Quitting cigarettes is the single most wholesome new year’s resolution
QUITTING smoking is one of the most popular new year resolutions, and it is now time to check on its progress. If you have already started, then you are at what counsellors call the ‘‘ action stage’’. But if you are wavering, or were thinking maybe you’d hold it off until next year, then you’re at the ‘‘ contemplation’’ stage.
While motivation alone is not always enough to successfully quit smoking, it is essential to getting the process started. People often need a more personal understanding of why they smoke and what it costs them. We all know at some level that smoking is bad for us, so there must be powerful reasons why we do it anyway.
Typically the immediate consequences of smoking are regarded as good: it helps people relax and socialise, while the long-term consequences — both health and financial — are regarded as bad.
While motivation is important, quitting still tends to pit long-term against short-term, delayed gratification against immediate pleasure, reason against reflex. Sadly, brainstem usually trumps cortex, making willpower alone an unreliable instrument. This is one reason why the person who quits once and forever is a rarity — most of us make several attempts before quitting for good. (This is true for most drug dependencies.) So each relapse is not a failure, but a milestone on the road to eventual success.
Smoking is both an addiction and a habit, so both behavioural strategies and medication are helpful for augmenting our willpower and improving quit rates.
Behavioural strategies involve looking at what situations trigger smoking and how to avoid them. This often means not hanging out with other smokers, and going to places where smoking is not permitted. It also helps to work out which are the most keenly anticipated cigarettes of the day — the one with coffee at morning tea, or a beer after work on Friday — and working out alternatives in advance. Unfortunately alcohol is a great disinhibitor; it muffles our pesky frontal cortex, the bit of the brain that’s always telling us to be sensible. While it can be good to be let off the leash sometimes, it doesn’t help when you’re trying to quit, so avoiding or limiting alcohol is a good idea.
Actual cravings are more a manifestation of dependence than habit, but behavioural strategies such as the four Ds can still help. These
wobbly refer to delay, deep breathing, drink water and distraction. Urge surfing is another term for delaying. The nature of cravings is that they build to a peak and then decay, so if you defer lighting a cigarette for five minutes it’s likely you won’t want it so much.
Medications play an increasingly important role. The available options are nicotine replacement (NRT), as gums, patches or inhalers; Zyban (bupropion), and more recently Champix (varenicline).
NRT is extremely safe, reflected in its nonprescription status. It almost doubles the unassisted quit rate. Bupropion, originally created as an antidepressant, is as effective as NRT. It can cause insomnia, dry mouth, headache and rarely, seizures. It is contraindicated in those who have a history of, or are at risk for epilepsy. Varenicline is a partial nicotine receptor agonist and has been associated with higher quit rates than bupro- pion. It frequently causes nausea, and there have been reports of depression and suicide, making it contraindicated in people with mood disorders. Bupropion and varenicline are prescription-only medications. While they can have side effects, used appropriately all three medications can be safe and effective anti-smoking aids — far safer than continued smoking.
If you smoke, quitting is almost certainly the single best thing you can do to improve your health. If you have resolved to quit, best of luck and make sure you use all available help. If you’re still contemplating, weigh up the pros and cons and see if you think smoking is really worth it.
For information and support visit your local doctor or call the Quitline on 131848, or visit the National Tobacco Campaign website Quitnow at www.quitnow.info.au
Simon Cowap is a GP in Newtown, Sydney.