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The Mind and Body Connection

Smoking is addictive—both physically and psychologically. The physical addiction can be traced to the nicotine in each cigarette. It hooks an individual just as completely as heroin and cocaine, and the withdrawal symptoms—cravings, anxiety, agitation, nausea, cramps, depression, and dizziness—are similar.

Like these other drugs, nicotine surges through the bloodstream and gives smokers a high—a quick jolt that makes them think they feel better. In the meantime, what really happens is that smokers develop a tolerance for nicotine, which is why they go from a couple of cigarettes a day as a teenager to two and a half packs a day as an adult. The psychological addiction is, in its own way, just as bad. Smoking becomes second nature, like blinking or breathing. If one considers that a single pack of cigarettes per day can turn into two hundred puffs a day, seven days a week, fifty-two weeks a year, it is easy to see how hard it is to quit.

The Key to Quitting

The key to quitting is patience, perseverance, and having a plan. For many people, it is simply picking a reason that they believe in to quit smoking, whether for their family or for their own personal health. Changing one’s environment is also useful, as it removes an individual from smoking triggers and can help that person avoid secondhand smoke. Tapering off is also a successful technique, though some studies show that a majority of permanent quitters achieved their goal by quitting “cold turkey.” The key to tapering off is to cut down the number of cigarettes smoked each day. Techniques for this approach involve delaying the first cigarette of the day. Whether an individual decides to taper off or quit completely, the goal must be the same: abstinence.

Practicing the “Three D’s”—delay, deep breathing, drink water—is also helpful for smoking cessation. This involves delaying smoking a cigarette when the need or craving arises, breathing deeply (while often counting to ten), and drinking a target of eight eight-ounce glasses of water each day. Water helps to flush nicotine out of the body. Keeping a diary is also an effective technique. A person can simply write down the time of day that they feel like having a cigarette, using a scale of one to three, with one representing the worst craving.

Medication has also proved to be successful for smoking cessation for some people. A medication called varenicline (Chantix) is a novel type of treatment that works by stimulating the release of low levels of dopamine in the brain. Nicotine in the cigarettes causes dopamine to be released, resulting in the positive feelings associated with smoking. At the time of smoking cessation, a drop in dopamine levels is related to the many withdrawals symptoms. By stimulating the release of this chemical in the brain, varenicline helps to reduce the signs and symptoms of withdrawal.

Varenicline also blocks nicotine receptors in the brain, so it helps the individual stay away from cigarettes. If a person resumes smoking while taking the medication, nicotine will not be able to stimulate the brain’s receptors the way it did in the past, making the habit much less pleasurable. Based on the research available thus far, it appears that varenicline works better than placebo and bupropion, another antidepressant used for quitting smoking. Taking varenicline has been associated, however, with some side effects. The most frequently reported include: nausea, headache, insomnia, bad dreams, and changes in the way food tastes. Varenicline and bupropion also may increase the risk of serious mood and behavior changes.

Other options to help a person quit smoking are: over-the-counter nicotine patches, gum, and lozenges, which may be used alone or in combination; prescription nicotine inhalers or nasal sprays; the prescription antidepressant bupropion; alternative therapies, such as hypnosis and acupuncture; and smoking cessation classes. Self-help programs such as Internet and computer-based programs are another option. There are also telephone quit lines, cell phone programs, and text messaging programs. For some, group behavior therapy may be more helpful than self-help programs. Trying a combination of these options may work best. For example, using a nicotine patch and going to group therapy may be the best option for some individuals.

Although electronic cigarettes (e-cigarettes) were orginially introduced to the market in 2004, they did not gain in popularity in the United States until several years later. Beginning around 2009, debates heated up about whether e-cigarettes should be promoted as a tool for smoking cessation. Proponents of using e-cigarettes to help in the process to quit smoking argued that the devices, which release an aerosol mist containing only a small amount of nicotine, can help smokers to cut back on the habit more easily because they can still go through the motions of puffing on a cigarette without ingesting all of the toxins present in a typical cigarette. Those who argue against this method share concerns that the e-cigarette will actually draw more people into smoking—mainly youths. By 2015, studies were still underway to determine what kind of impact e-cigarettes actually have on attempts to quit smoking.


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