Kick the habit the right way: Smoking cessation tips from experts
File photo by MV Times
Kicking the cigarette habit is a popular New Year's resolution. But, even among those who actually attempt to follow through on their resolution, the majority will be smoking again by the time the next New Year's Day rolls around.
According to a research paper published by the National Center for Biotechnology Information, the 12-month abstinence rate for smokers who did not use assistance (counseling, drugs, etc.) is a disheartening 7 percent. However, with assistance of some kind, that success rate more than doubles to 15 percent. Not exactly an encouraging statistic but, for those who are serious about quitting, there is hope.
Said primary care physician G.S. Prit Gill, M.D., who set up a practice at the Martha's Vineyard Hospital last spring after spending more than two decades working in the field of addiction medicine, "If you're motivated to quit those individuals succeed." However, "Unless one deliberately puts into place a plan, and truly wants to quit, they don't succeed."
While maintaining a general practice, Dr. Gill spent 15 years as the medical director for the patient addiction medicine unit at the Great Plains Regional Medical Center in Elk City, Okla. "At the chemical level, nicotine is almost as potent as some of the other more powerful stimulants like cocaine and amphetamines," he said.
Adding to the addictive nature of smoking is the combination found in cigarettes today. "The interesting thing about cigarettes is that tobacco predominantly has nicotine, but it also has other chemicals in it which have the opposite effect – soothing and sedating," Dr. Gill said. "When people smoke a cigarette they have the benefits of using a stimulant and a soothing agent. It's a combination of mood elevation and calming." He added, "We know from experiments of other chemicals that the combination is much more powerfully addictive than one alone. It's little wonder that nicotine is hard to give up."
Dr. Gill's experience has demonstrated that the main determinant for success is motivation: "People who are really committed to quitting seem to succeed no matter what program they follow." Of the smoking cessation aids available – both chemical and naturopathic – Dr. Gill said, "The success rate for all of those things is about equal. It's not the program, it's where you start, that matters."
As for medication alternatives, Dr. Gill noted that the options fall into three categories. The first, nicotine equivalent products, available over the counter, are designed to help you cut down on your consumption of nicotine and eventually quit. Second, a few of the anti-depressents have proven effective in reducing cravings. Dr. Gill noted that any physician can prescribe an antidepressant – the most commonly used one for smoking cessation being Wellbutrin. Paxil and Prozac are others that Dr. Gill noted have been found effective as craving reducers.
He recommends that his patients stay on an anti-depressant for six to eight months after they have quit. "Some smokers have quit smoking but then they relapse wthin two or three months."
The third category includes Varenicline (trade name Chantix), which both reduces cravings and decreases the pleasurable effects of nicotine. However, Dr. Gill said, "We use it with great caution because in some people it can contribute to depression. I only use it as a last resort, if someone has not had luck with the other two."
Most insurers will cover the costs of all three types of chemical aids. However, for alternative practices, one will probably have to pay out of pocket, even though things like acupuncture, hypnosis, and meditation have proven very successful for nicotine addiction and have no negative side effects.
Auricular acupuncture (needles in the ear) similarly helps to control cravings. "It's not a magic bullet," said licensed acupuncturist Hellie Neumann of Vineyard Complementary Medicine, "but if someone has the desire to quit, acupuncture is an amazing tool." She added, "It's generally a weaning process. With each visit you have less desire and your body is detoxing." Ms. Neumann recommends that people do six treatments over the course of three weeks, and noted that most people have no pain or discomfort and that many experience "a feeling of incredible calmness and peace."
Sessions cost $55 or $45 with the Island Club Card. On Saturdays from 9 am to 12 noon, Ms. Neumann offers a free clinic for veterans, active duty military, fireman, policemen, Coast Guard, and EMTs. "These are people who often deal with stress, anxiety, and trauma and it's the same protocol as the smoking treatments," Ms. Neumann said.
Acupuncturist Nancy Gilfoy of Vineyard Haven refers to her practice as Whole Person Health Care. Although she doesn't provide treatments for smoking cessation only, she has helped a number of clients to achieve wellness goals that included giving up cigarettes. "Stopping smoking is a process," she said. "It's not a 'one walk dog'. Acupuncture can help in that process – help people through withdrawal."
Ms. Gilfoy individualizes her one-hour treatments (sliding scale fee of $85 to $110) which involve needles in various points all over the body, based on what the client's goals and needs are. "It's always a matter of working with the bigger picture," she said, and added, "Most things that you want to change that are largely lifestyle issues take an integrative approach." For those trying to stop smoking, she suggests trying as many methods as possible.
Hypnosis has proven highly successful for quitting smoking, according to Cynthia da Silva, who owns Aazora Face and Body Sanctuary on Main Street, Vineyard Haven. Ms. da Silva is certified by the national guild of hypnotists and has been practicing hypnosis for nine years.
She offers one-on-one sessions for smoking cessation for $95 a session or $340 for four. "I encourage people in most cases to allow three to six sessions," she said. "What we're doing is reprogramming the way we think – the way we behave. Since smoking is so ingrained in our behavior, it usually takes more than one session."
Ms. da Silva noted that she designs each individual's treatment based on an extensive phone interview conducted ahead of time. Part of that initial conversation is often focused on clearing up misconceptions about hypnosis. "The stage acts kind of imply that the hypnosis is controlling you. The important thing to know is that the client is in control at all times in what they experience, what they take in. You're not ever asleep or unconscious. I like to compare the state of hypnosis to daydreaming. You're completely aware of everything but you're focused on that one little thought."
Hypnosis works by communicating with the unconscious mind – deprogramming reinforcers of bad habits. Like all of the experts interviewed for this story, Ms. da Silva cautioned, "It's important for a smoker to be ready to stop."
So, if you've chosen this time to quit simply to start the new year off on the right foot, you may be better off giving your decision some thought and waiting until you're mentally prepared. Dr. Gill cautioned that setting yourself up for failure can prove disastrous in the long run. He recommends spring or summer as the best times to quit. "Winter is a hard time to break habits. When one is combined inside it's tougher."
Part of the reason for that is that there are fewer opportunities to exercise, an invaluable aid to kicking the habit, according to Dr. Gill. "I like to encourage people to quit smoking and at the same time put into place some kind of aerobic exercise program...Whether it's walking or something more strenuous. They succeed more often when they are aware of their breathing and exercise helps reduce anxiety."
Perhaps the best plan for smokers is to fulfill two resolutions at the same time – finally follow through with a promise to join a gym and quit smoking at the same time. Not a bad plan for those often less productive winter months on the Vineyard.