate for average ex-smoker drops to 12 deaths per 100,000 (... almost the rate for a non-smokers and a full order of magnitude less than a smoker) * precancerous cells are replaced * other cancer rates (e.g., mouth, larynx, oesophagus, bladder, kidney and pancreas) decrease as well

In addition:

* ex-smokers tend to live longer than continuing smokers * smoking cessation decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease * women who stop smoking before pregnancy or during the first three to four months reduce their risk of having sickly babies, as compared to women who continue to smoke

40. OK, I quit. Why do I feel worse?

[From CancerNet from the National Cancer Institute. CancerNet News. Clearing the Air: How to Quit Smoking...and Quit for Keeps. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health.]

National Cancer Institute, NIH Publication No. 94-1647, September 1993:

"Immediate Effects

"As your body begins to repair itself, instead of feeling better right away, you may feel worse for a while. It's important to understand that healing is a process - it begins immediately, but it continues over time. These 'withdrawal pangs' are really symptoms of the recovery process.

"Immediately after quitting, many ex-smokers experience 'symptoms of recovery' such as temporary weight gain caused by fluid retention, irregularity and dry, sore gums or tongue. You may feel edgy, hungry, more tired, or more short-tempered than usual; you may have trouble sleeping or notice that you are coughing a lot. These symptoms are the result of your body clearing itself of nicotine, a powerful addictive chemical. Most nicotine is gone from the body in 2-3 days."

[To treat these 'symptoms of recovery,' give your body what it really needs - NOT the poison which it is working so hard to expel! If you're tired, nap; edgy, try camomile tea, warm milk, a soothing bath; when constipated, get some exercise and eat some dried fruit. Keep in mind that these symptoms are temporary and are steps leading to better health than you've known in a long time! -ed.]

41. On the other hand ... why do I feel so potent?

Smoking robs the bloodstream of oxygen, causing constricted blood vessels and reduced bloodflow to the fingers and toes, the brain, and er, other extremities. Men who quit smoking have erections which are comparatively larger, firmer, and of longer duration than when they smoked. Enjoy.

42. I've smoked for so many years, what's the point of quitting now?

By Barry Pekilis:

"LOTS! A new study (coordinated by the University of Manitoba and involving 10 sites in the United States and Canada) proves for the first time that smokers who quit wind up with healthier lungs, no matter how long they had smoked. The study involved more than 5,800 smokers who were victims of chronic obstructive lung disease: a combination of emphysema and bronchitis (the fourth leading cause of death in the U.S.A.).

"The study was the first proof that if you stop smoking at any age, you will have healthier lungs.

"It was the largest study ever conducted on the prevention of lung disease and showed without a doubt that quitting smoking is the most effective way of preventing lung function decline.

"So there you have it, conclusive proof the it worth quitting no matter how old you are or how long you have smoked for."

43. How can I urge someone to quit smoking, or encourage someone who is trying to quit? * Do not pester someone who is trying to quit smoking or who is in the initial stages of thinking about quitting as it is probably the worst thing someone trying to offer support can do -- also do NOT nag, insult, or attempt to shame a smoker into quitting; * Remember that even well-intentioned praise might irritate the quitter at any given moment. Do what you can to gauge the quitter's mood, leave a wide berth where necessary, and forgive what seem to be irrational reactions; * Let your spouse/friend/roommate know that no matter what happens that you value them as a person (even though you may disapprove of their smoking) and that you respect them for trying to break free addiction; * Learn to listen non-judgmentally and attempt to understand and see the problems of quitting a powerful and seductive addiction through the smoker's eyes; * Remember to praise a smoker for even the smallest effort in trying to quit or cut down -- quitting is a process and it takes time!

A final thought:

"The hard part is staying quit and to do that, you need an armamentarium of alternatives to smoking as long as they aren't other addictions that just serve as a substitute 'friend'. It important not to use anything that will obscure or divert us from finding out that the best friend that we have, in some ways, the only consistent one, is the one inside." - Donna Payne, posted March 1996

-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=

End of Alt.Support.Stop-Smoking FAQ.